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Effective Use of Trichloroacetic Acid (TCA)

One of the agents widely used for acne or acne scar treatment is trichloroacetic acid (TCA). TCA does not react to light and can be kept at room temperature. It is not toxic and helps control peeling depth according to its concentration. In most cases, 20~30% TCA is used for peeling treatment and 70~100% TCA is used for dot peeling to treat wider pores or acne scars.

 

A 20% TCA peeling agent is made by melting 20g of TCA crystals in 100 ml of purified water. 20-30% TCA causes light peeling. It is effective for improving hyperpigmentation lesion, speckles, freckles, damage by sunlight, acne scars, and skin texture.

 

TCA Peel Application Method

 

Before applying a TCA solution (with 20~30% concentration), it is good to remove foreign substances or oil from the skin using alcohol swabs. White frost appears on the skin after TCA application. Unlike in the case of salicylic acid, the frost turns white in proportion to the peel depth upon the application of TCA. For convenience, peel depth is classified into four groups based on the level of frost. 

 

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Tingling and burning symptoms occur after application of a TCA solution and these last for 1 to 5 minutes.  After the treatment, patients should not intentionally peel off the peeling skin or eschars. It is recommended that patients use a mild moisturizer and apply sunblock. If the patient complains of severe irritation, itching or erythema, the use of light steroid ointment is recommended.

 

I have recently seen some cases of patients concerned about side effects because skin care specialists or practical nurses in some hospitals have demonstrated lack of care and used a 100% TCA solution.  However, if excessive amounts are not applied and the solution is cleaned off after an adequate time period, the skin is restored without any bigger side effects, but it is important that concentrated TCA is always stored carefully and only used by doctors.

 

- To be continued