Background: Trichloroacetic acid (TCA) is a commonly used chemical method for skin resurfacing and management of dermatologic conditions, including acne scars. Although adverse events associated with TCA are uncommon, improper application may lead to serious complications. This report presents a case of facial chemical burn resulting from unsupervised application of 80% TCA for acne scar treatment.
Case Presentation: We describe a 20-year-old woman with Fitzpatrick skin phototype IV and atrophic acne scars who was considered a candidate for TCA CROSS treatment. However, she had self-administered an 80% trichloroacetic acid solution topically at home in an attempt to improve her acne scars. She presented with marked frosting and a severe burning sensation consistent with chemical injury. The patient was treated with oral prednisolone, betamethasone lotion, alpha ointment and zinc oxide ointment. After one week, nightly Kligman's formula in combination with sunscreen was initiated. Platelet-rich plasma (PRP) therapy was administered weekly for four weeks, followed by platelet-rich fibrin (PRF) dressing in week 6, PRF injection in week 7, and another PRF dressing in week 8.
Conclusion: This case, along with similar evidence in the literature, clearly demonstrates the potentially dangerous and occasionally irreversible consequences of unsupervised application of high-concentration chemical peeling agents such as TCA (50%–80%). Successful management of this complex chemical burn was achieved through a multimodal stepwise protocol, including acute inflammatory control, prevention of infection, targeted management of post-inflammatory hyperpigmentation, and early sequential application of biologic regenerative therapies (PRP and PRF), ultimately resulting in acceptable clinical improvement and tissue restoration.