Manual Resurfacing and Trichloroacetic Acid for the Treatment of Patients with Widespread Actinic Damage

Abstract

The deeper level of this peel explains the improved cosmetic outcome and greater eradication of actinic keratoses. This treatment is particularly well suited for patients with extensive photodamage and widespread actinic keratoses.

Randomized controlled trial comparing 35% trichloroacetic acid peel and 5-aminolaevulinic acid photodynamic therapy for treating multiple actinic keratosis

“…Whereas TCA peeling is an extensively performed procedure in aesthetic dermatology to reverse signs of photodamage, its role in treating AKs is as yet poorly delineated . As a consequence, chemical peels are in general mentioned only briefly or even omitted completely from current treatment recommendations for AK and field cancerization.…”

“…Whereas TCA peeling is an extensively performed procedure in aesthetic dermatology to reverse signs of photodamage, 14 its role in treating AKs is as yet poorly delineated. [19][20][21][22][23] As a consequence, chemical peels are in general mentioned only briefly 24,25 or even omitted completely from current treatment recommendations 26 for AK and field cancerization. In theory, TCA peeling appears to be a promising therapeutic approach for AK as, like PDT, it allows for treating large skin areas in a single therapeutic session and at the same time may improve the appearance of chronically photodamaged skin.…”

“…Another trial in patients with widespread facial AK compared a peel with Jessner's solution and 35% TCA against fluorouracil 5% after pretreatment with tretinoin 0Á025% and found a 79% reduction of AK at the 12-month follow-up. 21 Thus, the combination of TCA with other chemical 21,29 or mechanical abrasive 19 procedures may enhance the therapeutic effect of the peeling procedure. Recently, Di Nuzzo et al compared TCA 50% and PDT using methyl aminolaevulinate (MAL) in an intrapatient study of 13 male patients with multiple AKs on the scalp.…”

Facial Resurfacing for Nonmelanoma Skin Cancer Prophylaxis

“…Preliminary studies 14,15,[17][18][19] have shown that resurfacing of the face can prevent or delay the occurrence of these lesions, especially in high-risk patients. We compared 2 skin resurfacing regimens, carbon dioxide laser resurfacing and 30% trichloroacetic acid peel, with topical 5% fluorouracil cream to determine whether any modality was superior for AK reduction and skin cancer prevention during a 5-year study.…”

Guidelines for the management of actinic keratoses

“…The nonblinded right/left comparison by Witheiler et al 24 of a 35% TCA peel and 5‐FU on the face suggested that they were of similar efficacy, with improvement sustained up to 12 months, waning considerably by 32 months. TCA can be combined with 70% glycolic acid 48 or with manual dermabrasion with silicon carbide sandpaper 49 …”