A trichloroacetic acid peel, also known as a TCA peel, is a type of chemical peel that is commonly used in a cosmetic procedure in which the epidermis and part of the dermis is removed. Benefits of a medium depth TCA peel includes removal of superficial blemishes, smoothing out of fine surface wrinkles and correcting skin discoloration.
Milia
Milia are superficial cysts or white bumps that can appear on skin that has been treated with a TCA peel. According to “Color Atlas of Chemical Peels,” by Antonella Tosti and Maria Pia De Padova, the white bumps are a side effect of TCA peels. The bumps might be caused by the thick or occlusive ointments applied to the skin after a TCA peel. It can be reduced with the use of less occlusive ointments while the skin is healing from the TCA peel.
Herpes Simplex Infection
Herpes simplex infection can develop in a patient with or without a medical history of this condition, after a TCA peel. According to “Controversies in Otolaryngology” by Myles L. Pensak, it can be prevented by administering anti-viral agents to a candidates for TCA peels two days before the procedure is done. The antiviral therapy is continued for seven days after the peel. If herpes simplex infection still occurs after the TCA peel and antiviral treatment, then stronger agents such as acyclovir are administered.
Hypertrophic Scarring
Scarring is a rare side effect of TCA peels, according to “Cosmetic Dermatology” by Cheryl M. Burgess. Scars might occur in patients who have had facial plastic surgery. Other risk factors for scar development after a TCA peel includes poor skin care, thin skin, skin infections, uneven penetration of trichloroacetic acid into the skin and injury to the peeled skin that may be a result of scratching. Steroid injections are used to treat post-peel scars, if they occur.
Postinflammatory Hyperpigmentation
Postinflammatory hyperpigmentation is the most common side effect of TCA peels. It is a side effect in which areas treated with a TCA peel become darker than other areas of the skin. It usually stems from sun exposure. Patients who are on birth control pills are also at risk for developing postinflammatory hyperpigmentation. They might be advised to discontinue taking the pill to reduce the risk of postinflammatory hyperpigmentation. Sunscreen application may prevent postinflammatory hyperpigmentation. If this condition does occur, it can be treated with retinoic acid and hydroquinone products.
