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Naomi Lawrence, MD; Sue Ellen Cox, MD; Clay J. Cockerell, MD; Robert G. Freeman, MD; Ponciano D. Cruz, Jr, MD

Arch Dermatol. 1995;131(2):176-181.

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)

Author Affiliations
From the Department of Dermatology, University of Texas Southwestern Medical Center, Dallas. Dr Lawrence is now with the Department of Medicine, Division of Dermatology, Cooper Hospital, University of Medicine and Dentistry of New Jersey, Camden.

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