Recently, focal chemical peels with
trichloroacetic acid (TCA) have been introduced for the treatment of pigmentary disorders to minimize the side effects such as
pain or
scarring associated with medium-to-deep chemical peeling. This is a controlled, prospective study to compare the efficacy of a focal medium-depth chemical peel regimen using 70%
glycolic acid and 35% TCA with
cryosurgery, in the treatment of solar
lentigines of the hands. Twenty-five patients were treated with either focal medium-depth chemical peel or
cryosurgery, which was randomly assigned to the left or right hand. Clinical improvement was graded by the three blinded investigators 2-months after the treatment. In the focal medium-depth chemical peel treated side, clearing was achieved in four out of 23 patients (17.4%) compared with five out of 23 patients (21.7%) in the
cryosurgery treated side. Statistically, the difference between the clinical improvement of solar
lentigines with chemical peel and
cryosurgery was not significant, according to chi-square test (p = 0.940). However, we suggest that treatment of the solar
lentigines with a focal medium-depth chemical peel may be clinically superior to treatment with
cryosurgery, due to the paucity of side effects, such as
hypopigmentation and
pain, associated with the chemical peel regimen.