Real-World Safety and Efficacy of Cosmo Peel 18% & 20% (TCA Medium Chemical Peels): Results from a Retrospective Clinical Study.

A retrospective real-world study confirming the safety and efficacy of medium TCA peels across a broad range of skin indications.

Cosmo Peel 18% and Cosmo Peel 20% are medium chemical peels formulated with trichloroacetic acid (TCA), classified as class IIa medical devices in France. A retrospective clinical study was conducted to evaluate their real-world performance and safety across a range of skin indications in 20 patients treated at two investigational sites between December 2020 and December 2023. Efficacy was assessed using the Investigator's Global Assessment (IGA) scale.

Both peels demonstrated clinically significant improvements in pigmentary disorders, particularly solar and senile lentigines, as well as in skin texture parameters including rough skin, skin irregularities, and smoker's complexion. No serious adverse events were observed. These findings support the favorable safety and efficacy profile of Cosmo Peel 18% and 20%, and their use as customizable, practitioner-led treatments adapted to individual patient needs.

Background

Trichloroacetic acid (TCA) has long been established as a reliable keratolytic agent in dermatological practice. By penetrating the superficial layers of the skin, TCA induces controlled exfoliation and promotes cellular renewal, making it a recognized option for treating a variety of pigmentary and textural skin conditions.

Cosmo Peel 18% and Cosmo Peel 20% are medium chemical peels developed by Dermaceutic (Dermosciences France), formulated respectively with 18% and 20% TCA. Manufactured in France under ISO 13485 quality standards, both products are specifically designed to treat solar lentigines, senile lentigines, pigmented lesions, elastosis, wrinkles, mild sagging skin, rough skin, smoker's complexion, and skin irregularities. They are performed as part of a full treatment with several peel sessions.

In alignment with Dermaceutic's ongoing commitment to advancing non-invasive dermatological solutions and improving patient care, this retrospective clinical study was conducted as part of the company's post-market surveillance plan for these medical devices. By sharing real-world clinical outcomes, Dermaceutic continues to support evidence-based skincare practices and the safe and effective use of these medical devices.

Objective

The primary objective of this study was to describe the safety and performance of Cosmo Peel 18% and Cosmo Peel 20% in patients treated in routine clinical practice. The study contributes to advancing knowledge about superficial to medium chemical peels as an alternative treatment for skin abnormalities.

This clinical study is registered in the French public registry, Health Data Hub, under the title: "Étude en vie réelle des conditions d'utilisation, de l'efficacité et de la tolérance du Cosmo Peel 18% et 20%".

Materials & Methods

• Study Design
  This was a retrospective, observational study carried out in France using historical data from patients previously treated with Cosmo Peel 18% and/or 20%. Data were collected from two investigational sites between December 2020 and December 2023.
• Patient Population
  Twenty (20) patients were included in this analysis. The collected data covered patient demographics, skin phototypes, skin indications, reported adverse events, and follow-up assessments.
• Efficacy Assessment
  Treatment efficacy was evaluated by comparing the severity of each indication before and after the procedure, using the Investigator's Global Assessment (IGA) scale as the reference measure. Negative variation values indicate clinical improvement.
• Safety Assessment
  Safety was assessed by comparing observed adverse events with skin reactions commonly reported in scientific literature for TCA-based chemical peels.
• Data Analysis
  Data were recorded and analyzed using EasyMedStat software.

Patient demographics

Variable	N	Mean (SD)
Average age (range: 29–80 years)	20	54.45 (14.44)
Treated with Cosmo Peel 18% (range: 29–80 years)	9	54.64 (17.06)
Treated with Cosmo Peel 20% (range: 32–69 years)	11	55.30 (11.93)

Sex: 95% female (n=19/20), 5% male (n=1/20).

Fitzpatrick Phototype Distribution:

Phototype	N (%)
I	1 (5%)
II	6 (30%)
III	12 (60%)
IV	1 (5%)

 

Conditions of Use

1. 90% of patients were treated on the full-face area; 5% on the craniofacial area; 5% on the cheeks area.

2. 100% of participants were treated for a minimum of two skin indications simultaneously, reflecting real-world multi-indication clinical practice.

3. Each product was used for a minimum of two sessions.

Associated Dermaceutic Protocol

Protocol steps / Dermaceutic Products

• Pre-treatment: Turn Over, Sun Ceutic 50+, Foamer 5, K Ceutic
• Treatment: Cosmo Peel 18% (at least 2 sessions) / Cosmo Peel 20% (at least 2 sessions)
• Post-treatment: K Ceutic, Sun Ceutic 50+.

Results

Efficacy

Cosmo Peel 18% and 20% demonstrated overall clinical improvement across several skin conditions. The most pronounced effects were observed in pigmentary disorders, particularly solar and senile lentigines. Improvements were also noted in skin texture parameters, including rough skin, skin irregularities, and smoker's complexion. Cosmo Peel 20% showed slightly greater efficacy across several indications, suggesting a concentration-dependent effect. No significant improvement was observed for wrinkles, indicating limited impact on deeper structural signs of aging.

Table 1. Average variation of severity grade (IGA scale) after treatment. Negative values indicate improvement.

Skin Condition	Cosmo Peel 18%	Cosmo Peel 20%	Combined 18% & 20%
Solar Lentigines	-1.17	-1.50	-1.36
Senile Lentigines	-1.20	-1.80	-1.50
Pigmented Lesions	-1.00	No value*	-1.00
Elastosis	-0.40	-1.00	-1.00
Skin Irregularities	-1.14	-1.00	-1.07
Rough Skin	-1.00	-1.50	-1.33
Smoker's Complexion	-2.00	-1.50	-1.67

 

* None of the patients in this panel were treated with 20% TCA for pigmented lesions.

Safety
No serious adverse events related to the treatment were observed. One unexpected but transient event, temporary wrinkling of the facial skin following TCA 18% was observed, without affecting the overall safety assessment.

Expected adverse events consistent with the known profile of TCA-based chemical peels included:

• Erythema
• Burning sensation
• Itching
• White frosting (during peel application)
• Desquamation (part of the normal healing process, typically resolving within 72 hours)

Discussion

Strongest impact on pigmentation
Solar and senile lentigines showed the most pronounced improvements, consistent with the primary indications for which these peels are designed. These results align with the well-documented ability of TCA to target superficial pigmentary disorders through controlled keratolysis and epidermal renewal.

Meaningful texture improvements
Rough skin, skin irregularities, and smoker's complexion all responded well, including some of the largest IGA reductions observed in the study. This highlights the broader utility of Cosmo Peel 18% and 20% beyond pigmentation alone.

Concentration-dependent effect
Cosmo Peel 20% consistently delivered slightly greater efficacy compared to Cosmo Peel 18% across several indications. This concentration-dependent effect gives practitioners the ability to tailor treatment intensity to individual patient needs and clinical profiles.

Customizable to each patient
Every patient was treated for at least two indications simultaneously, reflecting the multi-indication clinical reality in which these peels are used. This underscores the versatility of Cosmo Peel 18% and 20% within comprehensive treatment plans.

Conclusion

Cosmo Peel 18% & 20% demonstrate clinically significant improvements in pigmentary lesions, elastosis, and overall skin quality, with excellent tolerability. The availability of two concentrations allows practitioners to precisely tailor treatment intensity and provide a personalized approach to each patient’s needs.

Authors & Affiliations

Rana Mteirek (Ph.D)¹ | Achraf Ettaqi¹ | Ancra Debu (MD)² | Marie Hélène Vassal (MD)³ | Nicola Fagiuoli¹
¹ Dermosciences France, 15 chemin des presses, Cagnes sur Mer, France — Legal manufacturer of Cosmo Peel 18% and 20%.
² Antibes, France
³ Perpignan, France

This study was conducted as part of Dermaceutic's post-market surveillance plan and is registered in the French public registry, Health Data Hub.