Actinic keratoses and lentigines

Keratoses and lentigines need relatively deep treatment, but it is not essential to give the whole face a deep treatment when there are only a limited number of lesions a local application of Only Touch is enough in this case. 

Using a 1 cm syringe, the required quantity of 80% m/m TCA is drawn up and injected into the bottle of OT base solution. It should be remembered that 80% m/m means 80 g of TCA crystals with an added 20 g of distilled water. 

After making up the OT solution, between 0.2 and 0.5 cm (the amount depends on the number of lesions to be treated) are drawn up. This solution is put in a small glass or ceramic bowl (under no circumstances should a metal container be used). A cotton bud is then soaked in this solution and partly squeezed out to make sure that 

Solar lentigines (a) before and (b) after treatment with a combination of OT and Easy TCA . 

The product should be tested on a small area of skin before the first application. OT is applied with a cotton bud or, for very small lesions, with a wooden pick soaked in the solution. Great care should be taken to avoid any runs or drips of excess solution. Half a millimeter is usually enough for an application on both hands and forearms. 

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Photoaging, actinic keratoses and lentigines. (a) Before and (b) after a peel to the papillary dermis with TCA (Unideep ) and phenol (Lip Eyelid formula) around the mouth and on the large lentigo on the left temple only, (c) Before and (d) on the 6th day after the peel. For more details, see Chapter 23. 

Epidermal growths such as actinic keratosis, lentigines or thin seborrheic keratoses can all be treated effectively with 25-35% TCA peels. Thicker epidermal growths or growths involving the dermis will be more resistant to treatment such as hypertrophic actinic keratoses and thicker seborrheic keratoses and may even be resistant to a medium-depth peel. Resistant lesions many times are best treated with a combination of a medium-depth chemical peel and other modalities such as manual dermasanding or CO, laser. 

Lentiginosis and photoaging, (a) Before treatment, there are about 40 lentigines and/or actinic keratoses, (b) After four sessions of Easy TCA peels to the Grenz zone, there are only about 10 lentigines/keratoses left. The signs of photoaging are visibly reduced fine lines, quality of the skin, improved eyelid tension, etc. 

OT is used to treat localized and benign solar lentigines (SLs) and/or actinic keratoses (AKs) in patients with skin phototypes I to III, or sometimes IV (Figures 22.2-22.4). 

Actinic keratoses can be selectively treated with either TCA (30%) or pyruvic acid (50-60%). In melasma, pyruvic acid can be utilized in combination with 40% salicylic acid alone or with 30% salicylic acid -I- TCA 10% gel. Pyruvic acid peels can also be used in post-inflammatory hyperpigmentation and solar lentigines. 

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