Cryopeeling Is Superior to TCA 35% Peeling in Treatment of Solar Lentigines

Cryotherapy treatment to remove precancerous cells from a hand
Investigators sought to determine whether cryopeeling provided faster and superior improvement of solar lentigines than trichloroacetic acid 35% peeling.

Cryopeeling was superior to trichloroacetic acid (TCA) 35% peeling in treatment of solar lentigines (SLs), according to recent study results published in Dermatologic Therapy.

SLsare sun-induced benign pigmented lesions of great aesthetic concern for many patients. Although cryotherapy is the gold standard treatment for SL, it may result in adverse events. Trichloroacetic acid peeling may be an effective alternative, but with some concerns regarding potential tumorigenesis. The cryopeeling technique is better tolerated andimproves the entire sun-damaged skin region.

In this prospective study, the researchers aimed to evaluate the efficacy and adverse effects of cryopeeling compared with TCA 35% peeling in the treatment of solar lentigines on the dorsum of the hands, and to assess their influence on the number of epidermal LCs. A total of 25 patients (9 men and 16 women; aged 50.24±8.56 years) were included in the study; 92% of patients had Fitzpatrick skin type IV. The right hand of each patient was treated with TCA 35% and the left hand with cryopeeling. Two treatment sessions were completed 3 weeks apart. Evaluations were conducted at weeks 0, 3, and 8. Skin lesions were biopsied before and 3 weeks after treatment via immunohistochemical staining for cluster of differentiation (CD)1a+ epidermal LCs.

The results indicated that cryopeeling produced faster and greater reduction in the number of SL lesions compared with TCA peeling. The number of lentigines was significantly reduced after the first session on the hand treated with cryopeeling (P <.001), but only after the second session with TCA peeling (P =.004). The number of lentigines was significantly lower after cryopeeling compared with TCA peeling (P <.001) After the end of the follow-up, cryopeeling produced significant lightening, in which 68% of patients demonstrated more than 50% improvement, whereas TCA-treated hands produced more than 50% improvement in 44% of patientss (P =.015). Hyperpigmentation/hypopigmentation blistering was shown with cryopeeling, whereas only hyperpigmentation was reported after TCA peeling. The number of LCs remained nearly constant with from pretreatment to post=treatmentcryopeeling (P =.058), although the number of LCs decreased after TCA (P =.002).

Limitations of the study include the small sample size and the relatively short follow-up period.

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The authors believe that the study findings demonstrate that cryopeeling is a reasonably safe alternative to TCA peeling for the treatment of SL in an effort to avoid the potential hazards of TCA on the skin.

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Elazim NEA, Makboul R, Botros SN, Awad SM. Cryopeeling versus Trichloroacetic acid peeling in the treatment of solar lentigines: Effect on epidermal Langerhans cells [published online March 2, 2020]. Dermatol Ther.