The TCA peel is a skin procedure that can help with more pronounced wrinkles and lesions that are precancerous. It is also called a medium peel, as you can learn more about in this article.

There are basically three types of skin peel procedures you have:

Light peels are most commonly performed using alpha hydroxyacids. These are naturally occurring acids found in fruits and other foods. AHAs have proven to be effective in treating dry skin, acne, liver or sun spots, lessening fine facial wrinkles, decreasing pore size, and improving skin texture. They are usually performed in a series of six peels, each peel about three weeks apart. This type of peel leaves the skin with a red glow which only lasts for a few days. As such it offers the quickest recovery time.

Medium peels are usually performed with trichloroacetic acid (TCA). These are only performed once every few years. TCA peels have the same benefits as the light variety, and in additioncan remove larger wrinkles and precancerous skin lesions because of deeper penetration. The drawback is that it makes the skin on the face look like a severe sunburn for one week.

If you have multiple precancerous skin lesions this is a better option than using Efudex (a skin drug) which makes the face look sore for a longer period of time, about six to eight weeks. This type of peel is also better than liquid nitrogen because it treats small precancers which can’t be seen with the naked eye. A person having a medium peel must stay in for one week to recover from the procedure. Like a medium peel, liquid nitrogen also takes one week of recovery time but is only good for treating larger precancerous skin lesions.

Deep peels get rid of large wrinkles and can have results as dramatic as a face lift. This type of peel has a recovery time of 1-2 months. It is the most effective, due to its deep penetration, but is only for very severe skin conditions.

TCA Peel Side Effects

The first week after the peel the skin will be red and swollen. The skin will also burn and may weep slightly.

They can sometimes cause persistent redness of the skin.

The most common side effect after a peel is brown discoloration of the skin. This is usually reversible but can rarely be permanent. This reaction usually occurs only in those who have had sun exposure after their peel and who are not compulsively using sunscreen SPF 25 or higher. So it’s important to avoid the sun post-procedure. If you can’t make sure you are well protected.

If you get cold sores, a peel can cause them to flare. Since most people have been exposed to cold sores, all patients must take a prescription medication to prevent a flair.

Are there any precautions to be aware of?

If you have any of the following problems, you need to let the doctor know so some precautions can be taken before and during your TCA peel:

* Facial Warts

* Prior bad reaction to a peel or dermabrasion

* Past herpes simplex (cold sores)

* If you have a history of sun allergies

* Recent radiation treatment for cancer

* If you form keloid or hypertrophic scars (thick scars)

* If you are now pregnant or breast feeding

Accutane use within the past six (6) months

* Sun burn or significant sun exposure in the last two days

* Surgery or cryosurgery within the last six weeks to the area that you plan to have treated

How to prepare for a medium chemical peel:

Each night before you go to bed, starting at least two weeks before your peel, you need to start applying Retin-A cream or alpha hydroxyacid lotion to the entire face and to any other areas that will be treated.

At least three to four weeks before your first peel, stop using exfoliating sponges.

All forms of hair removal should be stopped at least three to four weeks prior to the procedure.

Two days before the treatment you must start taking acyclovir 400 mg, 2 times per day or famciclovir 500 mg, 2 times per day.

Come to the dermatologist’s office with a fully cleansed face. No cologne, after shave, or cosmetics should be applied. Also try to avoid shaving the day of your peel.

How the TCA peel is performed:

First, the doctor or his assistant will review the possible side effects of a peel with you and give you a consent form to sign.

Next, your skin will be cleansed thoroughly and degreased with acetone.

Jessner’s solution will then be applied to one area of the face at a time. The solution will be left on the skin for several minutes. The skin will burn and tingle.

Next the doctor will apply 35% trichloroacetic acid. During this time the burning will be very intense.

Cool compresses will then be applied followed by Polysporin. During this time the skin will begin to feel better.

What to do after your treatment:

For 7 days after the peel, clean the skin with warm water using Lever 2000 liquid soap. Use your fingertips since the skin is very sensitive at this time. Avoid the use of abrasive or exfoliating sponges. After washing, pat dry with a clean towel, then apply Preparation H ointment (available at the drug store without a prescription). To avoid the possibility of scaring, please do not peel, pick, scrape, or scratch the skin.

Three (3) Advil, Nuprin, or ibuprofen (200 mg) are to be taken 3-4 times daily with food to reduce swelling and discomfort.

After the seven day period, start applying Retin-A cream or alpha hydroxyacid lotion to the face each night after washing the face with Cetaphil Lotion. In the morning and afternoon wash the face with Cetaphil Lotion then apply 4% Solaquin Forte.

For one week after the peel, acyclovir 200 mg, 5 times per day or famciclovir 500 mg, 2 times per day must be taken. This medication is available by prescription only. This will keep cold sores from spreading to the freshly treated skin. Failure to take this medication can lead to severe scaring. Call your doctor immediately if you feel a cold sore coming on.

Avoid sun exposure, this includes tanning beds. Sunlight on the skin after a peel can cause brown discoloration of the skin. You must use a sunscreen of SPF 25 or higher every morning before going outdoors. Apply the sunscreen over the 4% Solaquin Forte. A good sunscreen to use is Shade Lotion SPF 45 available from your local drug store.

With a TCA peel, scarring and brown discoloration of the skin is unlikely unless you go to a tanning salon after having the treatment or lie out in the sun. Daily sunscreen use should continue indefinitely to prevent new photo damage from occurring.

You may start wearing make-up one week after the peel providing you do not have any crusting or tenderness.

If you have persistent redness in an area after the first week, let your doctor know right away. Persistent redness of the skin can lead to brown discoloration of the red area and a scar if it is not treated right away.

For at least one month after the peel, you should not have hair removed by any technique because it can cause severe irritation of the skin. Also hair removal while using Retin-A can cause scabbing of the skin.

Do not take Accutane for at least six months after your peel. There are reports of scarring in people who have taken Accutane after a peel.

TCA peels can be very effective, but make sure you follow your dermatogist’s instructions prior to and following the procedure to minimize complications and side effects.