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Atlanta — The Cook body peel facilitates a predictable, controlled peel despite the use of up to twice as much trichloroacetic acid (TCA) as conventional body peels.
Atlanta - The Cook body peel facilitates a predictable, controlled peel despite the use of up to twice as much trichloroacetic acid (TCA) as conventional body peels.
"The main difference between other body peels and this one is the use of glycolic acid gel, which prevents the penetration of the TCA," says Sue Ellen Cox, M.D., clinical assistant professor at the University of North Carolina, Chapel Hill, department of dermatology.
The Cook body peel comprises application of a 70 percent glycolic acid gel to the skin followed by a 40 percent TCA preparation.1
"Usually when we do other body peels that rely on TCA alone, we don't use above a 20 percent or 25 percent application of TCA," Dr. Cox tells Dermatology Times.
Dr. Cox discussed the topic of body peels at the recent annual meeting of the American Society of Dermatologic Surgery, here.
The method provides consistently good results on the skin of the neck, chest, arms, hands, back and other non-facial skin, according to Dr. Cox.
"The beauty of the Cook peel is that the thick coat of this glycolic gel impairs the penetration of the acid and you can actually neutralize it when you've gotten your desired endpoints so it's a really controlled predictable peel."
With the glycolic acid gel as a barrier, the TCA slowly penetrates through the gel and into the skin. The desired endpoint is a white speckling of the skin. Once this occurs, it should be neutralized vigorously with sodium bicarbonate.
"At this point, it will sizzle or bubble and then it stops the reaction completely."
The peel takes approximately 10 to 15 minutes. Prior to the application of gel, the portion of the body receiving the peel should be scrubbed with acetone.
"You can use either 35 percent or 40 percent glycolic acid gel. I recommend 40 percent because I get a better result with that," Dr. Cox says.
"In the past, we used a lot of peels where we were just using the TCA by itself in lower concentrations and we would get a lot of 'hot spots' or areas that would pick up the acids more quickly and get more penetration," Dr. Cox says.
Indications for the Cook body peel include precancers, lentigines and photodamage in general.
"I find it particularly effective in cases of DSAP, which is disseminated superficial actinic porokeratosis, which can be very difficult to treat and can sometimes stump the most diligent dermatologists," Dr. Cox says.
This peel also works well on blending adjacent resurfaced skin such as when someone has a laser peel on the face and the face has become lighter than the neck and on fragile skin to help thicken skin that bruises easily, Dr. Cox points out.
Frequency for best results
Kim Cook, M.D., who developed the peel, recommends monthly treatments repeated as needed, though Dr. Cox says she's had success in the majority of cases with a single Cook body peel.
"The only exception to that would be in cases of DSAP, which required two peels to get my best results. I spaced them about one month apart," she says.
There are no specific contraindications for the Cook body peel. However, Dr. Cox points out that it shouldn't be used in the presence of active infection or on someone who has had significant amounts of radiation exposure because they might not be able to re-epithelialize as easily as the average patient.
It is possible, though not likely, to get hypopigmentation if it penetrates too deeply in some areas.