Chemical peels are used to exfoliate a few or many layers of skin to improve the skin’s appearance and texture or to rejuvenate or repair damage to the skin. Glycolic acid peels are mild and are used primarily for cosmetic purposes to improve the skin’s texture and appearance. When a more extensive procedure is needed to address skin discoloration, lines resulting from age, surface blemishes, or to even out more severe problems with the skin’s texture, medium-strength peels such as those accomplished with trichloroacetic acid (TCA) can be used effectively.
Trichloroacetic Acid (TCA) Peels
A TCA peel is considered a medium-strength chemical peel. The TCA peel may be used on the patient’s face, neck, and back of the hands. Many other types of peels can only be used on the face.
The TCA peel has deeper exfoliating effects than those obtainable from glycolic acid peels. The problems for which TCA peels are effective include:
- Fading dark spots, sun spots, and freckles;
- Smoothing marks left by acne;
- Relieving congested pores;
- Removing pre-cancerous lesions;
- Diminishing fine lines and wrinkles; and,
- Removing skin damaged by sun exposure.
TCA peels are not recommended for reducing or eliminating acne scars or moles, but have been found to be effective in removing or fading tattoos.
The procedure for the medium-strength peel is similar to a light peel; however, the chemicals used are stronger in order to remove more skin layers and are typically left on the skin for a longer period of time. The skin is cleansed and the chemical is applied. The length of time before the chemical can be neutralized and then removed is generally longer – this is to accomplish a more extensive modification to the skin, and the process is monitored by a physician or other medical staff to administer the procedure safely and effectively. TCA can be administered in formulations from mild to deep depending on the required penetration needed to treat the condition.
Patients report that TCA peel is generally more painful than a glycolic acid peel due to the chemical’s deep penetration into the skin. Typical effects are stinging or a burning sensation. The TCA peel is usually performed as an out-patient procedure; however, the physician may likely administer a sedative prior to the procedure to help the patient remain calm and to reduce discomfort.
Trichloroacetic acid is a chemical used for skin resurfacing. The chemical and its properties were discovered and documented in 1839 by Jean-Baptiste Dumas. It can be used in varying strengths determined suitable for the condition being treated and the desired results.
Candidates for a TCA Peel
Fairer-skinned persons are considered to be the best candidates for chemical peels, and, although darker-skinned persons can have successful chemical peel procedures, it is highly-recommended that the procedures are closely monitored by a physician. Conditions for effective results from TCA peels generally include, but are not limited to:
- Skin that has developed brown spots;
- Wrinkling caused by the onset of aging;
- Sun damage; or,
- Complexion that has become dull.
The patient’s ability to effectively prepare for the TCA peel has an impact on the penetration of the chemical peel solution, length of time required for recovery, success of the intended procedure, and mitigating incidences of skin discoloration.
To prepare the skin, a TCA peel requires a more regimented process than a glycolic acid peel. The patient’s physician will advise on specific steps needed to prepare for a TCA peel, and, the preparation required will take into account how extensive the chemical peel process will be. The patient may be asked to use Retin-A, glycolic acid, and bleaching agents, of a combination of those substances, for as many as six weeks. The glycolic acid enhances the effectiveness of the Retin-A to stimulate skin regeneration. Bleaching agents are often administered to darker-skinned patients to reduce the occurrence of blotchy skin following the TCA peel.
Using sunscreen and limiting sun exposure is highly recommended during the preparatory period.
Right after going through the procedure, most patients experience skin that is reddened, tight, and swollen. A stinging sensation is common, and the patient’s physician will most likely apply a protective ointment to the affected area. Some patients find it necessary to sleep in a more upright position than normal or to use ice packs to reduce swelling. During the days following the TCA peel, the patient is likely to experience darkening of the treated skin and a crust may form. New skin forms within about two weeks, and the area may continue to be red for several weeks.
TCA peel patients experience improved color and texture of the skin. Depending on the depth of the chemical penetration, the patient may enjoy more extensive smoothing of scarring or wrinkles.
There are some potential negative side effects; however, most can be avoided by following the physician’s direction for preparation for the peel and caring for the affected skin as directed following the peel. Acne sufferers may experience breakouts following the peel. Redness and discomfort are common.
Over-the-counter products are available for such peels; however, home administration of the chemical products is not recommended. As TCA peel is a medium-grade peel, it is imperative that a physician or other qualified medical staff monitors the procedure to control the extent of the chemical penetration and to act if any unexpected results occur.