Are these PIH spots or are they early stage scabs? (Photos)

Question

They have no texture, some have a little texture. I used a 30% TCA peel to do the cross method last night and woke up to this, I definitely frosted, I removed the tca then applied neosporin, please help, I’m worried that these are going to stay dark spots, it looks worse now, I’m trying to fill in my icepick scars

Nelson Lee Novick, MD · Answer

TCA is a potent acid that has been used successfully in variation concentrations for a variety of medical and aesthetic reasons for many decades. I have been personally been performing TCA CROSS for successfully treating dilated pores, ice pick scars and very narrow-base boxcar scars--its primary indications--over twenty years, using 100% TCA, its most potent form. Properly performed TCA CROSS is "color blind," meaning that it may be safely used in all skin types including deeply pigmented African-American skin. When done properly, only a very narrow collarette of frost should be seen on the surface of the skin immediately following treatment. .But this is not a procedure that should be performed at home, even with lower strengths, as in this case. From what I can see, too much acid got applied to the normal skin around the scars, which resulted in what appears to be postinflammatory hyperpigmentation, a complication that may be more prolonged and persistent in skin of color. You would do well to see a board certified aesthetic dermatologist asap, so that appropriate therapy can be initiated to deal with and mitigate this issue.  Let this also serve as a word to the wise among any readers of this column that self-treatment can be risky and may end up more costly in attempting to fix things than seeking appropriate professional care would have been in the first place. Best of luck.

Jason Emer, MD · Answer

Thank you for your question. I recommend that you get a formal evaluation with a Cosmetic Dermatologist. This type of treatment should be performed by a Medical Professional with years of experience. Best Dr. Emer

Connie Hiers, MD, FACS · Answer

Thank you for your questions and pictures. Although i can not fully determine if the spots are indeed PIH  or the onset of scabs. I would advice you to be very careful on TCA treatments in the future. TCA is a great treatment for hyper pigmentation, but if used incorrectly can have the opposite effect. For treatment of acne scars i would advise that you look into something called PRP with Micro-needling. PRP ( platelet rich plasma) is separated from the blood by a centrifuge and then applied topically to the dermis like a serum. Immediately after applied, a microneedling facial is performed to drive the PRP deep into the skin. Microneedling facials are greatly beneficial in reducing pore size, redness, fine lines, wrinkles, and treating acne scarring and other skin texture irregularities.Consult with a board certified plastic surgeon that has this form of treatment in their office.

Davin Lim, MBBS, FACD - Account Suspended · Answer

This is due to protein coagulation after the TCA paint/ peel. Given the sheer extent and spillage, this is no way a focal CROSS procedure. 98% chance you will PIH over the coming months. SPF and banal dressings / ointment can reduce the duration of PIH. The one thing I do not know is what scars you were attempting to target (ice pick I know but the exact morphology is unknown). Additionally we do not know of the layers or coats of TCA you used. Hopefully this procedure did not convert focal ice pick scars to broad pox scars or even fibrotic saucer scars. Above all, please, please be careful. Dr Davin S. Lim. Brisbane. Australia.

Are these PIH spots or are they early stage scabs? (Photos)

Answers (4)

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Answers (4)

More TCA Peel Questions

Ten days ago, I used 100% TCA chemical peel on my nose. It has a crater on the top. Does it look like it will scar? (Photos)

Can I use Glycolic Acid instead of TCA for my acne scars?

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