Deep peels testing

If there is a personal history of PIH, a sensitivity test could be carried out on a hidden area. It is worth bearing in mind that if the test is negative, patients will be convinced that they are safe from complications and it is far more likely that any problem that might arise will be put down to the practitioner s presumed incompetence rather than any particular skin sensitivity. Different areas of the face do not react to peels in the same way a patch test behind the ear does not really say anything about how the area around the mouth will react. Sensitivity tests should therefore be seen more as a means of dissuading a patient who is likely to have complications rather than a means of preparing for any potential problems. A patient with a pigmentary reaction to a test should be ruled out for treatment with medium or deep peels and be oriented towards a peel that causes less melanocyte stimulation. 

Figure 15.1 The preauricular area is an excellent place to test deep peels. Note the type of blanching which has occurred following the application of Baker s solution using a saturated Q-tip (cotton bud).

Figure 15.4 In this patient a skin test using Baler s solution and 50% TCA was carried out. The hypopigmentation that resulted made deep peels an unacceptable option for this patient...

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