الفهرس 
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Abstract
Summary
Solar lentigines are local and benign proliferation of melanocytes which is common in old individuals and creates a major concern considering beauty.
Cryotherapy and Trichloroacetic Acid (TCA) are accessible and cost effective treatments and have shown good results in treating solar lentigines. However, contradictory results have been obtained regarding effects of TCA peeling and its comparison with other treatments for solar lentigines.
Cryopeeling is performed by applying the freezing substance with movements of a brush along the length of the forearm until whitening of the skin. To our knowledge this is the first study to present the potential use of the cryopeeling technique in treating solar lentigines, no previous studies have been reported on treatment of solar lentigines with cryopeeling.
The present study was designed to compare the efficacy and safety of TCA 35% and cryopeeling in the treatment of solar lentigines and to assess their histopathological and immunohistochemical effects on the number and distribution of LCs.
The study was performed on 25 individuals with solar lentigines on their hands. The right side was treated with TCA 35%, and the left hand was treated with cryopeeling. The treatment was repeated after three weeks. Both sides were compared regarding the degree of the improvement (lightening) of the lesions, patients satisfaction and the resultant side effects 3 weeks after the second session.
Punch biopsies (3mm) were taken from skin lesions before and 3 weeks after 1st treatment session (after complete re-epithelization) from each side from 15 patients. Histopathological examination and Immunohisto-chemical staining for CD1a was done to investigate the number of epidermal LCs before and after the two treatment modalities.
Cryopeeling was superior to TCA 35% peeling in treatment of solar lentigines; significant reduction in the number of lesions was evident from the first session of cryopeeling, in contrast to TCA peeling in which significant reduction of lesion number was detected only after the second session. In addition, the decrease in the number of lesions was significantly greater in the cryopeeling treated side compared to TCA treated side after the final treatment.
Moreover, considerable lightening (more than 50% improvement) was achieved after two sessions in 68% of cases on the cryopeeling treated hand and in 44% on the hand treated with TCA 35%. More than 75% improvement was obtained in 48% of patients (the lesions were almost clear in 20% of patients and excellent response was obtained in 28% of patients) on cryopeeling side, while on the TCA side none of the patients had almost clear lesions and excellent response was obtained in 16% of patients only.
More side effects were reported with cryopeeling including severe pain, blistering, hypopigmentation and hyperpigmentation. While after TCA treatment only hyperpigmentation was observed.
On histological examination, we demonstrated that both modalities decreased pigment intensity which was more marked with cryopeeling. Decreased elongation of rete ridges was also noticed after both treatments.
Cryopeeling did not significantiy affect the number of LCs, where the number of LCs remained at about the pre treatment number. On the contrary, TCA peeling significantly influenced the number of LCs which was significantly reduced after TCA peeling.
Conclusion
• Cryopeeling is superior to TCA peeling in treating solar lentigines as it showed better clinical response and higher patient’s satisfaction.
• It seems that cryopeeling is efficient, affordable, and easy to apply.
• Although cryopeeling has better results compared with TCA, it is more painful and takes longer to heal with some side effects. However, cryopeeling technique seems to improve the results of cryotherapy and reduce the rates of side effects
• TCA peeling seems to exert some inhibitory effect on skin immune system via reduction in LCs number.