MANUAL RESURFACING AND TRICHLOROACETIC-ACID FOR THE TREATMENT OF PATIENTS WITH WIDESPREAD ACTINIC DAMAGE - CLINICAL, AND HISTOLOGIC OBSERVATIONS

BACKGROUND. A facial resurfacing regimen combining manual abrasion of the skin and 25% trichloroacetic acid has been reported to produce exc ellent results, but the histologic depth of injury produced by this te chnique has not been studied. OBJECTIVE. TO describe our experience wi th this technique treating patients with extensive actinic damage and to determine the histologic depth of injury produced. METHOD. We treat ed 40 patients using manual resurfacing and trichloroacetic acid, prim arily for widespread actinic keratoses. Resurfacing tools included sil icone carbide sandpaper, drywall screen, electrocautery tip cleaners, abrasive pads, scalpel blades, and curettes. Four patients underwent s equential biopsies to evaluate the depth of wounding using this techni que. RESULTS. Manual resurfacing combined with trichloroacetic acid co nsistently produced excellent cosmetic results and nearly complete era dication of actinic keratoses. Histologically, treated areas showed re placement of the dermal elastotic band by newly formed collagen, a sig nificantly deeper level of wounding than the Jessner's/35% trichloroac etic acid peel. There was no evidence for foreign body granulomas clin ically or histologically as a result of the abrasive materials. CONCLU SIONS. The deeper level of this peel explains the improved cosmetic ou tcome and greater eradication of actinic keratoses. This treatment is particularly well suited for patients with extensive photodamage and w idespread actinic keratoses. (C) 1997 by the American Society for Derm atologic Surgery, Inc.