It is of paramount importance that the dermat-ologic surgeon be familiar with the complications of TCA peels. These include infections (bacterial, viral, fungal), pigmentary changes, prolonged erythema, milia, acne, textural changes, and scarring. Bacterial infections include Pseudomonas, Staphylococcus or Streptococcus. In general, prophylaxis with antibiotics is not indicated and strict adherence to wound care instructions will prevent this untoward complication. In patients with a history of herpes labialis, even if remote, prophylaxis with antiviral agent is necessary. Scarring is a rare, yet feared complication of medium-depth chemical peels. Although the etiology of scarring is unknown, factors which are contributory include poor wound care, infections, uneven peeling depth, mechanical injury and previous history of ablative procedures. Localized areas of prolonged erythema, particularly on the angle of the jaw can be indicative of incipient scarring. Proper attention to risk factor, use of mild topical steroids for localized areas of erythema and proper wound care and infection prophylaxis can minimize the risk of scarring. If scarring is imminent, use of higher-strength steroids (class I to II), silicone gel and/or sheaths, and pulsed-dye lasers may be beneficial. Prolonged erythema may be secondary to underlying rosacea, eczema, or use of tretinoin. Use of a mild topical steroid such as 2.5% hydrocortisone lotion is likely beneficial. Milia formation is most likely due to over occlusion and can be minimized with the use of less occlusive emollients after reepithelialization. As noted previously, use of sunscreens, bleaching agents, and tretinoin can minimize pigmentary changes which can develop post peeling.
Was this article helpful?