Trichloroacetic acid in vitiligo management: mechanisms, clinical applications, and future directions

Vitiligo presents a therapeutic challenge due to its unpredictable course and limited treatment options for achieving repigmentation. Trichloroacetic acid (TCA), known for its keratolytic and caustic properties, has emerged as a potential adjunctive therapy in vitiligo management. This review explores the role of TCA alongside established treatment modalities, including phototherapy, topical corticosteroids, and surgical interventions. Mechanisms of action, clinical applications, safety considerations, and future research directions are discussed. TCA acts by inducing controlled chemical injury to the epidermis, facilitating exfoliation and stimulating re-epithelialization. It may also enhance melanocyte migration, proliferation, and pigment production. Combining TCA with phototherapy has shown promise in improving repigmentation rates, while adjunctive use with topical corticosteroids may augment treatment efficacy. In surgical interventions, TCA aids in preparing recipient sites and optimizing graft survival. Adverse effects of TCA include hyperpigmentation and scarring, necessitating careful patient selection and monitoring. Future research should focus on optimizing TCA protocols, conducting large-scale clinical trials, and exploring novel therapeutic combinations. Overall, TCA holds potential as a valuable adjunctive therapy in the multifaceted approach to vitiligo treatment, offering hope for improved outcomes in affected individuals.