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A Comparison of the Efficacy and Safety of Jessner's Solution and 35% Trichloroacetic Acid vs 5% Fluorouracil in the Treatment of Widespread Facial Actinic Keratoses

A Comparison of the Efficacy and Safety of Jessner's Solution and 35% Trichloroacetic Acid vs 5%... Abstract Background and Design: We compared the efficacy and safety of a medium-depth chemical peel with those of the standard regimen of topical fluorouracil in the treatment of widespread facial actinic keratoses (AK). Fifteen patients with severe facial actinic damage and similar numbers 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 acid and on the right side with twice daily applications of 5% fluorouracil cream for 3 weeks. Evaluations were conducted before treatment and at 1, 6, and 12 months after treatment. Visible AK were counted, random skin biopsies performed, adverse effects monitored, and patients questioned about preference and perception of efficacy. Results: Both treatments reduced the number of visible AK by 75% and produced equivalent reductions in keratinocyte atypia, hyperkeratosis, parakeratosis, and inflammation, with no significant alteration of preexisting solar elastosis and telangiectasia. Except for erythema that lasted 3 months in one patient, no untoward side effects were observed with the chemical 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% trichloroacetic acid is a useful alternative therapeutic option for widespread facial AK, particularly for poorly compliant patients, because it equals fluorouracil in efficacy while being superior in terms of the convenience of a single application with little associated morbidity.(Arch Dermatol. 1995;131:176-181) References 1. Preston DS, Stern RS. Nonmelanoma cancers of the skin . N Engl J Med. 1992; 327:1649-1662.Crossref 2. Dodson JM, DeSpain J, Hewett JE, Clark DP. Malignant potential of actinic keratoses and the controversy over treatment: a patient-oriented perspective . Arch Dermatol. 1991;127:1029-1031.Crossref 3. Marks R, Rennie G, Selwood TS. Malignant transformation of solar keratoses to squamous cell carcinoma . Lancet. 1988;1:795-797.Crossref 4. Hodge SJ, Schrodt GR, Owen LG. Effect of topical 5-FU treatment on actinic keratosis . J Cutan Pathol. 1974;1:238-248.Crossref 5. Dillaha C, Jansen T, Honeycut M, et al. Selective cytologic effect of 5-fluorouracil . Arch Dermatol. 1963;88:247-256.Crossref 6. Hodge SJ, Jansen T, Honeyut M. Treatment of actinic keratosis with topical fluorouracil . Med Rec Ann. 1966;59:500-505. 7. Simmonds WL. Topical management of actinic keratosis with 5-fluorouracil: results of a 6-year follow-up study . Cutis. 1972;10:737-741. 8. Eaglestein WH, Weinstein GD, Frost P. Fluorouracil: mechanism of action in human skin and actinic keratoses . Arch Dermatol. 1970;101:132-139.Crossref 9. Goette DK. Topical chemotherapy with 5-fluorouracil . J Am Acad Dermatol. 1981;4:633-645.Crossref 10. Pearlman DL. Weekly pulse dosing: effective and comfortable topical 5-fluorouracil treatment of multiple facial actinic keratoses . J Am Acad Dermatol. 1991;25:665-667.Crossref 11. Drake LA, Cornelison RL, Dorner W, et al. Guidelines of care for actinic keratoses . Dermatol World. July 1993( (suppl) ):3-5. 12. Benedetto AV, Griffin TD, Benedetto EA, Humeniuk HM. Dermabrasion: therapy and prophylaxis of the photoaged face . J Am Acad Dermatol. 1992;27:439-447.Crossref 13. Spira M, Freeman K, Arfai P, et al. Clinical comparison of chemical peeling, dermabrasion and 5-FU for senile keratoses . Plast Reconstr Surg. 1970;46: 61-66.Crossref 14. Stegman SJ. A comparative histologic study of the effects of three peeling agents and dermabrasion on normal and sun-damaged skin . Aesthetic Plast Surg. 1982;6:123-135.Crossref 15. Collins PS. The chemical peel . Clin Dermatol. 1987;5:57-74.Crossref 16. Brody HJ. Medium depth peeling . In: Chemical Peeling . St Louis, Mo: Mosby-Year Book Co; 1992:75-97. 17. Ayres S. Dermal changes following application of chemical cauterants to aging skin: superficial chemosurgery . Arch Dermatol. 1960;82:578-585.Crossref 18. Collins PS. Trichloroacetic acid peels revisited . J Dermatol Surg Oncol. 1989; 15:933-940.Crossref 19. Brodland DG, Roenigk RK. Trichloracetic acid chemexfoliation (chemical peel) for extensive premalignant actinic damage of the face and scalp . Mayo Clin Proc. 1988;63:887-896.Crossref 20. Brody HJ, Hailey CW. Medium-depth chemical peeling of the skin: a variation of superficial chemosurgery . J Dermatol Surg Oncol. 1986;12:1268-1275.Crossref 21. Monheit GD. The Jessner's + TCA peel: a medium-depth chemical peel . J Dermatol Surg Oncol. 1989;15:940-950.Crossref 22. Brody HJ. Variations and comparisons in medium-depth chemical peeling . J Dermatol Surg Oncol. 1989;15:953-963.Crossref 23. Clark RE, Weingold DH, Hirsh E, et al. TCA chemical peel effective for extensive actinic keratosis . Skin Allergy News. 1991;22:34. 24. Kligman AM, Grove GL, Hirose R, Leyden JJ. Topical tretinoin for photoaged skin . J Am Acad Dermatol. 1986;15:836-859.Crossref 25. McDonald CJ. Cytotoxic agents for use in dermatology . J Am Acad Dermatol. 1985;12:753-775.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

A Comparison of the Efficacy and Safety of Jessner's Solution and 35% Trichloroacetic Acid vs 5% Fluorouracil in the Treatment of Widespread Facial Actinic Keratoses

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1995.01690140060009
Publisher site
See Article on Publisher Site

Abstract

Abstract Background and Design: We compared the efficacy and safety of a medium-depth chemical peel with those of the standard regimen of topical fluorouracil in the treatment of widespread facial actinic keratoses (AK). Fifteen patients with severe facial actinic damage and similar numbers 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 acid and on the right side with twice daily applications of 5% fluorouracil cream for 3 weeks. Evaluations were conducted before treatment and at 1, 6, and 12 months after treatment. Visible AK were counted, random skin biopsies performed, adverse effects monitored, and patients questioned about preference and perception of efficacy. Results: Both treatments reduced the number of visible AK by 75% and produced equivalent reductions in keratinocyte atypia, hyperkeratosis, parakeratosis, and inflammation, with no significant alteration of preexisting solar elastosis and telangiectasia. Except for erythema that lasted 3 months in one patient, no untoward side effects were observed with the chemical 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% trichloroacetic acid is a useful alternative therapeutic option for widespread facial AK, particularly for poorly compliant patients, because it equals fluorouracil in efficacy while being superior in terms of the convenience of a single application with little associated morbidity.(Arch Dermatol. 1995;131:176-181) References 1. Preston DS, Stern RS. Nonmelanoma cancers of the skin . N Engl J Med. 1992; 327:1649-1662.Crossref 2. Dodson JM, DeSpain J, Hewett JE, Clark DP. Malignant potential of actinic keratoses and the controversy over treatment: a patient-oriented perspective . Arch Dermatol. 1991;127:1029-1031.Crossref 3. Marks R, Rennie G, Selwood TS. Malignant transformation of solar keratoses to squamous cell carcinoma . Lancet. 1988;1:795-797.Crossref 4. Hodge SJ, Schrodt GR, Owen LG. Effect of topical 5-FU treatment on actinic keratosis . J Cutan Pathol. 1974;1:238-248.Crossref 5. Dillaha C, Jansen T, Honeycut M, et al. Selective cytologic effect of 5-fluorouracil . Arch Dermatol. 1963;88:247-256.Crossref 6. Hodge SJ, Jansen T, Honeyut M. Treatment of actinic keratosis with topical fluorouracil . Med Rec Ann. 1966;59:500-505. 7. Simmonds WL. Topical management of actinic keratosis with 5-fluorouracil: results of a 6-year follow-up study . Cutis. 1972;10:737-741. 8. Eaglestein WH, Weinstein GD, Frost P. Fluorouracil: mechanism of action in human skin and actinic keratoses . Arch Dermatol. 1970;101:132-139.Crossref 9. Goette DK. Topical chemotherapy with 5-fluorouracil . J Am Acad Dermatol. 1981;4:633-645.Crossref 10. Pearlman DL. Weekly pulse dosing: effective and comfortable topical 5-fluorouracil treatment of multiple facial actinic keratoses . J Am Acad Dermatol. 1991;25:665-667.Crossref 11. Drake LA, Cornelison RL, Dorner W, et al. Guidelines of care for actinic keratoses . Dermatol World. July 1993( (suppl) ):3-5. 12. Benedetto AV, Griffin TD, Benedetto EA, Humeniuk HM. Dermabrasion: therapy and prophylaxis of the photoaged face . J Am Acad Dermatol. 1992;27:439-447.Crossref 13. Spira M, Freeman K, Arfai P, et al. Clinical comparison of chemical peeling, dermabrasion and 5-FU for senile keratoses . Plast Reconstr Surg. 1970;46: 61-66.Crossref 14. Stegman SJ. A comparative histologic study of the effects of three peeling agents and dermabrasion on normal and sun-damaged skin . Aesthetic Plast Surg. 1982;6:123-135.Crossref 15. Collins PS. The chemical peel . Clin Dermatol. 1987;5:57-74.Crossref 16. Brody HJ. Medium depth peeling . In: Chemical Peeling . St Louis, Mo: Mosby-Year Book Co; 1992:75-97. 17. Ayres S. Dermal changes following application of chemical cauterants to aging skin: superficial chemosurgery . Arch Dermatol. 1960;82:578-585.Crossref 18. Collins PS. Trichloroacetic acid peels revisited . J Dermatol Surg Oncol. 1989; 15:933-940.Crossref 19. Brodland DG, Roenigk RK. Trichloracetic acid chemexfoliation (chemical peel) for extensive premalignant actinic damage of the face and scalp . Mayo Clin Proc. 1988;63:887-896.Crossref 20. Brody HJ, Hailey CW. Medium-depth chemical peeling of the skin: a variation of superficial chemosurgery . J Dermatol Surg Oncol. 1986;12:1268-1275.Crossref 21. Monheit GD. The Jessner's + TCA peel: a medium-depth chemical peel . J Dermatol Surg Oncol. 1989;15:940-950.Crossref 22. Brody HJ. Variations and comparisons in medium-depth chemical peeling . J Dermatol Surg Oncol. 1989;15:953-963.Crossref 23. Clark RE, Weingold DH, Hirsh E, et al. TCA chemical peel effective for extensive actinic keratosis . Skin Allergy News. 1991;22:34. 24. Kligman AM, Grove GL, Hirose R, Leyden JJ. Topical tretinoin for photoaged skin . J Am Acad Dermatol. 1986;15:836-859.Crossref 25. McDonald CJ. Cytotoxic agents for use in dermatology . J Am Acad Dermatol. 1985;12:753-775.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Feb 1, 1995

References