Trichloroacetic acid is formulated on a hydroglycerinated base. It is a versatile peeling agent and is useful for superficial and medium peels. The depth of the peel correlates with concentration.
In dark skins, 10-15% is safe, but concentration beyond 25% has high risk of pigmentary changes.
It is safer to combine two peeling agents in lower concentration sequentially rather than increase concentration. TCA can be combined with other techniques such as manual derma sanding.
CROSS technique is useful for post acne ice pick scars.
It causes coagulation of skin proteins leading to frosting. Precipitation of proteins leads to necrosis and destruction of epidermis. Coagulation is followed by inflammation and activation of mechanisms of wound repair. This leads to epithelialization with replacement of smoother skin with an even tone. There is collagen remodelling with production of new collagen. It is self- neutralizing and hence not absorbed in systemic circulation.
A technique consisting of the application of higher TCA 40% to 65% concentrations by pressing hard on the entire depressed area of Atrophic acne scars. This technique is called Chemical Reconstruction of Skin Scars (CROSS).
Performed for Fibrotic, superficial as well as deep Ice Pick scars, deep rolling and Boxcar scars. Excellent improvement in 3-5 sittings conducted at monthly intervals.
Repeated CROSS application destroys the atrophic pit with restructuring and thickening of dermal collagen.
Best results are seen for Fibrotic, Ice Pick, Boxcar scars and dilated pores.
CROSS method with dermaroller in same sitting targets improvement in most scars of grade 2-3.
- Epidermis renewal.
- Increases fibroblastic activity, which synthesizes the different macro molecules of the extracellular matrix.
- Reorganizes collagen and elastin fibres, improving physiological and mechanical qualities of the skin.
- Acne, Acne scars.
- Actinic & Seborrheic keratosis.
- Active bacterial infection.
- Herpes simplex.
- Open cuts, wounds, inflammation.
- Uncooperative patient.
- H/o Photosensitive drugs.
TCA 10-15 % is used for superficial peels (up to str. corneum).
TCA 25 % used as medium peels (up to basal layer of epidermis).
TCA 10-15% can be used on face. Beyond TCA 15%, it is to be used on the body.
- Cleanse the required area with pre-peel cleanser ( to be used according to the skin type i.e. oily, normal, dry etc.)
- Then if client is for the first time do a Peel Sensitivity Test.
- Explain the procedure to the client in detail.
- Take informed consent and before and after photo of the client.
- Apply TCA Peel 20% in strokes with a peel brush. Single stroke application. If redness or intolerable burning is felt, then immediately apply cold compress.
- Mild itching and burning sensation is experienced which is normal.
- The end point of the peel is white frosting with minimal or no erythema.
- Peel will flake lightly and heal in 2-4 days. In cases of deeper peels, second coat is required which takes 5-7 days to heal.
- Apply sunscreen according to the skin type.
Post Peel Care:
Patient will feel tightness of the skin after a peel. Sunscreen and moisturizers are used till desquamation subsides. In superficial peels little or no peeling occurs with flaking and scaling at few places. Darkening of skin returns to normal in 2-7 days. If crusting occurs, topical anti-bacterial ointment is used to prevent bacterial infection. Peels are repeated every 2 weeks, till improvement which occurs after 4-6 peels.
- Persistent erythema.
- Bacterial infection.
- Acneiform eruptions.
- Demarcation lines.
- Reactivation of Herpes.
- Contact Dermatitis.
- Hypertrophy / Keloids.