Comparison between 5% imiquimod cream and Jessner’s solution with 35% trichloroacetic acid chemical peel in the treatment of the facial field cancerization

INTRODUCTION: Cutaneous squamous cell carcinoma may originate from premalignant lesions, with actinic keratosis (AK) being the most frequent. The field cancerization is defined as an area of apparently healthy skin, but with important photodamage around the AK lesions. In this study, we compared imiquimod, an immunomodulator , to a medium-strength chemical peel, with Jessner’s solution combined with 35% trichloroacetic acid.
OBJECTIVE: To compare the efficacy/ acceptability of the two methods in treating the facial field cancerization.
METHODS: Ten patients who underwent the two forms of treatment were selected: in one hemiface, they used 5% imiquimod cream three times a week for 4 weeks; in the other, they applied the medium-strength chemical peel, with Jessner’s solution combined with 35% trichloroacetic acid. Patients were evaluated 30 days after the end of the treatment by counting the AKs and recording the degree of patient satisfaction and the adverse effects with both treatment modalities.
RESULTS: Treatment with imiquimod led to the resolution of 51.8% of the AKs and melanoses together and 72.8% when only the AKs were evaluated. Peeling treated 74.9% of AKs and melanoses and 79.1% of AKs. All patients felt satisfied at some level with both forms of treatment, with greater satisfaction with the chemical peel.
CONCLUSION: Both modalities were effective, but the chemical peel was more efficient and easier to apply, however, with more intense adverse effects

Keywords: Skin, cancer; Keratosis, actinic; Chemexfoliation