Combination Trichloroacetic, Lactic Acid Effective in Reducing Signs of Facial Photoaging

A chemical peel containing 6% trichloroacetic acid and 12% lactic acid was well-tolerated and efficacious in improving facial signs of photoaging.

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According to a study,¹ researchers sought to determine the efficacy of a combination chemical peel in improving signs of skin aging, citing the efficacy of chemical peeling in improving facial cutaneous aging. They noted that these results are often possible with lowered risks and limited side effects among patients with darker skin types, limited finances, or sensitive skin, compared to alternative skin resurfacing techniques.

The study, which was single-arm, single-center, and prospective in nature, involved the recruitment and screening of 33 female patients. Prospective patients ranged in age from 35 to 60 years of age, were healthy in nature and demonstrated mild to moderate signs of facial photoaging. Researchers also ensured that participants represented Fitzpatrick Skin Types I through V.

Two weeks prior to the start of the study, researchers instructed all participants to discontinue use of any anti-aging skin care products, including glycolic acid, peptides, and retinoids both prior to and during the study.

Researchers then obtained clinical photographs of each participant’s face. These photographs were assessed using the Griffiths’ 10-point grading scale and were revisited throughout the study at each treatment visit, where additional photographs were obtained.

During treatment, researchers applied 2 layers of the 6% trichloroacetic acid and 12% lactic acid combination peel to participants’ faces. This was repeated 4 weeks later, and 4 weeks later after that.

For 5 to 7 days after receiving treatment, participants were instructed to apply the same 1% hydrocortisone healing cream, gentle cleanser, moisturizer, spot treatment ointment as needed, and sunscreen. Following this period, they used a daily gentle cleanser, moisturizer, and sunscreen.

Participants were assessed for side effects and Griffiths’ 10-point grading scale score at each visit. Approximately 1 week after treatment, participants were asked to describe their facial response to the peel. Four weeks after the third and final treatment, all participants completed a subject self-assessment questionnaire. The questionnaire asked participants to describe their response to the peel and to evaluate their overall improvement in accordance with the Global Aesthetic Improvement Scale (GAIS).

On average, participants experienced notable improvements to their skin’s:

• Brightness/clarity
• Evenness of skin tone (pigmentation, redness)
• Fine lines
• Overall appearance
• Tactile roughness
• Visual roughness

However, wrinkles did not appear to improve or decline in any capacity throughout the 12 weeks, remainingalmost entirely unchanged.

Of all participants, 66% reported little to no sensation during treatment, and 91% reported little to no peeling after treatment. The majority of participants (n=66%) reported smoother and more luminous skin as early as after the first treatment. On average, participants’ GAIS score (n=0.56) was indicative of subjective improvements to skin aging.

Furthermore, researchers noted that over time, photographs of participants demonstrated clinically notable improvements to aesthetic appearance, brightness, fine lines, glow, and hyperpigmentation.

Adverse events (n=4) were mild in nature and included acne flares, cheek swelling, and hyperpigmentation.

"[A] Series of three treatments with a combination peel containing 6% TCA and 12% lactic acid achieved modest improvements in mild-to-moderate signs of facial skin photoaging. This chemical peel treatment is well-tolerated and safe for patients of Fitzpatrick Skin Types I–V,” study authors wrote. “To optimize treatment outcomes and satisfaction, deliberate patient selection and adequate counseling on patient expectations is paramount. Meticulous, standardized photographs before and after treatment are necessary to demonstrate global changes in skin texture, brightness, and pigmentation.”

Reference

1. Fanning J, Jacob C, Diaz I, Ibrahim O. Treatment of mild‐to‐moderate facial cutaneous aging using a combination peel containing 6% trichloroacetic acid and 12% lactic acid. J Cos Dermatol. Published online 2023. doi:10.1111/jocd.15814