trichloroacetic acid

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trichloroacetic acid

 [tri-klor″o-ah-se´tik]
a strong acid used as a protein precipitant in clinical chemistry and also as a caustic in chemabrasion and for removing warts.

tri·chlor·o·a·ce·tic ac·id

(trī-klōr'ō-ă-sē'tik as'id),
Agent used as an astringent antiseptic in 1-5% solution or as an escharotic for venereal and other warts; a widely used protein precipitant.

trichloroacetic acid

/tri·chlo·ro·ace·tic ac·id/ (tri-klor″o-ah-se´tik) an extremely caustic acid, used in clinical chemistry to precipitate proteins and applied topically in chemabrasion and to remove warts.

trichloroacetic acid

(trī-klôr′ō-ə-sē′tĭk)
n. Abbr. TCA
A colorless, deliquescent, corrosive, crystalline compound, C2HCl3O2, used as a herbicide and topically as an astringent and antiseptic.

trichloroacetic acid

Dermatology An astringent antiseptic used as a exfoliant for Pts with extensive actinic keratosis

tri·chlor·o·a·ce·tic ac·id

(TCA) (trī-klōr'ō-ă-sē'tik as'id)
Agent used as an astringent antiseptic in 1-5% solution or as an escharotic for venereal and other warts.

trichloroacetic acid

; CCl3COOH caustic, crystalline, self-limiting escharotic used in wart and verruca treatment; saturated solution applied topically to treat small verrucae; three applications of saturated solution alternated with three applications of 75% silver nitrate solution is used as a mild treatment for superficial and mosaic verrucae (see Table 1 and Table 2)
Table 1: Factors that should be considered in the use of chemical cauterizing agents to destroy verrucae
FactorComment
Lesion siteSuperficial lesion, non-weight-bearing skin - use liquid caustics
20% salicylic acid in collodion
Trichloroacetic acid, saturated solution (+75% sliver nitrate)
Deeper lesion, weight-bearing skin, good fibrofatty padding - either liquid or solid caustics
Monochloroacetic acid, saturated solution
40-70% salicylic acid ointment
Number and size of lesionsLarge lesions: ointment-based caustics
40-70% salicylic acid ointment Smaller and satellite lesions: caustic solutions
Alternating layers of trichloroacetic acid, saturated solution and 75% silver nitrate
Skin textureSweaty or hyperhidrotic skin
Padding cannot be retained in situ
Fair skin or atopic individuals; atrophic or dry skin
Tend to overreact/undergo tissue breakdown, to applied caustics
CirculationReduced arterial supply (diabetes, atherosclerosis)
Caustics may cause ulceration or predispose to infection as healing response is depressed (use astringents or mild keratolytics)
Impaired venous or lymphatic drainage (oedematous tissues)
Avoid strong caustics (use astringent agents or mild keratolytics)
NeuropathyImpaired pain awareness (as in diabetic neuropathy)
Do not use caustics (use astringents or mild keratolytics)
AvailabilityStrong acids should not be used unless both practitioner and patient are available for emergency appointments
Caustics may not be treatment of choice if patient cannot return weekly for ongoing treatments (consider a 'one-off' treatment, e.g. cryotherapy)
Opt for self-applied milder, topical ongoing treatments, if in patient's best interests
AgeStrong caustics should be avoided in young patients with a low pain threshold
Caustics that require padding to be retained in situ between treatments may be contraindicated in patients who cannot keep foot dry (e.g. swimmers)
Previous treatmentsIt is pointless continuing with a treatment that has already proved to be ineffective, or has caused an adverse reaction
Single treatmentsVerrucae pedis do not often respond to a single treatment, but methods include:
• Cryotherapy (application of liquid nitrogen, optimally every 3 weeks; ice ball must extend beyond lesion edge; contraindicated in patients with peripheral vascular disease)
• Electrosurgery (peripheral tissues must also be removed in order to clear all virally infected cells; requires local anaesthesia; contraindicated in patients with peripheral vascular disease or those with an indwelling pacemaker)
Alternative treatmentsAlternative treatments may be indicated for cases that have not responded to other forms of treatment: many of these therapies have not been tested by formal research
Thuja tincture: painted on lesion once or twice a day
Kalanchoe leaves: fleshy leaves split open and fleshy pulp left in situ on lesion; changed every 24-48 hours
Tea tree oil: painted on lesion daily, and covered
Banana skin: small piece of banana skin cut to size of lesion and strapped in place, pith side against lesion; changed every 24-48 hours
Table 2: Summary of types of topical verrucae treatments
Treatment typeExamples
Physical therapiesCryosurgery (e.g. liquid nitrogen)
Electrosurgery (fulguration, electrodesiccation and hyfrecation)
Occlusion therapiesCollodion (± active ingredient, e.g. occlusal)
Strapping (duct tape)
Chemical therapiesCaustics, keratolytics, strong astringents
Alternative therapiesThuja (topical tincture or homeopathic 30C pillules)
Banana skin

trichloroacetic acid

an extremely caustic acid, CCl3COOH, used as a topical caustic for local destruction of lesions and as a protein precipitating agent.