A COMPARISON OF THE EFFICACY AND SAFETY OF JESSNERS SOLUTION AND 35-PERCENT TRICHLOROACETIC-ACID VS 5-PERCENT FLUOROURACIL IN THE TREATMENTOF WIDESPREAD FACIAL ACTINIC KERATOSES

Background and Design: We compared the efficacy and safety of a medium -depth chemical peel with those of the standard regimen of topical flu orouracil in the treatment of widespread facial actinic keratoses (AK) . Fifteen patients with severe facial actinic damage and similar numbe rs of AK on both sides of the face were treated on the left side with a single application of Jessner's solution and 35% trichloroacetic aci d and on the right side with twice daily applications of 5% fluorourac il cream for 3 weeks. Evaluations were conducted before treatment and at 1, 6, and 12 months after treatment. Visible AK were counted, rando m skin biopsies performed, adverse effects monitored, and patients que stioned about preference and perception of efficacy. Results: Both tre atments reduced the number of visible AK by 75% and produced equivalen t reductions in keratinocyte atypia, hyperkeratosis, parakeratosis, an d inflammation, with no significant alteration of preexisting solar el astosis and telangiectasia. Except for erythema that lasted 3 months i n one patient, no untoward side effects were observed with the chemica l peel. The majority of patients preferred the peel over fluorouracil because of the single application and less morbidity. Conclusion: The medium-depth peel induced by Jessner's solution and 35% trichloroaceti c acid is a useful alternative therapeutic option for widespread facia l AK, particularly for poorly compliant patients, because it equals fl uorouracil in efficacy while being superior in terms of the convenienc e of a single application with little associated morbidity.