Combination Salicylic Acid/TCA Chemical Peeling

Abstract

The author has extensive experience using the combination of salicylic acid and TCA 10–15% for facial peeling [1]. She has treated innumerable patients with moderate to severe melasma with this combination regimen. In the initial series of 27 patients, 9 were classified as Fitzpatrick skin type IV, 11 were skin type V, and 7 were skin type VI. Many of the subjects included in the pilot group of patients had not responded to salicylic acid or glycolic acid peels. The concentration of salicylic acid was 20% and 30%, and the TCA concentration was 10%. A series of four peels were performed at 2-week intervals. Thirty percent of the patients experienced moderate improvement, and 70% experienced significant improvement in hyperpigmentation. Sixteen percent had minimal to mild side effects, which cleared within 1 week. The results of the study suggested that the combination peel is safe and efficacious for treatment of moderate and severe melasma. The peel has since been used successfully in all skin types. Swinehart pretreated a series of patients with lentigines, pigmented keratoses, and actinic damage of the dorsal hands with TCA 20% prior to application of a 50% salicylic acid paste [2]. He reported excellent results.