Low Tech Spot Remover
Trichloracetic acid (TCA) peels have been used for decades to target discoloration. While the results can be dramatic, so can the downtime. Many practices don’t offer TCA peels because they consider the follow-up and monitoring it requires too time-intensive. This is a real a shame for the consumer who doesn’t mind a little downtime because TCA peels can be very effective.
TCA is the peeling agent in Obagi’s famous Blue Peel. It can also be ordered by physicians who mix it with distilled water to a specific strength (usually 15 - 30%). For some reason, TCA, does a good job of targeting hyperpigmentation, and seems to do this better than other acids. It also self-neutralizes (i.e. doesn't need to be washed off) and doesn’t pose as high a risk of scarring as other acids traditionally used in the past. Still, it’s very disturbing to see physician-strength TCA being sold over the internet – it’s not something to try at home.
Don’t be too suspicious if the doctor wants you to buy some products before the peel - it benefits the skin to be ‘prepped’. Preparing the skin often involves using hydroquinone and tretinoin (retinoic acid) – a regime discussed in more detail in Prescription vs. Over the Counter.
Studies show that applying tretinoin daily helps speed recovery, which, even if you were looking forward to hanging indoors for a few weeks, is still important because it reduces the chance of infection. A hydroquinone regime is essential for darker skin types as darker skin may respond to the peel by producing more discoloration (PIH), and this tendency has to be suppressed as much as possible. It is not uncommon for a doctor or practitioner to have a patient use a hydroquinone cream for six weeks before a peel.
Now, let’s not prevaricate: the peel burns. Some doctors may prescribe valium, but most do not anesthetize, and you will definitely feel it. The heat will rise for a few minutes, and then slowly dissipate. Most people manage the pain very well - some not so much. In my experience, patients in the latter group tend to panic and that’s more traumatizing than the pain. It may sound silly, but if you suspect that's how you'll react, tell yourself before the peel starts that the stinging and heat you'll feel is normal and you are not in danger. This seems to head off the 'fight or flight' response that prompts the panic.
After the peel your skin will feel tender and hot, and over the next five days or so it will darken to a leathery-looking brown then peel off. It’s not a pretty process (hence the nickname 'the ugly peel'), but the results can be stunning. Healing can take about 10 to 14 days, and a little pinkness may persist for a few months. The doctor will give you instructions on how to care for your skin post peel, and will most likely want you to return a few days after the peel so your skin can be checked for any sign of infection.
Really, you should be monitored throughout this approach – a professional should gauge your skin’s reaction to tretinoin, to hydroquinone, the peel and the recovery – and recommend a post peel regime to give you the best outcome possible (it will take several months for results to fully realize).
The benefit of a TCA peel and supporting home-care regime is that it works for all skin types. It can reduce or eliminate existing hyperpigmentation, and keep new from forming, which is why it is more appropriate for hyperpigmentation that is hormonally triggered.
It bears repeating: don’t try this at home. Experienced practitioners will know the best program for your skin type, and will aim to give you the most significant benefit with minimal risk. As risks can include permanent disfiguring such as scarring and hypopigmentation, your skin deserves the advantage of this experience.
