Chest peels

Gladstone HB, Nguyen SL, Williams R, Ottomeyer T, Wortzman M, Jeffers M, Moy RL (2000) Efficacy of hydroquinone cream (USP 4%) used alone or in combination with salicylic acid peels in improving photodamage on the neck and upper chest. Dermatol Surg 26(4) 333-337... 

Fig. 10.3. a Patient with photodamage of the chest, b Note significant improvement after combination salicylic acid/TCA peel... 

A 67-year-old woman was provided with a totally implantable venous device in the right subclavian vein by the Seldinger technique with a peel-away sheath. The device was used for a course of chemotherapy. After about 1 month there was subcutaneous extravasation of the drug. A chest X-ray showed that the sihcone catheter had fractured below the clavicle and the distal portion of the catheter had embolized into the right atrium. The fragments were removed. 

Pinellia and Poria dispel dampness and transform phlegm. Citrus and Orange Peel rectify the qi and loosen the chest. Fresh Ginger, Red Dates, and Licorice regulate the constructive and defensive and harmonize all the other medicinals. Taken as a whole, this formula emits the exterior, diffuses the lungs, and cools and resolves dryness. It also disinhibits the qi, transforms phlegm, and stops cough. 

The supervisor was placed into a medically induced coma for three months to prevent further pain while the hospital staff peeled off layers of his scarred and damaged flesh. This victim was burned on every part of his body except for the palms of his hands, his face, chest, and feet. He endured months of painful skin grafts, and his hospital stay lasted more than six months. 

Any cosmetic unit can be treated with a glycolic acid peel. In general, chest, back, forearms, dorsal hands, and legs are easily treated with higher concentrations of glycolic acid without fear of overtreatment. However, necks are the more sensitive body area and conservative treatment with lower concentrations first is recommended. 

If too much surface area (face, arms and chest - 20% of the body s surface area) is exposed to several coats of salicylic acid (14% in ethanol) that is left on the skin (as in the classic Jessner peel) eight to twelve hours later the patient can develop severe nausea, vomiting, dizziness and tinnitus from salicylism. 

Caution is necessary when peeling nonfacial skin such as the neck. Nonfacial skin has fewer adnexal stmctures as compared to the face. For this reason, peels on the neck and other nonfacial areas, should not exceed the level of the papillary dermis unless the physician is highly skilled. Usually one coat of 20% TCA-blue peel or two coats of 15% TCA-blue peel is evenly applied. The greatest amount of add should be applied near the jawhne with less apphed as one proceeds towards the chest to create a blending effect between the skin on the face and that cm the chest. 

Past exposure to radiation in the neck, chest or other proposed site to be peeled is also relevant. Radiation diminishes the number of pilosebaceous units in treated areas and places these patients at an increased risk for development of postoperative scarring. Presence of adnexal structures can be assessed clinically by observation of vellus hairs or microscopically by performing a small punch biopsy as Brody describes. Similarly, a history of hypertrophic scar or keloid formation is also relevant especially if peeling will take place in high risk areas such as the chest, back shoulders and junction of the jaw and neck. 

Peeling in nonfacial areas (neck, chest, hands)... 

Figure 16.16 Hypertrophic scars of the chest after a TCA peel by an aestheticlan...

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