Easy TCA:an immediate frosting has occured

An almost complete frosting has appeared with the first layer of Easy TCA;
why has this happened? What should I do?

This abnormally swift frosting could have appeared due to various reasons:

You may have erroneously used Only Touch Peel (or directly the TCA solution in a 50% mass/mass) on the whole of the face. In this case, the peeling will be too deep: OTP is in no case recommended for this purpose. The remedy is to consider the post peel as a deep classical TCA, without omitting the prevention of pigmentary rebounds (Skin Tech blanching-blending cream and strong sun cream) and scars.

You may have applied an excessive number of layers of the acid solution of Easy TCA. (Do you let the skin completely dry before applying the next layer?)

The safest way to use Easy TCA is to interrupt the application of the acid solution when the first frosting points appear. Each layer should dry completely before the next is applied: sudden, cloudy frosting may appear over greater or larger areas if a layer is applied on a layer that is not dry.

Your patient may have carried out a skin preparation such as the one indicated for before a "classical TCA"...

The base protocol for Easy TCA (see technical booklet) requires application without a pre peel preparation and without removing grease from the skin. If the patient uses creams containing retinoids or AHA, Easy TCA shall penetrate deeper and faster, sometimes exceeding the necessary depth (frosting points). Patients do not need to stop applying these creams before the peelings, however, when applying the acid solution the cotton buds should be soaked in lesser amount.

Another option is that the solution has been made up inadequately.

Little trick:

Mark the bottle when injecting the TCA with either a coloured sticker or by writing directly on the glass.

Before carrying out any operation, read the instructions for use, as the necessary information and indications are clearly stated within. Said mistake usually occurs when a third person makes up the solution instead of the person who is going to apply it. Thus, the acid may have been injected twice into the adjuvant bottle. Thus meaning, that 4.8 ml of TCA at 50% m/m must have been injected into the adjuvant bottle for the first peeling and before applying the second, another 4.8 ml of TCA must have been injected. Thus, the second peeling has been carried out with a solution that is much more concentrated, therefore producing sudden frosting.

The last possibility is that the epidermis’ permeability has increased notably for various reasons:

the patient has recently undergone other peelings without notifying you;

the patient has undergone a deep facial treatment before coming to your surgery;

the patient has carried out a skin "exfoliation" using abrasive cream to remove dead skin from the former peeling.

your assistant has cleaned and removed grease from skin too aggressively before the peeling.

the patient regularly uses a cortisone-based cream to slow-down the evolution of a dermatological disease. Cortisone-based creams thin skin and increase its permeability.

What to do?

After the peeling, which should be carried out with great care, apply the post peel Easy TCA cream (mask). When the cream has penetrated, apply a thick layer of Skin Tech Bleaching + Blending cream and let penetrate. When the patient leaves the surgery, he/she should be recommended to avoid the sun completely and apply an F60 sunscreen (at least) in the morning, at around midday and at 3 in the afternoon, regardless of the degree of sunshine. She must also use the Bleaching + Blending cream every night for 3-6 months.