Available Brands of TCA Peels in .NET framework

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Available Brands of TCA Peels
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Many physicians use the Delasco brand of liquid TCA, which is available in various concentrations (Fig 20-12) Other physicians prefer to use chemical peel kits that combine TCA with an indicator that reveals when the peel has frosted Because there are legal concerns associated with the shipping of TCA, most of the companies that sell these kits require that the practitioner purchase the TCA solution separately Table 20-4 lists the more commonly used TCA peels on the market Biomedic developed a combination of TCA and SA called The Pigment Peel Plus, which is used for dyschromias and photoaging in addition to acne Although one coat of these peels produces a superficial peel, several coats can
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FIGURE 20-13 Obagi Blue Peel kit contains cleanser and blue base TCA must be purchased separately
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TABLE 20-4 Comparison of Costs and Properties of Available TCA Peels TCA INCLUDED Yes Yes No HOW SUPPLIED 2 oz bottle 2 oz bottle Box of 6 kits COST PER PATIENT $100 $100 $8000 EASE USE
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NAME TCA 30% liquid TCA 40% liquid Obagi Blue Peel
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COMPANY Delasco Delasco Obagi
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STRENGTH 30% wt/vol 40% wt/vol 4 coats
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COST $2800 $3175 $47500
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OTHER Clear, so can drip Clear, so can drip Blue, very hard to wash off
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FIGURE 20-14 Obagi Blue Peel applied to hands
the skin begins to peel off in sheets The peeling should be complete by day 10; however, the erythema may last until day 14 Patients should be shown pictures of how they will look so that there will be no surprises (Fig 20-15) Many authors advise against using TCA at greater than 50% concentration Contraindications for medium-depth peels include patients with darker skin types and those who have been recently treated with isotretinoin or topical radiation53 Because reepithelialization occurs from adnexal structures, some authors have theorized that patients recently treated for hair removal with lasers may have trouble healing after medium- or deepdepth peels However, at this point, this complication has not been reported One should be extra cautious when using medium-depth peels on the mandible, neck, and chest because these areas are more likely to get scars Patients should be warned that lesions such as solar lentigos may initially disap-
COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
with success in the treatment of moderate acne, photoaging, and melasma46 48 Given the fact that pyruvic acid is converted into CO2 and acetaldehyde, the CO2 buildup in the bottle may lead to explosion if the container is left in place for a while49 This chemical peel is usually used at 40% to 60% concentrations on facial skin, previously prepared with topical retinoids At such concentrations, it is considered a medium-depth peel and therefore must be used with caution in darker skin types or patients with sensitive or irritated skin After 2 to 5 minutes, or when adequate frosting is observed, the face is soaked in water, which is more for the patient s comfort rather than neutralizing the peel50 Some authors recommend neutralizing a pyruvic acid peel with 10% sodium bicarbonate and water48 Since the vapors from the chemical peel may be strong and irritating to the upper respiratory tract, the procedure is best done in a well-ventilated room and with use of an electrical fan Reepithelialization is observed in 1 to 2 weeks, while erythema may last for up to 2 months50 Pyruvic acid has also been used successfully in combination with 5fluouracil for the treatment of actinic keratoses and warts51,52
Side Effects and Precautions
Patients should be warned that they will look terrible for at least 10 days following a medium-depth peel During the first 2 days, the skin appears slightly pink On days 3 and 4 the skin darkens By day 5
FIGURE 20-15 Patient 4 days after four coats of the Obagi Blue Peel Patient should be told not to peel off the dark skin, but to let it peel naturally
tion of TCA Various combinations have been used including glycolic acid followed by TCA ( Coleman peel )54 and Jessner s peel followed by TCA ( Monheit peel ) The initial application of Jessner s solution results in reducing the cohesion of the epidermal cells, allowing better and more even penetration of the 35% TCA solution This combination is effective in mild to moderate photoaging, including lentigines, pigmentary changes, and rhytides55 (Box 20-3) Patients may need mild sedation and would benefit from the antiinflammatory effects of NSAIDs prior to this procedure Dr Harold Brody popularized the use of solid CO2 (dry ice) followed by 35% TCA The application of solid CO2 also causes interruption in the epidermal consistency and deep penetration of TCA56 There are several excellent texts on chemical peeling that further discuss these combination methods
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