Improvement in Favre-Racouchot Disease Treated with a Combination Medium-Depth Chemical Peel Containing Jessner's Solution/35% Trichloroacetic Acid

Abstract

Introduction: Favre-Racouchot disease is a condition typified by grouped comedones occurring on sun-damaged skin. This disorder affects mainly white men who have had extensive exposure to sun and harsh weather and has been estimated to occur in 6% of persons older than 50 years. Although topical retinoids have been the mainstay of therapy for this condition, many patients have an incomplete response to this therapeutic modality, and other treatments such as manual extraction, oral isotretinoin, staged excision, dermabrasion, and combination approaches have been attempted. Materials and Methods: A combination medium-depth chemical peel containing Jessner's solution/35% trichloroacetic acid was used to treat a 53 year-old white woman with Favre-Racouchot disease. The patient showed no response to topical retinoids applied twice daily for greater than 16 weeks and a more superficial combination peel consisting of Jessner's solution/20% trichloroacetic acid. Complicating factors included preexisting rosacea and early rhinophyma. Results: After treatment with a medium-depth chemical peel containing Jessner's solution/35% trichloroacetic acid, marked improvement was noted with concomitant resolution of >90% of comedones. No postoperative complications, such as prolonged erythema, scarring, viral reactivation, or bacterial infection, were observed. The patient was pleased with the overall result. Discussion: These results demonstrate the utility of combination medium-depth chemical peels containing Jessner's solution/35% trichloroacetic acid in the management of Favre-Racouchot disease that is resistant to more conservative therapies. We recommend the judicious use of this procedure in patients who do not respond to more conservative measures.