TCA chemical peels

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TCA (Trichloroacetic acid) peels are a time tested method of treating sundamage, uneven skin texture, and decreased skin tone. Peeling with TCA gives a predictable response and result.  The procedure takes approximately 10-15 minutes to perform and is conducted in one of our operating theatres by a specialist dermatologist trained in this procedure.  Generally one to three peels are conducted over six to ten weeks.

TCA peel procedure can be divided into:

1. Pre peel procedure

Patients will be supplied with a kit containing a vitamin A prescription, and a pre peel  home kit.  The combination of these two prescriptions increases healing time in addition to increasing the efficacy of the peel

2. Peel procedure

The skin is cleansed and disinfected with a light scrub. A known concentration of TCA is evenly applied with a sterile applicator until the necessary depth is reached. Application is complete within 10 minutes.

3. Post peel procedure

This home kit contains a simple cleanser, barrier cream and also Sunscreen. Instructions are provided in regards to application.

Recovery from TCA peels depends on two important factors- the concentration of TCA used and also the site of treatment.  The most common concentration used is between 20-30% for the face, with a typical recovery time of 6-8 days.  TCA peels of the chest area generally take longer to heal- 10-12 days in total.

Day 1-3

Skin undergoes peeling in sheets. Pigment lifts to reveal new skin. Patients need to moisturise frequently during this stage.

Day 3-5

Peeling continues. The underlying wound is red, itch may develop during this phase.

Day 5-8

Peeling ceases and the skin starts to recover. The treated areas are still red, however new skin has started to replace the shed skin. Make up can be worn at day 7 to day 9.

TCA peels can be an excellent method of treating skin pigmentation and uneven skin texture.  Conditions such as freckles, solar keratoses/ sun damage, and melasma can be successfully treated by TCA peeling. In addition higher strength TCA peels can improve wrinkles and increase skin tone. In higher concentrations of TCA , dermal collagen is stimulated – which accounts for the improvement in tone and wrinkle reduction.

TCA at very high concentrations can be use to treat certain types of acne scars.

TCA peels can be used on the face, chest and hands.  The number of treatments needed will depend on the location, and severity of pigmentation/ solar damage. As a guide, one treatment of TCA on the face will improve textural and pigment changes by approximately 60-80%. Peeling of the chest and hands are more conservative due to the longer healing time compared to the face. One peel will reduce pigmentation by 30% in these areas. We recommend a series of 2-3 peels for the chest/ hands.

More information on TCA Cross for acne scars

The effects of TCA peels can be compared to laser, however several differences are apparent. A direct comparison is difficult due to the variables such as the concentration of TCA, and the depth of laser treatment.

In general -

• Patients heal quicker with fractionated laser compared to TCA peels
• The side effects of fractionated photorejuvenation is less compared to TCA peels
• One treatment of medium depth TCA peel with a 7-9 day recovery period is equilivent to a series of Fractionated laser treatments
• The cost of TCA peels are generally less than laser treatments

The cost of TCA peels varies with the concentration and site of peels.

As a guide -

Prior to TCA peels, a in depth consultation with a specialist dermatologist is required.  The consultation is aimed at obtaining a full medical history, examination of the proposed treated areas, and a discussion of the risks and benefits of TCA peels. Your dermatologist may also give you other possible options.

**TCA peeling is NOT covered under private health or Medicare

Side effects are proportional to the depth of the chemical peel. Common side effects such as redness and itchiness are seen in almost all patients undergoing higher concentration TCA peels. These side effects subside over days ( itch) or weeks ( redness). Other side effects are exceedingly rare however will be discussed below.

Redness

Universally seen with deeper peels. This is most marked within the first 2-3 weeks however decreases over the next 2-4 weeks. Make up can be worn after the skin stops peeling, usually 7 days after a peel

Itchyiness

This is commonly seen with higher concentration TCA peels ( 20% of greater). Acne or folliculitis maybe seen in higher strength peels and may contribute to the itch. In these cases antibiotics will help alleviate the symptoms.

Infection

Viral , bacterial or fungal. Uncommon side effects, follow up post peel will generally pick up the early signs of infection. Your dermatologist may elect to prescribe anti-virals prior to deeper peels as a precaution- especially in patients with a history of cold sores.

Pigment changes / Demarcation lines

TCA peels are designed to minimise the sharp demarcation lines commonly seen after IPL treatments. A technique known as feathering is used to blend in the treated skin with the surrounding areas, minimizing demarcation.

Scarring

Very uncommon. To minimise the event of scarring, patients with a history of keloid scarring are excluded from TCA peels.  Scarring may occur if infections are not treated, or if treatments are too aggressive. Treating physicians will ensure that the depth and concentration of TCA peels are ideal for the condition, location and skin type.

moreDr Davin Lim

Dr Davin Lim, Dermatologist

In the new age of IPL, Fractionated laser resurfacing and Fractionated Photofacial treatments, TCA peels still remains a useful modality for dermatologist. TCA peels are predictable in the outcome, and are quick to perform.  They remain a useful method of treating both solar keratoses (sunspots) as well as addressing uneven skin texture and reduced skin tone.  By varying both concentration of the TCA and the aggressiveness of the pre-peel prep, I can tailor recovery and results consistently.

Down side to peels are the longer recovery period for patients and more intensive aftercare compared to newer modalities such as Fractionated Photorejuvenation laser treatments, never the less TCA peels will still remain to be a very effective treament for many patients.