Trichloroacetic Acid Peel Research Articles

A comparative study of 70% glycolic acid and 30% trichloroacetic acid peel in the treatment of facial atrophic acne scars: A split-face study.

Medium-depth peels are dynamic tools when used as part of office procedures for the treatment of acne scars. Most of the available literature on chemical peels focuses on their role in skin rejuvenation and hyperpigmentation. There is a paucity of well-conducted studies that have compared peels in the treatment of acne scars in Asian patients. The study aimed to compare the efficacy of 70% glycolic acid (GA) and 30% trichloroacetic acid (TCA) chemical peels in the treatment of facial atrophic acne scars. A longitudinal, right-left study was conducted to assess the effectiveness and side effects of 70% GA and 30% TCA in 30 patients with acne scars. A total of four peeling sessions were performed every 4 weeks. Evaluation of the response was done using Goodman and Baron's quantitative global acne scarring grading system (GBASG), physician visual analog scale (VAS), and patient VAS at baseline and 4, 8, 12, and 16 weeks. Relevant statistical tests were employed to study the effectiveness of both TCA and GA peels. Significant reduction was noted in mean GBASG scores on both sides at 8, 12, and 16 compared to baseline score (P = 0.000). Mean GBASG scores decreased from 12.67 ± 3.19 to 8.97 ± 2.73 on the 70% GA side while that on the 30% TCA side reduced from 13.20 ± 3.56 to 6.83 ± 2.60 (P = 0.003). The results were much better on the TCA peel side as compared to GA peel as per physician VAS (P = 0.000) and patient VAS (P = 0.000). Side effects such as post-inflammatory hyperpigmentation and acne were seen on both sides while dryness and crusting were more common on the TCA peel side. A 30% TCA peel is efficacious and well-tolerated for mild-to-moderate acne scars. About 70% GA peel is an effective alternative to TCA peel, especially for patients not tolerating TCA or requiring lesser downtime.

Efficacy of 15% trichloroacetic acid peel versus 35% glycolic acid peel in acanthosis Nigricans: A randomized open-label study.

Acanthosis Nigricans (AN) is an acquired disorder of keratinization. It presents as hyperpigmentation, velvety texture of skin that can involve any part of the body including the face. Different topical, systemic therapies, or physical therapies including laser have been explored. However, there are not many randomized controlled studies for the majority of therapy alternatives besides lifestyle modifications and weight reduction. The aim of this study was to compare the effectiveness of 15% trichloroacetic acid (TCA) and 35% glycolic acid (GA) peel for AN. Forty participants were included and randomized into two groups. In groups A and B, peeling with 15% TCA and 35% GA was done, respectively. The effectiveness of each peel was assessed using changes in the Acanthosis Nigricans Area and Severity Index Score (ANASI) and Physician Assessment Score. Statistical analysis included Wilcoxon-Mann-Whitney test, Friedman test, and generalized estimating equations. The overall change in ANASI over time was compared in the two groups using the generalized estimating equations method. A significant difference was observed in the trend of ANASI over time between the two groups (P < 0.001). TCA peel group showed more change in ANASI as compared with GA peel group. In our research, 15% TCA has a better efficacy when compared with 35% GA peel after three sessions of chemical peeling. We therefore recommend the use of 15% TCA peel in AN as a safe and effective treatment option. However, more comprehensive randomized control studies are required for supporting data.

Does Systemic Metformin Have a Role in Treating Melasma?

Melasma is a common pigmentary condition that affects the patients' quality of life and all the prescribed treatment options till now are not satisfactory, especially in dark-skinned patients. To evaluate the efficacy and safety of systemic metformin (1,000 mg and 500 mg) combined with trichloroacetic acid (TCA) peeling versus TCA alone in the treatment of melasma. The study included 60 melasma patients divided into 3 groups: Group A received systemic metformin (1000 mg/d), Group B received systemic metformin (500 mg/d) and Group C received placebo. The 3 treatment groups were treated by TCA 25% over the whole face bimonthly for a total of 6 sessions. Melasma area and severity index (MASI), and Melasma impact Quality of life Scale (MELASQOL) were used to assess the outcome. There was a statistically significant decrease in the MASI, and the MELASQOL in the 3 studied groups after treatment with significantly better improvement in Group (A) than Group (C) ( p = .045). Systemic metformin is a safe and promising therapeutic option for treating melasma.

A prospective comparative study of efficacy and safety of 15% trichloroacetic acid peel, 35% glycolic acid peel and Q-switched Nd-YAG laser in patients of macular amyloidosis.

The unappealing appearance of skin in macular amyloidosis (MA) interferes with the patient's quality of life, and treating the condition has been challenging. To compare the efficacy and safety of 15% trichloroacetic acid (TCA) peel, 35% glycolic acid (GA) peel, and Q-switched Nd-YAG Laser in MA. Open, prospective study was conducted over 2 years, where after fulfilling the criteria, randomization was done into three groups. Group A: 15% TCA peel; Group B: 35% GA peel; Group C: Q-switched Nd-YAG Laser. Procedures were repeated at monthly intervals for six sittings. On each visit, patients were scored on the following parameters: color score, visual analog score (VAS), physician global assessment (PGA) scale, subjective improvement, and adverse effects. A total of 75 patients (25 patients in each group) completed the treatment. The mean age of study-population was 35.68 ± 9.8 years, with female to male ratio of 11.5:1. The mean change in color score (1.68) was more by Group A, followed by Group C (1.4), followed by Group B (1.16). Similar results were noted by subjective improvement, VAS, and PGA. Adverse events were more in Group A, followed by Group C, followed by Group B. No patient showed permanent adverse events. TCA-peel showed superior results over Nd-YAG laser and glycolic-acid peel. TCA-peel being cost-effective with excellent acceptability should be considered a treatment modality.

The Efficacy of the Combination of Microneedling with Jessner’s Plus 35% Trichloroacetic Acid Peel versus the Efficacy of the Combination of Microneedling with Platelet-rich Plasma Therapy for the Treatment of Atrophic Acne Scars: A Comparative Study

Background: Acne is a common skin condition that is prevalent in 90% of the adolescent population. Inflammatory lesions of acne may lead to scarring. Various treatment modalities such as subcision, punch excision, chemical peels, microdermabrasion, and fractional lasers have been tried for acne scars but with unsatisfactory results. Purpose: The aim of the present study is to compare the efficacy of microneedling with Jessner’s plus 35% trichloroacetic acid (TCA) peel versus the efficacy of microneedling with platelet-rich plasma (PRP) therapy for the management of atrophic acne scars. Methods: Sixty patients having atrophic scars due to acne were segregated into two groups each containing 30 patients. On Group A, patients microneedling was performed at weeks 0, 6, and 12 and Jessner’s plus 35% TCA peel was performed at weeks 3, 9, and 15. On Group B, patients microneedling and intradermal PRP were performed sequentially at weeks 0, 3, and 6. Patients were followed at the outset of the procedure and 24 weeks after the procedure using the Echelle d’Evaluation Clinique des Cicatrices d’acne (ECCA) score. Results: The difference in the mean ECCA score at the outset of the procedure and 24 weeks after the procedure was more in Group B as compared to Group A (47.8 ± 13.6 vs. 39.1 ± 11.4). Conclusion: The efficacy of the combination of microneedling with PRP was higher than the combination of microneedling with Jessner’s plus 35%TCA peel for the treatment of atrophic acne scars.

Comparative evaluation of therapeutic efficacy and safety of black peel versus 25% trichloroacetic acid peel in mild to moderate acne vulgaris: a split face study.

Peeling has withstood the test of time as a simple, minimally invasive method to renew the skin, despite the introduction of more advanced procedures like lasers. Thirty patients (or 60 sites) with age ranging from 15 to 45 years with mild-to-moderate acne vulgaris were included in the study. Assessment at baseline was done by the global acne grading system score for including mild and moderate acne patients. On grading the improvement according to the 5-point Global Assessment Scale (GAS), it was found that in area A (black peel), 6.7% of patients showed excellent improvement, 86.7% of patients showed good improvement, and 6.7% of patients showed fair improvement. In area B (25%TCA peel), 6.7% of patients showed excellent improvement, 80% of patients showed good improvement, and 13.3% of patients showed fair improvement. None of the patients showed poor or worse outcomes in any of the areas. The difference between the groups was not significant (P = 0.688). There is a paucity of data in the literature regarding the comparison of black peel with other conventional peels in the treatment of acne vulgaris. To the best of our knowledge, this is the first study comparing black peel with TCA peel in the treatment of acne vulgaris.

Comparative Efficacy of Chemical Peeling Agents in the Treatment of Melasma.

Melasma is a complex skin disorder characterized by brown or dark patches, primarily affecting facial areas. Despite numerous treatment options, the effective management of melasma remains challenging. This study aims to fill a gap in the literature by rigorously comparing the effectiveness of three prevalent chemical peeling agents, 15% trichloroacetic acid (TCA), 15% phenol, and 2% glycolic acid, in treating melasma. A randomized controlled trial was conducted involving patients who were clinically diagnosed with melasma. Participants were divided into three groups, each receiving one of the chemical peeling treatments. The primary measure of efficacy was the Melasma Area and Severity Index (MASI) score, recorded before and after the treatment series. Side effects were also documented and analyzed. Preliminary findings suggest a significant reduction in MASI scores in the group treated with 15% TCA peel. The average MASI score reduction was 8.5 points for the TCA group, 6.0 points for the phenol group, and 5.2 points for the glycolic acid group. Side effects such as redness and mild irritation were noted but were least prevalent in the TCA group. Our study indicates that 15% TCA peel is not only effective but also comparatively safer in treating melasma. It shows a more rapid and significant improvement in reducing melasma symptoms than 15% phenol and 2% glycolic acid peels. However, further research is warranted to validate these findings over a larger population.

A comparative study between the use of the combination of trichloroacetic acid peeling with hydroquinone and hydroquinone alone in patients with melasma

Background: Melasma is a common acquired pigmentary disorder that is aesthetically displeasing. Kligman’s and Modified Kligman’s formula using topical steroids, hydroquinone and retinoids, and various other depigmenting agents is being widely used all over for melasma with varying results. Chemical peeling is newly added to the therapeutic armamentarium and is showing encouraging results worldwide in patients with melasma. However, comparative studies are lacking in abundance in our part of the world. Aims and Objectives: To determine if serial trichloroacetic acid peels provide additional benefits when combined with time-tested topical therapy with hydroquinone 4% in patients with melasma. Materials and Methods: Fifty melasma patients were divided into two groups of 25 each. One group received serial trichloroacetic acid peel combined with topical hydroquinone 4%. The other group only received topical hydroquinone 4% cream. The results were evaluated by a clinical investigator both subjectively and with photographs taken at baseline, 12 weeks, and 21 weeks. For clinical evaluation, the melasma area and severity index (MASI) was used. Results: A significant decrease in MASI score from baseline to 21 weeks was observed in both groups (P&lt;0.001). The group receiving the trichloroacetic acid peel 20% showed a trend toward more rapid and greater improvement, with statistically significant results (P&lt;0.001). Only a few side effects were observed in the peel group. Conclusion: This study demonstrates that serial trichloroacetic acid peels provide an additional effect to a topical regimen of 4% hydroquinone cream for treating melasma in Fitzpatrick skin types III and above if used judiciously and under supervision. It demonstrates that superficial chemical peels can be used as an adjunct with better efficacy to treat patients with melasma.

TREATMENT OF PIGMENTATION IN THE ANOGENITAL AREA WITH THE USE OF TRICHLOROACETIC ACID: A CASE REPORT

Chemical peels are recently used in gynecology for the treatment of pigmentation in the anogenital area. Trichloroacetic acid is a peel used most commonly in cosmetic dermatology. It has a great potential to lighten and rejuvenate the skin in the anogenital area. We present a case of pigmentation of the vulva due to photoaging and pregnancy and its successful and efficient treatment with trichloroacetic acid. We describe the precise technique of trichloroacetic acid peel approach in the anogenital area.

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.

Trichloroacetic Acid With Microneedling Versus Trichloroacetic Acid Alone for Treating Melasma.

Melasma is a common acquired disorder of hyperpigmentation which is difficult to treat. We aim to evaluate the efficacy and safety of combined microneedling with trichloroacetic acid in the treatment of melasma. Forty women with facial melasma were included and randomly classified into 2 groups. Group A included 20 patients treated with bimonthly session of trichloroacetic acid 25% peeling (8 sessions) combined with a monthly session of microneedling (4 sessions). Group B included the other 20 patients that were treated by bimonthly trichloroacetic acid 25% peeling session (8 sessions) alone. After 1 and 3 months of treatment, the mean melasma area and severity index, modified melasma area and severity index, and melasma severity index scores showed significant improvement in each group (p < .05 for each). At 1 and 3 months, the mean percentages of change of all scores were significantly higher in group A than group B (p < .05). Combined trichloroacetic acid peel with microneedling is effective and a safe option for treating melasma.

Q-switched frequency-doubled Nd:YAG (532 nm) laser versus trichloroacetic acid 35% peeling in the treatment of dorsal hand solar lentigo: An assessor-blind split-hand randomized controlled trial.

Solar lentigo (SL) is a benign hyperpigmented spot occurring due to ultraviolet exposure, most commonly in the elderly. We aimed to compare the safety and efficacy of trichloroacetic acid (TCA) peeling with Q-switched laser in the treatment of SLs. This assessor-blind split-hand randomized controlled trial included 45 patients with symmetric SLs on the back of their hands referred to the dermatology clinics from March 1 to June 24, 2021. TCA 35% was applied to the back of one hand, and the contralateral hand received Q-switched laser. The interventions were repeated for a total of three sessions 4 weeks apart. Eight weeks after the last treatment session, lesion lightening was graded from 1 to 4. Patient satisfaction with treatment was assessed using a visual analogue scale (VAS). Adverse events were also noted. Of the 45 patients included in the current study with a mean age of 52.71 ± 9.73 years, 11 (24.4%) were male. The Fitzpatrick skin type was II in 11 patients (24.4%), III in 23 (51.1%), and IV in 11 (24.4%). Lesion lightening and patient satisfaction were both significantly better with Q-switched laser compared to TCA peeling (standardized mean difference [SMD]=-1.25, 95% confidence interval [CI] -1.69; -0.79, p < 0.001 and SMD=-1.12, 95% CI -1.56; -0.67, p < 0.001, respectively). Overall, post-inflammatory hyperpigmentation (PIH) occurred in one patient in the laser group and for in the TCA group. Also, erythema and pruritus were observed in all patients of both groups after intervention which were treated with topical repair cream. Q-switched laser was superior to TCA peeling for the treatment of SLs in terms of lesion lightening and patient satisfaction with a large effect.

Combined chemical peels versus trichloroacetic acid (TCA) for treating melasma: a split face study

Melasma is common skin condition presenting with hyperpigmentation. To evaluate the efficacy, tolerance, and complications of one session of combined chemical peels compared to traditional serial sessions of trichloroacetic acid (TCA) peeling in treating melasma. One session of combined chemical peels was carried out at the left side of the face, while six sessions of TCA 15% peel were carried out at the right side of the face every 10 days. The Modified Melasma Area and Severity Index (MASI) score was calculated at baseline (before starting peeling sessions), after one month (at the fourth TCA peeling session), and after three months (one month after the last TCA peeling session). Both sides of the face showed gradual reduction in modified MASI score throughout sessions. By the end of the study, the TCA-treated side showed slightly lower mean modified MASI score than the combined chemical peels-treated side of the face; however this difference was not statistically significant, (p = .405). A single session of combined chemical peels is as effective as six sessions of TCA peel in treatment of melasma. Combined chemical peels can be used as a convenient, tolerable and time saving safe procedure for treating melasma.

Efficacy of Combined Trichloroacetic Acid Peel and Topical Ascorbic Acid in Treating Epidermal Melasma

ABSTRACT Background: Melasma, a common dermatological problem which has no standard recommended therapy. This study aimed to compare the clinical efficacy of combined trichloroacetic acid peel and ascorbic acid with trichloroacetic acid peel alone in epidermal melasma. Methods: A quasi-experimental study was conducted on 148 patients with epidermal melasma, in the dermatology department of Pak Emirates Military Hospital, Rawalpindi from August 2019 to January 2020. Patients were randomly allocated into two groups; Group A (n=74) was given trichloroacetic acid peel 20% (weekly) plus ascorbic acid cream (once daily). Group B (n=74) was given trichloroacetic acid peel alone (weekly). Melasma Area and Severity Index (MASI) scores were calculated at baseline visit, 6th week and 3rd month. Efficacy was measured as a reduction in post-treatment MASI score to ≤10. Post-stratification Chi-square test was applied considering p-value ≤0.05 as statistically significant. Results: The mean age of patients was 31.63±8.20 years with a predominance of female gender 117(79.1%). The mean duration of persistence of melasma symptoms was 42.59±21.56 months while Fitzpatrick type IV (51%) was revealed as the dominant skin type. MASI score at the baseline, 6th week and 3rd month visits were 18.11±3.49, 12.48±3.16 and 7.74±3.91, respectively. Overall, the treatment was efficacious in 106(71.6%) patients. Reduction in MASI score was significantly higher in group A (83.8%) than group B (59.5%). Conclusion: The combination of trichloroacetic acid peel and ascorbic acid was more effective than trichloroacetic acid peel alone (p=0.001) in the treatment of epidermal melasma. Keywords: Ascorbic Acid; Trichloroacetic Acid; Melasma; Efficacy.

Trichloroacetic Acid Peeling for Treating Photoaging: A Systematic Review.

Photoaging can significantly contribute to lower quality of life. Medium-deep peeling using trichloroacetic acid allows controlled keratocoagulation through the dermis and into the dermal papillary layer that is effective for skin rejuvenation. The purpose of this article is to give updates regarding the efficacy, possible adverse events, and patient satisfaction of trichloroacetic acid (TCA) peeling for skin rejuvenation by assessing various photoaging parameters. A systematic review of prospective trial articles collected from PubMed, MEDLINE, EMBASE, Cochrane, and Scopus databases was conducted on November 2, 2020. Treatment efficacy was assessed based on the photoaging parameters used by each study. Adverse events and patient satisfaction as the secondary outcome were assessed based on patients-perceived improvements. Five studies included three randomized comparison studies and two prospective cohort studies. These studies show that TCA peeling significantly improve the cosmesis of photoaged facial skin. Low concentration is effective for superficial sun damage. Medium-depth peels using a higher concentration of TCA or as combination therapy are effective as skin resurfacing agents to reduce wrinkles. Some adverse effects may occur but usually resolve within weeks. Overall patients were satisfied with the treatment result. An equivalent basic skin preparation such as topical retinoic acid skin priming prior to intervention is necessary for more objective comparison. Further research studies with a larger sample size and longer follow-up period are required. This evidence suggests that TCA peeling is effective in photoaging treatment, either as monotherapy or as combination therapy with other modalities.

Evaluation of glycolic acid and trichloroacetic acid peels in the treatment of melasma

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Melasma is a chronic acquired hypermelanosis of the skin mainly affecting women. The etiopathogenesis of melasma is not fully understood but multiple factors like genetic influences, sunlight exposure, pregnancy, estrogen ingestion and family history are implicated. The present study was aimed to evaluate the therapeutic, efficacy of glycolic acid (GA) and trichloroacetic acid (TCA) superficial chemical peels in melasma patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Fifty patients with clinically diagnosed melasma of either sex attending the outpatient clinic of department of dermatology of Mamata medical college and hospital, Khammam during the period of April 2007 to March 2008 constituted the subject material.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Distribution of melasma patients by duration of lesions showed the duration varied from 6 months to 6 years in both the groups, the difference in the duration of disease in two groups was statistically non-significant. Whereas site involvement showed malar region (96%) was the most commonly affected site followed by forehead (80%) and chin (20%). Study also showed sunlight was the main precipitating factor and the most frequent Fitzpatrick skin phototype was type V. The majority of cases in both the groups pigmentation was homogenous. In both the groups, at the end of three peels, it was observed that maximum cases had moderate improvement. Burning sensation was significantly high in group B compared to group A, erythema was seen in more in group B.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study proposes to combine both their modalities of chemical peels for better results TCA peels are used initially to get prompt response and then followed by GA peels to further reduce the pigmentation and maintain the effect.&lt;/p&gt;

Peeling with 25% trichloroacetic acid in the treatment of facial skin photoaging

Introduction: The chemical peel consists of the application of chemical exfoliants that eliminate the layers of the skin so that it can regenerate with an improved texture and pigmentation. It is currently a valuable therapy in dermatology, however, few studies objectively evaluate its efficacy. Objective: To evaluate the efficacy and safety of peeling with 25% trichloroacetic acid in the treatment of facial skin rejuvenation. Method: An observational, analytical and longitudinal study was carried out in 250 patients from two hospitals (Surgical Clinic: “Hermanos Ameijeiras” and General Teaching: “Enrique Cabrera”), in the period between January 2010 and January 2020. Treatment It was applied monthly for 6 months. The final evaluation was carried out 3 months after the end of the treatment. Results: 238 women and 12 men were treated with an average age of 30.5 (± 8.4) years. After treatment, there were significant changes in the Glogau Photo Damage Scale (P=0.012), in the Lemperle Wrinkle Assessment Scale (P=0.016) and in the Global Aesthetic Improvement Scale (P=0.021). The adverse events found were burning, inflammation and scaling. The degree of satisfaction reported by the patients was good (4.4%) and very good (95.6%) (P=0.011). Conclusion: The 25% trichloroacetic acid peel proved to be effective and safe to reduce the signs of facial skin aging, associated with a high degree of patient satisfaction.

Therapeutic effect of bleomycin tattooing combined with trichloroacetic acid and shaving on treatment-resistant plantar warts

Background Bleomycin is used for the treatment of warts. However, only its injected form can be used due to systemic use side effects, and plantar warts have a high recurrence rate following administration of bleomycin tattooing alone. To find an effective alternative with fewer side effects, we decided to investigate the effectiveness of bleomycin tattooing combined with trichloroacetic acid (TCA) and shaving in the management of treatment-resistant plantar warts.Methods The patients with treatment-resistant plantar warts entered the present quasi-experimental study. the wart site was shaved ahead of bleomycin tattooing and TCA peeling. This treatment was provided at one-month intervals and was repeated a maximum of four times. Patients were followed for six months after completion of the therapy. Finally, the patients’ data were completed according to photographs (monthly photos taken of lesions) and careful examinations.Results The present study involved 56 patients with a mean age of 25.75 ± 12.22 years. Twelve patients (21.4%) recovered after the first treatment; 14 (25%) needed the second treatment, 12 (21.4%) needed the third, 10 (17.9%) the fourth, and eight (14.3%) did not recover after the fourth treatment. The recovery rate was 21.4% with one, 45.4% with two, 66.8% with three, and 85.7% with four treatment sessions.Conclusion The combination treatment of bleomycin plus TCA and shaving led to a remarkable recovery from treatment-resistant plantar warts (21.4% recovery with the first treatment session and up to 85.7% recovery after four sessions). The treatment included tattooing and local injections, leaving few side effects.

Efficacy and Safety of 25% Trichloroacetic Acid Peel Versus 30% Salicylic Acid Peel in Mild-to-Moderate Acne Vulgaris: A Comparative Study.

Both salicylic acid (SA) and trichloroacetic acid (TCA) have proven efficacy with good safety profiles in the treatment of acne vulgaris. This study compared the clinical efficacy and safety of 25% TCA and 30% SA peels in the treatment of mild and moderate acne vulgaris. Patients with mild or moderate acne vulgaris were randomized into 2 groups of 25 persons each, and treated with either the TCA peel or the SA peel at 2-week intervals for 12 weeks. Evaluation of active acne was done by individual lesion counts (comedones, papules and pustules) and calculation of the Michaelsson acne score (MAS). Both peels led to significant decrease in individual lesion counts and MAS compared to baseline values, without significant differences between the treatment groups. Thus, the peels had equivalent efficacy against acne vulgaris. The TCA peel was better in treating non-inflammatory lesions, while the SA peel was better for inflammatory lesions, but the differences were not significant. No serious adverse effects were recorded, but more patients in the TCA peel group experienced burning and stinging sensations. The efficacy of 25% TCA is comparable to that of 30% SA in mild-to-moderate acne vulgaris, but safety and tolerability were better with the SA peel than TCA peel.

Fractional carbon dioxide laser versus trichloroacetic acid peel in the treatment of pseudo-acanthosis nigricans.

Treatment of acanthosis nigricans (AN) is challenging, and new modalities are being explored continuously to increase the therapeutic efficacy. To evaluate the efficacy and safety of fractional CO2 laser compared to trichloroacetic acid (TCA) peel in the treatment of pseudo-acanthosis nigricans (pseudo-AN). The study included 40 patients with pseudo-AN on the neck and axilla allocated into two groups each containing 20 patients. Group (A) was treated with TCA 20% peel applied on the pigmented area while group (B) received fractional CO2 laser. Both treatments were performed till complete clearance or for a maximum of four treatment sessions. Patients with excellent response were further followed up for 6months after the end of treatment. Both modalities were effective in the treatment of pseudo-AN; however, the therapeutic response was significantly higher in the fractional CO2 laser group compared to the TCA peel group (p<0.01). Marked to excellent response (51%-100% clearance of AN lesions) was achieved in 85% of the patients in the fractional laser group versus 10% of the patients in the TCA group. Adverse effects, for example, persistent erythema, post-inflammatory hyperpigmentation, and burning sensation, were also statistically higher in the TCA group compared to the laser group (p=0.04). Fractional CO2 laser is a promising effective and well-tolerated treatment modality for pseudo-acanthosis nigricans.