title: Manual resurfacing and trichloroacetic acid for the treatment of patients with widespread actinic damage. Clinical and histologic observations.
abstract: BACKGROUND
  A facial resurfacing regimen combining manual abrasion of the skin and 25% trichloroacetic acid has been reported to produce excellent results, but the histologic depth of injury produced by this technique has not been studied.
  
  
  OBJECTIVE
  To describe our experience with this technique treating patients with extensive actinic damage and to determine the histologic depth of injury produced.
  
  
  METHODS
  We treated 40 patients using manual resurfacing and trichloroacetic acid, primarily for widespread actinic keratoses. Resurfacing tools included silicone carbide sandpaper, drywall screen, electrocautery tip cleaners, abrasive pads, scalpel blades, and curettes. Four patients underwent sequential biopsies to evaluate the depth of wounding using this technique.
  
  
  RESULTS
  Manual resurfacing combined with trichloroacetic acid consistently produced excellent cosmetic results and nearly complete eradication of actinic keratoses. Histologically, treated areas showed replacement of the dermal elastotic band by newly formed collagen, a significantly deeper level of wounding than the Jessner's/35% trichloroacetic acid peel. There was no evidence for foreign body granulomas clinically or histologically as a result of the abrasive materials.
  
  
  CONCLUSIONS
  The deeper level of this peel explains the improved cosmetic outcome and greater eradication of actinic keratoses. This treatment is particularly well suited for patients with extensive photodamage and widespread actinic keratoses.
authors.affiliation: Department of Dermatology, University of Maryland School of Medicine, Baltimore, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Cooley
authors.forename: D L
authors.initials: DL
authors.lastname: Casey
authors.forename: C L
authors.initials: CL
authors.lastname: Kauffman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002244:Carbon; D017554:Carbon Compounds, Inorganic; D002615:Chemexfoliation; D003094:Collagen; D003475:Curettage / Q000295:instrumentation; D003869:Dermabrasion / Q000295:instrumentation; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004547:Elastic Tissue / Q000473:pathology; D004564:Electrocoagulation / Q000295:instrumentation; D004954:Esthetics; D005148:Facial Dermatoses / Q000473:pathology / Q000601:surgery; D015745:Granuloma, Foreign-Body / Q000473:pathology; D006801:Humans; D007642:Keratosis / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017655:Silicon Compounds; D012867:Skin / Q000473:pathology; D015595:Skin Aging / Q000473:pathology; D016896:Treatment Outcome; D014238:Trichloroacetic Acid / Q000627:therapeutic use*
chemical_list: D017554:Carbon Compounds, Inorganic; D003879:Dermatologic Agents; D017655:Silicon Compounds; D014238:Trichloroacetic Acid; D002244:Carbon; D003094:Collagen; C022088:silicon carbide