Trichloroacetic Acid Application Research Articles

Characteristics of condyloma acuminata patients with HIV/AIDS at Prof. Dr. Sulianti Saroso infectious diseases hospital during 2019-2023

Introduction: Condyloma acuminata (CA) or genital warts is a sexually transmitted infection caused by the Human Papillomavirus (HPV). Individuals with CA are more susceptible to HIV compared to those without the condition. CA increases the risk of HIV occurrence and vice versa. This study examines characteristics of CA patients with HIV/AIDS visiting the Dermatology and Venereology Clinic of Prof. Dr. Sulianti Saroso Infectious Diseases Hospital during 2019-2023. Method: The research methodology employed in this study is a retrospective descriptive approach with a cross-sectional design. The sampling technique utilized was the total sampling method. Result: Among 22 recorded cases, 11 fulfilled the study criteria. Most patients were aged 19-44 years (86.7%), male (81.8%), with a history of homosexual relations (54.5%), and exhibited lesions primarily in the perianal region (54.5%). All patients received antiretroviral therapy (ART) (100%), and CD4 count results predominantly ranged from 101-200/mm3 (63.6%). Trichloroacetic acid (TCA) therapy was the most prevalent treatment modality (81.8%). Conclusion: The highest prevalence was noted within the age range of 19-44 years, with a majority of male patients. Unmarried status was most common among the patients. Homosexual history emerged as the predominant pattern of sexual intercourse. The perianal region was the most frequent location. The average CD4 count ranges from 101 to 200/mm3. The predominant treatment method utilized was the application of trichloroacetic acid (TCA).

Fractional Erbium YAG Laser Resurfacing Versus 20% Trichloroacetic Acid Chemical Peeling in the Treatment of Acne Scars: A Comparative Study.

Acne scarring not only affects the aesthetic appearance of an individual but also has a detrimental effect on mental health and social life. Various treatment modalities are available for acne scars. In this study, fractional erbium-doped yttrium-aluminum-garnet (Er:YAG) laser resurfacing was compared with 20% trichloroacetic acid (TCA) peeling in terms of efficacy and safety. This prospective comparative study included 50 subjects of acne scar who were randomly divided into Groups A and B, 25 patients in each group. Group A was treated with 4 sessions of fractional Er:YAG laser and Group B with 4 session of 20% TCA application as chemical peeling, repeated every 21 days over a period of 3 months. The patients were evaluated for improvement at each visit using Goodman and Baron's qualitative and quantitative acne scar grading. Statistically significant improvement in Goodman and Barron's qualitative acne scar grades was observed in both groups. At the end of therapy, that is, after 12 weeks of therapy, the mean percentage reduction in Goodman and Baron's quantitative acne scar scores was 21.69% ± 16% in Group A and 20.97% ± 8.70% in Group B. In regards of complications, both procedures were well tolerated. We concluded that fractional Er:YAG laser resurfacing and 20% TCA peel application in the treatment of atrophic acne scar are equally efficacious. Both procedures are safe and well tolerated by the patients.

Acral vasculitis and Chilblain-like lesions: is it COVID-19 infection?

The cutaneous manifestations associated with COVID-19 are increasingly reported, their exact incidence remains to be estimated, their pathophysiological mechanisms are largely unknown and the role, direct or indirect, of SARS-CoV-2 in their pathogenesis is still debated. We present a case of COVID-19 that manifested with a purpuric vasculitis pattern on the lower extremities and chilblain-like lesion in toe in a patient presented COVID-19 lungs involvement with polymerase chain reaction and serology are negatives. The reported presenting dermatological symptoms: associated chilblain-like lesions and vasculitis pattern of patient with negative COVID-19 RT-PCR and serology. The polymorphism of cutaneous lesions associated with the COVID-19 infection can mimic or appear similar to other well-known conditions. Even though, RT- PCR and serology are negatives, an infection of SARS-CoV-2 should be considerate.

Pilot Study on the Effect of a Single Topical Application of Trichloroacetic Acid 85% on Normal Cervical Tissue.

Background: Early detection and treatment of cervical intraepithelial neoplasia (CIN) through a “see and treat” approach is a pillar of cervical cancer prevention programs in developing countries such as Indonesia. One of the major challenges faced is the limited N2O or CO2 gas supply for cryotherapy. Thus, an alternative therapeutic method such as trichloroacetic acid (TCA) topical application is needed as an alternative solution. The effectiveness of this therapy will depend on its destructive effect on eliminating the whole lesion in CIN. Objective: To estimate the extent of damage in the normal cervical tissue after a single topical application of 85% TCA solution. Design and Methods: This research was an intervention study carried out by applying ±5 ml of 85% TCA solution into the cervix of 40 patients scheduled for total hysterectomy for indications other than cervical pathology 24 h before surgery. The extent of tissue destruction was determined microscopically using histopathological specimens. The study protocol is registered at www.clinicaltrial.gov (ID NCT04911075). Results: In the final analysis, 39 subjects were included. The necrotic area was detected at the superficial layer, accompanied by the full epithelial erosion thickness. In addition, there were also fibrotic areas resembling burned tissue in the stroma. The mean depth of destruction was 1.16 ± 0.01 mm in the anterior lip and 1.01 ± 0.06 mm in the posterior lip. There was no significant depth difference between the anterior and posterior lips (p ≥0.05). Moreover, the 85% TCA topical application was tolerable, as represented by the fact that the vast majority (82.1%) of participants experienced pain with a visual analog scale score of <4. Conclusion: Single dose of TCA 85% in topical solution was able to destroy the normal cervical tissue with a deeper mean depth than the mean depth of CIN III in squamous epithelium.

Fractional Carbon Dioxide (CO2) Laser Alone Versus Fractional CO2 Laser Combined With Triamcinolone Acetonide or Trichloroacetic Acid in Keloid Treatment: A Comparative Clinical and Radiological Study.

IntroductionKeloids are benign fibro-proliferative scarring extending outside the initial wound. Different treatment modalities as intralesional corticosteroid injection, fractional CO2 laser, and others can be used either as mono or combined therapies.ObjectivesTo assess the efficacy of fractional CO2 laser versus fractional CO2 laser accompanied with either triamcinolone acetonide or trichloroacetic acid 20% in keloid treatment clinically and radiologically.MethodsThe current study was conducted on 45 Egyptian participants with keloid scars at different sites of the body. They were classified into 3 groups treated by fractional CO2 laser only (group I), fractional CO2 laser followed by triamcinolone acetonide (group II), or trichloroacetic acid application (group III), respectively. Evaluation of the keloid was done with Vancouver Scar Scale (VSS) and Color Doppler Ultrasound (CDU) before and after treatment. Four sessions 4 weeks apart were applied for the patients. They were followed-up for 8 weeks after the last session.ResultsAfter treatment, there was a high statistically significant reduction in VSS among the 3 groups (P ≤ 0.001); the reduction was more in group II than in I and III. Also, a high statistically significant reduction in keloid scar thickness assessed by CDU was recorded (P ≤0.001 in group II and P ≤0.01 in group I and III).ConclusionsCombined therapy is favorable in the treatment of keloids. Trichloroacetic acid is a promising modality in treating keloid, hence it can be tried in different combinations. CDU is a promising method of keloids pre-and post-treatment assessment.

Endoscopic management of recurrent tracheoesophageal fistula with trichloroacetic acid in pediatric patients.

Surgical repair of recurrent tracheoesophageal fistula has a high risk of complications. Therefore, various endoscopic techniques have been used to avoid complications. To understand the usefulness of trichloroacetic acid endoscopic application for the treatment of recurrent tracheoesophageal fistula. An observational, descriptive, retrospective, case-series-based study was carried out in a tertiary pediatric hospital. Records of patients with recurrent tracheoesophageal fistula from 2015 to 2021 were reviewed. All patients within this period underwent brushing and trichloroacetic acid application. Mean time of recurrent tracheoesophageal fistula occurrence was 4.8 months (range: 1-19.2). Two patients had a small fistula (less than 4 mm), three patients had a medium fistula (4 mm), and two patients had a large fistula (more than 4 mm). Mean sessions for fistula closure were 2.2 (range: 1-4). Mean time between procedures was 22 days (range: 14-30). Mean follow-up since fistula closure confirmation was 33 months (range: 9-72), during which no recurrences were noted. Endoscopic management of recurrent transesophageal fistula with trichloroacetic acid is a safe and effective procedure. Brushing and trichloroacetic acid combined improve success rates. Fistulas over 4 mm in diameter require more procedures. However, a larger patient cohort and a longer follow-up period are needed to confirm this.

Effectiveness of Topical 100% Trichloroacetic Acid in Treatment of Anogenital Warts in Male Patients

Introduction: Anogenital warts are benign proliferation of skin and mucosa that result from different types of human papilloma viruses (HPVS). Treatment of AGW is aimed at relieving the patient physical and psychological discomfort and preventing the spread of infection by autoinoculation. There is evidence that localized topical application of trichloroacetic acid (100 %) is effective against AGW but due to differences in skin types and possible differences in papilloma virus’s types, it was necessary to confirm its effectiveness in Pakistani Population.

Autoinoculation versus 35% trichloroacetic acid for the treatment of molluscum contagiosum: An open-label randomized controlled trial

Background: Despite the availability of different treatment modalities, molluscum is often recurrent after the treatment. Autoinoculation in molluscum is a recently studied modality. Objective: The aim of this article is to evaluate and compare the efficacy of autoinoculation and trichloroacetic acid (TCA) for the disappearance of molluscum contagiosum (MC). Methods: This prospective, randomized controlled trial was done in which a total of 128 patients of molluscum were divided into two groups of 64 patients each: Group A treated with autoinoculation and Group B received TCA application. The patients were followed-up till 6 months for efficacy and safety. Results: At the end of 3 months, a statistically significant (P=0.023) complete clearance of lesions was noted in Group A (80%) when compared with Group B (62%). At the end of 6 months, the recurrence rate was significantly less in the autoinoculation group (3%) than in the TCA group (42%). Conclusion: We conclude that autoinoculation appears to be a safe, simple, and efficacious procedure with better clearance, minimal expertise, recurrence, and complications when compared with TCA.

Human papillomavirus (HPV) in pregnancy – An update

Human papilloma viruses (HPV) are small epitheliotropic DNA viruses, of which there are 200 genotypes, 40 of which are known to cause genital infections and are also oncogenic. HPV is the most common sexually transmitted infection. Clinical features vary from asymptomatic (identified at routine cervical cancer screening) to large lesions on the vulva, vagina, cervix and some extragenital sites. Its prevalence in pregnancy varies from 5.5% to 65% depending on age, geography and gestational age (increasing with gestational age). Infection in pregnancy has been associated with adverse outcomes such as spontaneous miscarriage, preterm birth, placental abnormalities and fetal growth restriction. However, the evidence for these adverse outcomes is varied. Besides being oncogenic (and thus associated with cancer of the cervix in pregnancy), vertical transmission to the fetus/neonate can cause neonatal infections, especially juvenile-onset recurrent oral and respiratory papillomatosis (JORRP). Where there are very large lesions on the vulva, delivery may be obstructed. Diagnosis in pregnancy is mainly by viral PCR or from the clinical appearance of the characteristic lesions on the vulva. Treatment is local by either surgical or laser excision or application of trichloroacetic acid. Podophyllin/podophyllotoxin is contraindicated in pregnancy. HPV Infection is not an indication for caesarean delivery as this has not been shown to prevent vertical transmission. For those diagnosed at routine cervical cancer screening, management should follow guidelines for cervical cancer screening in pregnancy. Vaccination is currently not recommended for pregnant women, although studies on those inadvertently vaccinated in pregnancy have not shown any adverse effects on either the fetus or mother.

Double-blind, randomized controlled trial comparing the use of microneedling alone versus chemical peeling alone versus a combination of microneedling and chemical peeling in the treatment of atrophic post-acne scars. An assessment of clinical effectiveness and patients' quality-of-life.

IntroductionAcne vulgaris is a common, chronic disease. One of the most commonly encountered complications of acne is permanent atrophic scarring. Treatment of atrophic scars includes fillers, dermabrasion, laser resurfacing, microneedling and peelings and it is often difficult to treat. In our double-blind randomized controlled trial (RCT), we investigated the synergistic effect of microneedling with the application of trichloroacetic acid, kojic acid and hydrogen peroxide in the treatment of atrophic acne scars.AimTo assess the clinical effectiveness and patients’ quality-of-life (HRQoL) after three types of atrophic post-acne scar treatment, namely microneedling alone (MN) vs chemical peeling alone (CP) vs. a combination of microneedling and chemical peeling (MN + CP).Material and methodsA total of 120 patients were enrolled into the study following strict inclusion/exclusion criteria and randomized into the three treatment groups – MN, CP (a combination of trichloroacetic acid, kojic acid and hydrogen peroxide), and MN + CP. According to a preapproved protocol, each patient underwent four treatment sessions, each spread 20 days apart. Both pre- and post-treatment clinical status (using the Goodman-Baron scale; two expert raters blinded to the treatment used) and patients’ HRQoL (using the Dermatology Life Quality Index) were assessed.ResultsDuring the 5-month recruitment period, a total of 120 patients were approached and agreed to take part in the study (94 females – 78.3% and 26 males) (mean age of 30.14 ±3.64 years; range: 18–45 years). Only in the MN + CP group there was a statistically significant improvement according to the G-B scale post-treatment (2.87 ±0.83 vs. 2.03 ±1.16 respectively; p = 0.0005). Patients in all three treatment groups experienced a statistically significant improvement in their HRQoL post-treatment (all p’s < 0.05).ConclusionsA combination of microneedling and chemical peeling produces the best, objectively measured effects in the treatment of atrophic post-acne scars. All examined treatments, even if not producing a clinically significant treatment outcome, improve patients’ HRQoL.

Thoracoscopy and chemical pleurodesis in treatment of pancreatogenic pleural effusion

Objective. To determine the opportunities of thoracoscopy and the effectiveness of induction of chemical pleurodesis by intrapleural administration of drugs for pancreatogenic pleurisy.&#x0D; Material and methods. We analyzed the results of surgical treatment of 17 patients with acute pancreatitis and 14 with pancreatic cysts after necrosis complicated by pancreatogenic pleural effusions, accounting for 3,7 % of all effusions.&#x0D; Results. Mild and moderate pleurisy was successfully suppressed in 4 cases (12.9 %) by pleural punctures. Six patients (19.4 %) with pancreatic necrosis and huge pleural effusion in case of severe conditions underwent pleural drainage. In 20 cases (64.5 %), fragmented pleurisy was treated using thoracoscopy. Pleurodesis was performed by means of insufflation of talcum powder in five cases that permitted to reduce the drainage time from 7.14 2.96 days without pleurodesis to 4.2 1.1 days (p = 0.026). Pleurodesis using application of trichloroacetic acid had no effect in three patients. Five patients received 200300 g of octreotide diluted with 40 ml of isotonic sodium chloride solution into the pleural cavity through the drainage. The drainage period reduced to 3.5 1.0 days (p = 0.018). The effect was maximally expressed in the cases with high amylase level in the pleural exudate. After that, 20 patients underwent various operations on the pancreas.&#x0D; Conclusions. Thoracoscopy is indicated to patients with pancreatogenic pleurisy for removal of fragments and sanation of the pleural cavity. Intraoperative pleurodesis with talcum effectively suppresses pleurisy and reduces the drainage period while application of trichloroacetic acid has no essential influence. Intrapleural administration of octreotide allows rapid reducing exudation when amylase index is high. Our study supports the effectiveness of mini-invasive procedures (videothoracoscopy combined with talcum powder pleurodesis and intrapleural administration of octreotide) to sanitize the pleural cavity, suppress pleurisy and shorten drainage periods.

Evaluating the efficacy of 100% trichloroacetic acid needling in the treatment of palmoplantar warts

Introduction: Warts are benign proliferations of skin and mucosa caused by the human papillomavirus (HPV). Palmoplantar warts are caused any HPV types 1, 2, 4, 27, 57 and occurs mostly in children and young adults. Among the treatment modalities, trichloroacetic acid (TCA) application along with needling after sufficient penetration causes coagulation of proteins of the infected cells of skin and causes necrosis. Aim: To study the efficacy of 100%TCA needling in the treatment of palmoplantar warts. Study Design: Longitudinal study carried out at a tertiary care center in Gujarat. Materials and Methods: Patients having palmoplantar warts between the age group of 4-50 years over a period of 8 months were included in the study as per our inclusion and exclusion criteria. 100% TCA application followed by needling using an insulin syringe was done once per week after informed consent. The necrosed skin was pared on each follow-up and the procedure was repeated till complete clearance of warts. Results: The total number of patients were 60 out of which 6 patients were irregular in follow up. In 4 patients, the treatment modality was changed after 6 weeks because of lack or response. 50 patients had complete clearance of warts. The minimum and maximum duration for complete clearance of warts were 3 weeks and 8 weeks respectively. Limitation: It gives varying results in different individuals and average duration in clearance of wart is comparatively slower as compared to some other methods. Conclusion: TCA needling is an effective treatment modality for palmoplantar warts.

Chemical Regeneration of Wound Defects: Relevance to the Canine Palatal Mucosa and Cell Cycle Up-Regulation in Human Gingival Fibroblasts.

Trichloroacetic acid (TCA) is an agent widely applied in dermatology for skin regeneration. To test whether TCA can offer an advantage for the regeneration of oral soft tissue defects, the cellular events following TCA application were explored in vitro and its influence on the oral soft tissue wound healing was evaluated in a canine palate model. The cytotoxicity and growth factor gene expression in human gingival fibroblasts were tested in vitro following the application of TCA at four concentrations (0.005%, 0.05%, 0.5% and 1%) with different time intervals (0, 3, 9 and 21h). One concentration of TCA was selected to screen the genes differentially expressed using DNA microarray and the associated pathways were explored. TCA was injected in open wound defects of the palatal mucosa from beagle dogs (n = 3) to monitor their healing and regeneration up to day 16-post-administration. While the 0.5-1% concentration induced the cytoxicity, a significantly higher expression of growth factor genes was observed after 3 and 9h following the 0.5% TCA application in comparison to other groups. DNA microarray analysis in 0.5% TCA group showed 417 genes with a significant 1.5-fold differential expression, involving pathways of cell cycle, FoxO signaling, p53 signaling, ubiquitin mediated proteolysis and cAMP signaling. In vivo results showed a faster reepithelialization of TCA-treated wounds as compared to spontaneous healing. TCA promoted the healing and regeneration of oral soft tissue wound defects by up-regulating the cell cycle progression, cell growth, and cell viability, particularly at a concentration of 0.5%.

Comparative Efficacy of 50% Trichloroacetic Acid Solution with 10% Potassium Hydroxide Solution in the Treatment of Plane Warts

Background: Warts are very common disorders. Plane warts are caused by Human Papilloma Virus (HPV) occurring mostly in children and young adults. Among the treatment modalities, topical application of trichloroacetic acid (TCA) is age old. Potassium hydroxide (KOH) has a keratolytic effect on virus-infected cells.&#x0D; Aims: To compare the safety and efficacy of topical 10% KOH solution with 50% TCA solution in the treatment of plane warts.&#x0D; Materials and Methods: Sixty-four consecutive patients with plane warts were randomly assigned into two groups of thirty-two patients. Group A received 10% KOH solution and group B received 50% TCA solution once weekly until the complete clearance of warts in a maximum period of 12 weeks.&#x0D; Results: In group under treatment with 10% KOH, 24 patients (75.0%) complete response, 5 patients (15.6%) moderate response, 2 patients (6.3%) mild response, and 1 patient (3.1%) had no response. In group under treatment with 50% TCA, 28 patients (87.5%) showed complete response, 2 patients (6.3%) moderate response, 2 patients (6.3%) mild response. Statistically no significant difference was found between the therapeutic response to 10% KOH and 50% TCA (P=0.41).&#x0D; Conclusion: 10% KOH was found to be equally effective in the treatment of plane warts compared to 50% TCA with the advantage of fewer side effects.

The effects of sclerotherapy with 5% trichloroacetic acid on the cyst diameter and ovarian tissue in the rat ovarian cyst model

The aim of this study was to compare the effects of only aspiration with aspiration and 5% trichloroacetic acid (TCA) application on ovarian cyst size and ovarian reserve. The ovarian cysts of 14 rats that were divided into two groups randomly were investigated after total salpingectomy procedure. G1 was the group of saline application after cyst aspiration, while in G2, after aspiration 5% TCA at half amount of aspiration volume was injected into the cyst and re-aspirated after five minutes. The abdomens of the rats were closed and re-explored after 1 month. The cyst diameters of the rats in each group were measured. Ovaries were removed for histopathological examination. There was no significant difference in cyst diameter in G1 before and after aspiration. In G2, there was a significant decrease in cyst size after TCA application. Ovarian follicle counts were not significantly different between the two groups. In conclusion, application of 5% TCA to the ovarian cysts for five minutes significantly reduces the cyst size.Impact StatementWhat is already known on this subject: Minimally invasive therapies come into prominence to avoid surgical complications and diminished fertility in the treatment of ovarian cysts. USG-guided aspiration and sclerosis has been reported as cost-efficient and effective treatment methods for localised benign cysts in other organs such as the thyroid, parathyroid, liver, kidney and spleen. It has been shown that sclerotherapy applied to infertile women with ovarian cysts reduces pelvic pain without affecting the number of follicles, term pregnancy and abortion rates, extracted oocytes, embryo quality or hormonal levels when compared to non-ovarian cystic infertile women. TCA is a chemical agent that is topically applied, not systemically absorptive, which causes denaturation of proteins and structural cell death, resulting in coagulation necrosis after chemical cauterisation. For this reason, we used 5% TCA to treat simple ovarian cysts on a rat model.What the results of this study add: In this experimental study, we showed that the application of 5% TCA into the cyst for five minutes – then aspirated – significantly reduced the size of the ovarian cysts. Five percent TCA application did not affect the ovarian reserve.What the implications are of these findings for clinical practice and/or further research: Our study is original because of the fact that to the best of our knowledge, this is the first study about the use of 5% TCA in treatment of ovarian cysts in the literature.

Trichloroacetic acid (80%) as a chemical debridement method for chronic venous leg ulcers-A pilot study.

Debridement is essential for the optimal care of venous leg ulcers. Several debridement methods with different limitations may be deployed. Trichloroacetic acid (TCA) is used for several dermatological purposes. Its application as a chemical debridement method for leg ulcers has never been explored. We designed a prospective study to determine the role of 80% TCA solution as a chemical debridement method for leg ulcers, regarding efficacy and procedure-associated pain. Chronic venous leg ulcers were treated with 3 cycles of 80% TCA solution or curettage over 1 week. Pain and the mean percentage of fibrin and devitalized tissue covering wound bed were evaluated. At the end of the study, a trend towards larger fibrin mean reduction among the TCA treated ulcers was observed, although this difference was not statistically significant (P = .35). The mean pain score after TCA application was significantly reduced compared to pain after curettage alone (P < 0.001). TCA presented several advantages over mechanical debridement: it is a more selective debridement method, has haemostatic properties, and a simpler and faster application. The 80% TCA solution may be a cheap, simple, and considerably less-painful chemical debridement method for venous leg ulcers compared to classical mechanical debridement.

Incomplete ear lobe cleft repair with 100% trichloroacetic acid

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the present study was to assess the efficacy of 100% trichloroacetic acid (TCA) for the incomplete ear lobe cleft repair.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 30 females with bilateral incomplete ear lobe cleft were included in the study group. Under local anaesthesia, 100% TCA was applied to the abraded surface with the help of toothpick till frosting was achieved and the wound was closed with a micropore tape. Patients were reviewed weekly and 100% TCA was applied until frosting was achieved, without abrasion on the edges of cleft once a week till complete closure of the ear lobe cleft.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 30 patients 28 (93.33 %) had complete closure of cleft. Two patients (6.66%) had incomplete closure even after four application of TCA. Temporary post inflammatory pigmentation was seen in 22 (73.33%) patients which subsided one week after the last TCA application. Minimum number of sittings required was one and maximum required for complete closure was 3 sessions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Multiple applications, temporary post inflammatory pigmentation, inward rolling of edges, mild scarring as a result of secondary healing of the wound and failure to repair the bigger clefts were the disadvantages of this technique.&lt;/p&gt;

Effectiveness of trichoroloacetic acid in treatment of focal epithelial hiperplasia lesions

Objective: The aim of the present study was to assesseffectiveness of trichloroacetic acid therapy in the treatment of oral lesions produced in focal epithelial hyperplasia cases. Material and methods: In the present study 11 patients were included. Patients exhibited clinical and histopathological characteristics of focal hyperplasia and were willing to participate in the study. Convenience sampling was executed in patients attending clinical consultation at the Dental Clinic of the Rafael Nuñez University Corporation and the University of Cartagena. Patients underwent excision biopsy in oneof the lesions so as to establish anatomical-pathological diagnosis.Subsequently, 80% trichloroacetic acid was applied every twoweeks on the lesions, until lesions disappeared. Results: Out of 11 pediatric patients 63.64% were female, average age nine years.Locations of greater involvement in the mouth were upper andlower labial mucosa (representing 100%). Anatomical-pathological study revealed in all cases presence of epithelial acanthosis, papillomatosis and koilocytiosis. The greatest number of acid applications was three and four episodes with 27%, average time for lesion disappearance was 61.3 days. No relapse was observed in 100% of cases. Conclusion: Trichloroacetic acid application in focal epithelial hyperplasia cases is an effective technique which achieves rapid, atraumatic stress-free lesion resolution which did not generate fear in involved patients.

Comparative Study to Evaluate the Efficacy of Radiofrequency Ablation versus Trichloroacetic Acid in the Treatment of Xanthelasma Palpebrarum.

Background:Xanthelasma palpebrarum (XP) is a metabolic disorder involving the eyelids. Radiofrequency(RF) surgery and trichloroacetic acid (TCA) applications have been listed among the procedures for XP, but comparative studies are not available.Aim:To compare the efficacy of radiofrequency surgery versus trichloroacetic acid application in the treatment of XP.Settings and Design:20 consecutive cases of XP attending dermatology, medicine and endocrinology out-patient departments of M.S. Ramaiah teaching hospital were enrolled for the study. It was an open-label clinical trial conducted in our hospital for a duration of 1 year.Materials and Methods:20 consecutive patients conforming to inclusion criteria were selected for the study. For each patient, lesions were treated with radiofrequency ablation on one side and TCA application on the other side.Results:RF ablation was done for 12 patients over right eye lesions and 8 patients over the left eye lesions. TCA applications were done for 8 patients over right eye lesions and 12 patients over left eye lesions. 70% of lesions treated with RF ablation had a score of improvement of 4 and 70% of lesions treated with TCA application had a score of improvement of 4, at 4 weeks of follow-up. At four weeks of follow-up 40% in RF group and 15% in TCA group had scarring and 45% in RF group and 30% in TCA group had pigmentation.Conclusion:RF ablation as compared to TCA application, required fewer sessions for achieving more than 75% clearance of lesions. However, TCA applications were associated with fewer complications comparatively.

Comparative Evaluation of Topical 10% Potassium Hydroxide and 30% Trichloroacetic Acid in the Treatment of Plane Warts.

Background:Warts are benign proliferations of skin and mucosa caused by the human papillomavirus (HPV). Plane warts are caused by HPV types 3, 10, 28, and 41, occurring mostly in children and young adults. Among the treatment modalities, topical application of trichloroacetic acid (TCA) is age old. Potassium hydroxide (KOH) has a keratolytic effect on virus-infected cells. It is less irritating, less painful, less scar forming, and can be safely used in children too. Hence, it could be a better topical agent in the treatment of plane warts.Aims and Objectives:To compare the safety and efficacy of topical 10% KOH with 30% TCA in the treatment of plane warts.Materials and Methods:Sixty consecutive patients with plane warts were randomly assigned into two arms of thirty patients each; arm A received topical 10% KOH and arm B received topical 30% TCA as a once weekly application until the complete clearance of warts or a maximum period of 12 weeks.Results:Statistically no significant difference (P = 0.07) was found between the objective therapeutic response to 10% KOH and 30% TCA at the end of study (12 weeks). However, subjective response to 10% KOH was better and statistically significant (P = 0.03). There was no recurrence of warts seen on follow-up for 3 months of complete responders in both the arms.Conclusion:10% KOH is found to be equally effective in the treatment of plane warts compared to 30% TCA with the advantage of faster onset of action and tendency of completely clearing warts with fewer side effects.