Chemical Peels [ Peels ]
Medium-strength Trichloroacetic acid (TCA) peels are best for those with fair skin (since post-inflammatory hyperpigmentation is possible) looking to tackle extreme pigment problems like melasma. Similarly, peels containing salicylic acid more readily aid in the sloughing of dead skin cells. Patients looking for a more aggressive sebum-reducing treatment, however, should consider a TCA skin peel, which alters the skin’s acidity levels to halt bacteria and oil overgrowth. “TCA peels should only be performed by an experienced physician, since the concentration of acid and duration of contact are critical in determining the peel’s effect,” notes Barrington, IL, dermatologist David Van Dam, MD. In higher concentrations, well-trained doctors use TCA in lieu of laser resurfacing to soften acne scarring and erase wrinkles deeper wrinkles.
Since TCA peels are medium strength, they always cause stinging and redness. “Stronger concentrations of TCA can penetrate into the dermis and create significant peeling and redness that may last for more than a week,” he says.
“There are a variety of peels that are effective for brown spots, such as the Obagi Blue Peel, which can only be found in doctors’ offices,” says Kirkland, WA, dermatologist, Dr. Julie Voss. One of the better-known types of TCA peels is the Obagi Blue Peel, which requires one cycle of pre-peel prepping to prevent hyperpigmentation from occurring during the actual peel. The Obagi Blue Peel (your doctor will let you know if you require a single treatment or a series), which is a TCA peel in mask form, is suitable for all skin types and works to correct fine lines, scars and pigmentation problems. Obagi Blue chemical peels are good for reducing fine lines, improving skin texture and even softening sun-damaged skin. The peel is designed to prevent over-exfoliation of the skin using a special blue tint that usually washes off in 12 to 24 hours.
Most TCA-based peels are a one-time treatment and require one to two weeks of downtime until crusting heals to reveal smoother, younger, clearer pink skin. (There is no downtime with lighter concentrations of TCA peels.)
While treatments vary, the skin’s surface must be rejuvenated to get rid of the sun-damaged cells and stimulate the body to make more collagen. To help resurface the skin and eliminate excess pigment, your dermatologist or plastic surgeon may prescribe Tri-Luma, which contains hydroquinone to lighten pigment, as well as a retinoid to speed skin-cell turnover and a steroid to prevent inflammation. “This should work within two months on irregular brown patches,” says Dr. Julie Voss.
What Trichloroacetic Acid Treats
TCA peels can also treat deeper acne scars and hyperpigmentation.
Usually just one TCA peel, which takes about 10 to 15 minutes, will reduce medium to deep discoloration—but in some cases, more than one treatment is needed to achieve the desired results.
Before the peel, your doctor will probably apply a topical anesthetic; otherwise you may feel some stinging. Post-peel, your skin will crust or scab and your face may be swollen for a few days. And while the results are not permanent, once your skin is fully healed (within about seven to 10 days after the treatment), it will still be able to produce pigment. To prevent hyperpigmentation from returning, make sure to stay out of the sun for the first few months after your peel and wear an SPF daily.
Can TCA Peels Prevent Skin Cancer?
A study published in the Archives of Dermatology compared the outcomes of a 30 percent TCA peel, CO2 laser skin resurfacing and the topical cream fluorouracil to treat precancerous skin lesions. After three months, all patients saw a reduction in the number of actinic keratosis lesions, but those receiving TCA peels experienced a “markedly lower” or 40-fold reduction in non-melanoma skin cancer. The sample size of the study was small, but the authors believe the results warrant additional studies with larger patient populations.
While the study demonstrated that TCA peels were effective for preventing non-melanoma skin cancers, Dr. David Van Dam says, “In order for a TCA peel to prevent skin cancer, it would have to be a deeper, more aggressive peel, not a light, ‘freshening’ version.” It’s important to note that the TCA peel used in this study requires 10 to 14 days for recovery, and you can expect the uppermost layers of the skin to shed for up to three days.