Patients should be counseled with the typical phases of wound healing post peeling. With superficial TCA peels, there may be mild to moderate erythema with fine flaking of the skin, lasting up to 4 days. Some patients may experience mild edema as well. With medium-depth TCA peels, patients should be advised that the peeled skin will feel and look tight. Preexisting pigmented lesions will darken considerably, and appear grayish to brown. There is also a varying degree of erythema and edema. Edema may last several days (peaks at 48 h) and patients should elevate their head while sleeping. Frank desquamation typically begins by the third day and is accompanied by serous exudation. Reepithelialization is usually complete by the 7th to 10th day, at which time the skin appears pink.
Following the chemical peel, patients are advised to wash their skin gently twice daily with a mild nondetergent cleanser. Acetic acid soaks (0.25%, 1 tablespoon of white vinegar in 1 pint of warm water) are performed up to four times
per day, and have antiseptic as well as debriding properties. In addition, a bland emollient such as plain petrolatum is applied to prevent dry-ness of skin and formation of crust. The patient must be advised not to vigorously rub their skin or pick at the desquamating skin, as this can lead to scarring. If patients complain of pruritus and are at risk for scratching, a mild topical steroid such as 1% hydrocortisone can be recommended. Once reepithelialization is complete, patients can use a moisturizing cream instead of the occlusive emollient. Long-term care following TCA peels is essentially the same as pre-peel priming regimen and includes use of broad-spectrum sunscreens, bleaching creams, tretinoin or vitamin C, in combination with an exfoliating agent such as alpha-hydroxy acid. Patients should be advised that the postpeel regimen is necessary to maintain the benefits gained from the peel. Although superficial TCA peels can be repeated every 4-6 weeks, medium-depth chemical peels should not be repeated for a period of 6 months, until the phases of healing are completed.
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