Translate this page into:
Trichloroacetic acid cautery is a simple procedure for repigmenting residual small-sized vitiligo lesions
*Corresponding author: Muhammed Mukhtar, Department of Dermatology, Mukhtar Skin Centre, Katihar, Bihar, India. drmmukhtar20@gmail.com
-
Received: ,
Accepted: ,
How to cite this article: Mukhtar M. Trichloroacetic acid cautery is a simple procedure for repigmenting residual small-sized vitiligo lesions. CosmoDerma. 2025;5:110. doi: 10.25259/CSDM_82_2025
PROBLEM
There are numerous medicinal and surgical therapies for vitiligo. Despite good medical therapy, there is a high frequency of vitiligo with few residual lesions. Surgical solutions for these remaining lesions exist, but they require facilities, personnel, and time, as well as being somewhat expensive. Cautery of the lesion to repigment the vitiligo is an old way of therapy that is now employed because to its simplicity and success.[1-3] We used this therapy on small residual vitiligo lesions.
SOLUTION
We recommend trichloroacetic acid (TCA 100%) for non-acral minor (<1 cm) persistent lesions more than a year after medicinal treatment. Under aseptic conditions, mupirocin is applied to the periphery of the lesions, followed by TCA until the lesions and their margins are frosted [Figure 1a-c]. Following that, the sites are mopped with ointment. If there is a burning feeling, the place is cleaned with a water-soaked gauze piece. An occlusive dressing is then applied to the location using transparent adhesive tape. Following that, patients are examined at 2-week intervals for a period of 3 months. After 2 weeks, the lesion is exposed to sunlight, and a moisturizing lotion is applied. If there is still a lack of pigmentation after 4 weeks, TCA cautery is repeated over the non-pigmented areas of the lesions. Smaller lesions repigmented from the periphery 6–8 weeks after cautery [Figure 1d]. If larger, we must perform successive or sequential cautery at the edges because it is repigmenting due to overproduction and melanin dispersion or migration in the depigmented epidermis from the pigmented border [Figure 2a and b]. Two tiny vitiliginous spots on the dorsum of the feet are treated with the cautery [Figure 3a and b]. We successfully treated three patients (10–25 years old, all female, with lesions on the neck and dorsum of the foot lasting more than a year) with few residual lesions, without experiencing any notable side effects. Thus, TCA cautery can be a suitable, cost-effective, rapid, non-surgical choice for repigmenting tiny lesions in a busy or satellite clinic with limited time, staff, and equipment. Except for the prevention of infection and dryness, no special training or ability is required for this approach.
- (a) A tiny residual vitiligo lesion on the neck, (b) an ointment is applied on the boundary of the lesions to avoid the spillage of trichloroacetic acid (TCA), (c) the lesions and their margin are cauterized, and (d) the almost repigmented lesion after 8 weeks of TCA cautery.
- (a) An elongated lesion of vitiligo on the neck before cautery, (b) the partially pigmented lesion after 4 weeks of cautery.
- (a) Two small vitiligo lesions over the dorsum of the feet before trichloroacetic acid cautery, (b) the lesions got almost repigmented after 8 weeks.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
References
- Trichloroacetic acid cautery for repigmenting nonresponsive vitiligo on lips. J Cutan Aesthet Surg. 2023;16:15-55.
- [CrossRef] [PubMed] [Google Scholar]
- Effect of different types of therapeutic trauma on vitiligo lesions. Dermatol Ther. 2017;30:e12447.
- [CrossRef] [PubMed] [Google Scholar]
- Trichloroacetic acid in different concentrations: A promising treatment modality for vitiligo. Dermatol Surg. 2021;7:e53-7.
- [CrossRef] [PubMed] [Google Scholar]