Chemical burn following 50% trichloroacetic acid for acne: Presentation of a case and a focused review

Abstract

Background: Chemical peels are widely used minimally invasive procedures with both cosmetic and medical indications. Although known for their general safety and efficacy, peels can rarely result in significant complications.Objective: Here we report the first case in the peer-reviewed literature of chemical burn from erroneous home use of 50% trichloroacetic acid.Methods: A focused literature review was performed of complications relating to chemical peels. Results: Chemical burns from trichloroacetic acid peels are rare. To our knowledge, this is the first such case reported with supporting histopathological data.Conclusions: Physicians must be aware of the potential complications of chemical peels, prevention strategies, and treatment modalities. Published by Elsevier B.V. on behalf of King Saud University. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

Professional-Grade TCA-Lactic Acid Chemical Peel: Elucidating Mode of Action to Treat Photoaging and Hyperpigmentation

“…To achieve desired depth and benefits with minimum side-effects, it is recommended to use TCA at lower concentration by combining it with other peeling agents, such as Jessner's solution and/or hydroxy acids ( 7 ). For example, a superficial peel consisting of <30–35% TCA and 10–70% hydroxy acids (alpha and/or beta) could achieve depth of penetration into papillary dermis, and can treat mild photoaging, acne scarring and pigmentary disorders ( 3 , 7 – 9 ). Although there is scarcity of literature on adversity of TCA-based chemical peels, there are possibilities of post-inflammatory hyperpigmentation and acid burn ( 7 ).…”

“…For example, a superficial peel consisting of <30–35% TCA and 10–70% hydroxy acids (alpha and/or beta) could achieve depth of penetration into papillary dermis, and can treat mild photoaging, acne scarring and pigmentary disorders ( 3 , 7 – 9 ). Although there is scarcity of literature on adversity of TCA-based chemical peels, there are possibilities of post-inflammatory hyperpigmentation and acid burn ( 7 ). Therefore, peeling should be performed by a trained professional or physician and a post-operative care should be followed to prevent complications associated with peeling agents ( 7 ).…”

“…Although there is scarcity of literature on adversity of TCA-based chemical peels, there are possibilities of post-inflammatory hyperpigmentation and acid burn ( 7 ). Therefore, peeling should be performed by a trained professional or physician and a post-operative care should be followed to prevent complications associated with peeling agents ( 7 ). A typical post-operative care regimen includes application of gentle cleansing, aquaphor ointment, moisturization, and sunscreen application to protect and nourish exfoliating skin ( 9 ).…”

“…A typical post-operative care regimen includes application of gentle cleansing, aquaphor ointment, moisturization, and sunscreen application to protect and nourish exfoliating skin ( 9 ). Although there is no universal protocol, several dermatologists prefer to use topical retinoids, such as tretinoin and retinol, hydroquinone, etc., pre- and post-peel to achieve optimum outcomes and safety ( 7 , 8 , 10 ). Chances of complications and post-operative care are minimum with superficial peels.…”

“…Chances of complications and post-operative care are minimum with superficial peels. TCA is most commonly used in combination with AHAs, such as lactic acid and glycolic acid ( 7 ) because mechanism of action of AHAs and their indications are well-understood ( 11 , 12 ). AHAs are indicated for use in many in-home and dermatologists' cosmetic and medical products for skin moisturization, wrinkle and pigment reduction, and chemical peeling ( 3 , 12 ).…”