Medically reviewed by Deborah Lenchus, MSN, APRN · Last reviewed August 2026
The most common question we get about PRX is some version of the same thing: “So it’s a peel, right?” It is a fair assumption. The main active ingredient is trichloroacetic acid (TCA), which is the same acid used in classic medium-depth chemical peels. But the way PRX is formulated and applied is designed to do something different — and understanding that difference is the key to understanding why there are three PRX formulas and which one might suit your skin.
The short answer: why PRX is not a chemical peel
A chemical peel works by controlled injury to the epidermis. The acid denatures (precipitates) surface proteins, the treated layer dies, and it sheds over the following days. The visible peeling is not a side effect — it is the mechanism. New skin surfaces underneath.
PRX is formulated to reach the dermis without destroying the epidermis on the way through. In PRX Derm Perfexion, the TCA is buffered by hydrogen peroxide. Published work describes it this way: the action of TCA on the epidermis is partially neutralized by the hydrogen peroxide, while the remaining hydrogen ions move into the dermis, where they promote cell proliferation and new collagen formation (Gold et al., J Clin Aesthet Dermatol, 2022). The stimulus is dermal; the epidermis is left largely intact.
That is the practical difference patients notice. In the 2022 study, subjects treated with the TCA-peroxide formula did not develop the white frosting and subsequent shedding of epidermal layers seen with traditional TCA peels, and investigator-rated peeling scores stayed at zero at every visit. A conventional TCA peel at 35–50% is classified as a medium-depth peel that penetrates to roughly 450 microns and is expected to frost and flake.
So: same acid family, different job. A peel resurfaces from the top down. PRX is best described as a biorevitalization or topical dermal stimulation treatment — it works from the dermis outward.
What the research actually shows — and its limits
We want to be straightforward about the evidence, because it matters.
The main published clinical study on PRX Derm Perfexion (Gold, Wilson & Biron, 2022) was a single-center, open-label pilot with five subjects, all women aged 49 to 72 with Fitzpatrick skin types II and III and mild-to-moderate wrinkling. Each had four treatments at one-week intervals plus daily home care. Investigator assessments improved significantly from baseline for skin tone, smoothness, texture, redness and overall appearance. Radiance improved but did not reach statistical significance, and the Glogau photoaging grade did not change significantly. No adverse events were observed; side effects were limited to transient tingling and mild erythema.
The honest caveats: five subjects is a very small sample, there was no control group, follow-up was 51 days, the study was funded by the manufacturer, and enrollment was limited to lighter skin types (Fitzpatrick II–III). The authors themselves called for larger, controlled studies with longer follow-up. The manufacturer markets PRX as suitable across skin types and tones; the published data in richer skin tones is limited, so candidacy is something to discuss individually rather than assume.
For PRX-PLUS, a 2026 pilot study of 15 women combined PRX-PLUS with microneedling over three sessions at 21-day intervals and reported improvements across several imaging-based skin-quality measures. Again: small, single-arm, pilot-level evidence.
Bottom line — the mechanism is well described and the early clinical signal is favorable, but this is not a large randomized trial literature. Individual results vary.
The three PRX formulas, side by side
All three are applied the same way — massaged into cleansed skin in the office, with no needles, no injections and no laser energy. What changes is the active chemistry, and therefore what each one is best aimed at.
PRX Derm Perfexion — the original
Formulation: 33% TCA, hydrogen peroxide and kojic acid. This is the globally patented TCA-plus-hydrogen-peroxide combination, developed by Italian dermatologist Dr. Rossana Castellana.
Best aimed at: general revitalization — the appearance of firmness, elasticity and hydration, fine lines and early signs of aging. This is the formula with the published clinical study behind it and the one most people start with.
The kojic acid piece: kojic acid is a tyrosinase inhibitor, so it contributes a mild brightening effect alongside the dermal stimulation.
PRX-PLUS — more correction, more brightening
Formulation: homocysteic acid, ammonium trichloroacetate (ATCA), plus citric and phytic acid. Note what is not in it: no free TCA and no hydrogen peroxide. ATCA is the ammonium salt of trichloroacetic acid, and the manufacturer describes PRX-PLUS as the first aesthetic treatment with a global patent built on a homocysteic acid formulation.
Best aimed at: mature or textured skin with more visible aging — the appearance of deeper wrinkles, enlarged pores and uneven pigment. It is the more corrective of the three.
PRX C — radiance and antioxidant support
Formulation: vitamin C as 3-O-ethyl ascorbic acid, ammonium trichloroacetate, homocysteic acid, plus citric and phytic acid.
Best aimed at: skin that reads dull, gray or environmentally stressed — where the goal is luminosity and resilience rather than wrinkle correction. 3-O-ethyl ascorbic acid is a stabilized vitamin C derivative, which matters because plain ascorbic acid is notoriously unstable in solution.
The three are not a hierarchy — PRX C is not “better” than Derm Perfexion. They are aimed at different complaints, and they can be alternated within a series depending on what your skin needs.
Quick comparison
| PRX Derm Perfexion | PRX-PLUS | PRX C | |
|---|---|---|---|
| Key actives | 33% TCA, hydrogen peroxide, kojic acid | Homocysteic acid, ammonium trichloroacetate, citric & phytic acid | Vitamin C (3-O-ethyl ascorbic acid), ammonium trichloroacetate, homocysteic acid, citric & phytic acid |
| Aimed at | Firmness, elasticity, hydration, fine lines | Deeper wrinkles, pores, uneven pigment, textured or mature skin | Dullness, gray tone, environmentally stressed skin |
| Published clinical study | Yes — small open-label pilot (2022) | Small pilot in combination with microneedling (2026) | No published clinical study located |
Where PRX fits with the rest of what we do
Because PRX does not remove the epidermis, it layers into a plan differently than a peel does.
- Alongside chemical peels: these are complementary, not interchangeable. A peel addresses the surface — texture, superficial pigment, congestion. PRX works underneath. Some patients rotate between them across a year; they are generally not done on the same day.
- With RF microneedling or DP4 microneedling: different collagen pathways — mechanical and thermal injury versus topical dermal stimulation. The 2026 pilot study looked specifically at PRX-PLUS with microneedling.
- Before or between Erbium or CO2 resurfacing: PRX is often used to condition skin in the run-up to a resurfacing laser, or to maintain results between them.
- As part of collagen banking: PRX is one of the lower-downtime ways to keep a collagen-stimulating stimulus in rotation.
Sequencing depends on your skin and your calendar. That is a consultation conversation, not a formula.
What a PRX appointment involves
The skin is cleansed thoroughly, the solution is massaged in layer by layer, then rinsed and moisturized. Most appointments run about 15 to 30 minutes. A typical starting course is four treatments spaced roughly a week apart, with home care in between — the at-home products were part of the published protocol, not an upsell, and they matter to the result.
Most people go back to normal activity the same day. Some tightness, mild redness, or light flaking for a day or two is possible. Daily sunscreen is part of the plan.
Who should not have PRX
PRX is not appropriate if you are pregnant or breastfeeding, have active infection, open wounds, or inflamed skin in the treatment area, have a known sensitivity to any component of the formula, or have recently used isotretinoin. Active or unstable melasma, a history of keloid scarring, and recent resurfacing or injectable treatment in the area all need to be reviewed before treatment. Deborah takes a full health history at consultation and will say plainly if PRX is not the right choice for your skin.
Frequently asked questions
Is PRX a chemical peel?
No. It contains an acid used in peels, but it is formulated so the epidermis is not destroyed and does not shed. A peel works by removing the surface layer; PRX is designed to stimulate the dermis while leaving the surface intact.
Will I peel or flake after PRX?
Usually not in the way you would after a peel. In the published study, investigator-rated peeling was zero at every visit. Some patients still notice mild tightness or light flaking for a day or two. Individual responses vary.
What is the difference between PRX Derm Perfexion, PRX-PLUS and PRX C?
Derm Perfexion uses 33% TCA with hydrogen peroxide and kojic acid and is the general-revitalization formula. PRX-PLUS uses homocysteic acid and ammonium trichloroacetate and is aimed at more textured or mature skin with pigment concerns. PRX C adds stabilized vitamin C and targets dullness and radiance.
How many PRX treatments will I need?
A common starting course is four treatments about a week apart, then maintenance. The right number depends on your skin and your goal, and is decided at consultation.
Does PRX hurt?
There are no needles. Most people describe a warm or tingling sensation during the massage. In the published study, patient-reported stinging, tingling, itching and burning scores were low throughout.
Can PRX be done in the summer in Florida?
PRX is generally used year-round, which is one reason it fits South Florida schedules. Daily broad-spectrum sunscreen is required regardless of season.
Book a PRX consultation in Davie
Every PRX treatment at LuXe Concierge Aesthetics is performed by Deborah Lenchus, MSN, APRN. If you are weighing PRX against a peel or a resurfacing laser, the consultation is the place to sort that out. Read more about PRX at LuXe or book online.
Sources
- Gold MH, Wilson A, Biron JA. Treatment of Mild to Moderate Facial Chrono- and Photodamage with a Novel Intense Liquid Trichloroacetic Acid Peel. J Clin Aesthet Dermatol. 2022;15(1):E61–E65. PMID 35309276.
- Kimura A, Kanazawa N, Li HJ, et al. Influence of trichloroacetic acid peeling on the skin stress response system. J Dermatol. 2011;38(8):740–747.
- Slominski A, Botchkarev V, Choudhry M, et al. Cutaneous expression of CRH and CRH-R: is there a “skin stress response system”? Ann N Y Acad Sci. 1999;885:287–311.
- O’Connor AA, Lowe PM, Shumack S, Lim AC. Chemical peels: a review of current practice. Australas J Dermatol. 2018;59(3):171–181.
- Product formulation and indication details: WiQo US — PRX Derm Perfexion, PRX-PLUS and PRX C product and science pages (manufacturer).
This article is for educational purposes and is not a substitute for a medical consultation, diagnosis or treatment. Individual results vary. PRX®, PRX Derm Perfexion®, PRX-PLUS® and PRX C® are trademarks of their respective owners.