Chemical peel of nonfacial skin using glycolic acid gel augmented with TCA and neutralized based on visual staging.

Abstract

Until recently, standard techniques for laser or chemical peeling have not always provided consistent results when applied to the nonfacial skin. The author describes a more controlled chemical peel technique for nonfacial skin using 70% glycolic acid gel combined with 40% trichloroacetic acid (TCA). The method has given consistently good results on the skin of the neck, chest, arms, hands, back, and other nonfacial skin. More than 3100 patients were given skin peels of the neck, chest, and other areas of the body as indicated. Seventy percent glycolic acid gel was applied to the areas to be peeled, then immediately augmented with 40% TCA. Each area was carefully monitored for the end point and then neutralized with copious amounts of 10% sodium bicarbonate solution. The end point was determined by visual observation using a six-stage classification to determine the degree of peeling. Clinical results were excellent, with smoother skin texture, decreased wrinkling and striae, and fading of lentigines and other pigmentary abnormalities. There was excellent blending into peeled facial skin and into adjacent areas of nonpeeled skin. Complications were minimal. This technique can provide the benefits of skin peeling to nonfacial skin with excellent cosmetic results and minimal complications.