A REEVALUATION OF THE EFFECT OF OCCLUSION ON THE TRICHLOROACETIC-ACIDPEEL

BACKGROUND. Prior studies have demonstrated reduced wounding with troc hloracetic acid (TCA) peels after tape occlusion. It is therefore reas onable to question whether or not other types of occlusion may have si milar effects, particularly those used in routine postoperative care. OBJECTIVE. To reevaluate the effect of occlusion after TCA peers in mu ltiple human models using various forms of dressings, at various times postoperatively, and to make recommendations regarding wound care tha t will not adversely affect the efficacy of the peel. METHODS. Equal-s ized sections of anterior alopecic scalps of four patients were peeled with 50% TCA, occluded with bacitracin, Vigilon, or Tegaderm at vario us times postoperatively, and biopsied 1 day later. Depths of necrosis were measured and compared with nonoccluded controls. RESULTS. Bacitr acin ointment and Vigilon did not lessen TCA wounding, and sometimes a ctually enhanced it. Conversely, Tegaderm lessened the degree of the T CA wound. Timing of application played a role in the case of occlusion with Vigilon. CONCLUSION. Occlusives used in conjunction with TCA pee ls do not have a uniform effect on depth of necrosis. ointments and Vi gilon can be used without reducing the efficacy of the TCA peel. Multi ple subjects and rigid control of variables are necessary in studies o f TCA-induced necrosis.