Dermis phenol effects

The fact that in most cases they cannot use camouflage make-up makes it difticult to carry out a local or full phenol peel. Moreover, phenol peels produce less spectacular results on thick skins than on thin skins. Shaving does not pose a problem, as a peel to the basal layer of the epidermis does not rule out shaving, even with a blade. For a peel to the papillary or reticular dermis, it is best not to shave while the skin is flaking. It is usually possible to shave after the 8th day. Alcohol-based aftershaves should be avoided, and a hydrating, anti-oxidant or firming cream should be used instead, followed by effective sun protection. 

AKs and SLs have been improved - sometimes temporarily - by peels to the papillary dermis (see Chapter 23). A full-face phenol peel is the most effective and long-lasting treatment for keratoses and solar lentigines (see Chapter 30). 

With EMLA, liposoluble anesthetic molecules penetrate the stratum comeum and the rest of the epidermal barrier and soon reach the skin nerve endings. The phenol, which is also liposoluble, can get through the epidermis more quickly. On the surface the shorter contact time between the epidermis and the phenol could reduce epidermal liquefaction. Deep down, a higher concentration of phenol in the reticular dermis could cause the formation of retractile scar tissue. The concentration gradient created in the perivascular spaces of the dermis speeds up the absorption of phenol. The risk of systemic toxicity can also increase. EMLA causes vasoconstriction followed by vasodilation. Vasodilation can sometimes be seen after only 30 minutes of EMLA under occlusion. How will these vasomotor changes affect the effectiveness or absorption of phenol - and therefore its toxicity ... 

Various phenol peel formulas can be found on the market that boast of the possibilities of doing a full-face peel without anesthetic . In some cases, this means without general anesthetic and in others the patient is put on strong analgesics, sedation and premedication. Some low-dose phenol peels (around 30%) are no more painful than a trichloroacetic acid to the papillary dermis, but they are not much more effective either. 

Recently, some phenol formulas have been presented as allowing a full-face peel without any anesthetic. A phenol peel that can be applied to the whole face without any type of anesthetic is a more superficial phenol peel that does not induce regeneration of the reticular dermis of the same quality as the classic phenol peels. Less pain goes hand in hand with inadequate results the results of this type of phenol peel are the same as for a TCA peel to the papillary dermis and may not have much effect on wrinkles. The pain caused by these peels is also the same as for a TCA peel to the papillary dermis. It is pointless to put a patient through the risks of phenol toxicity only to get the results that a simple, non-toxic molecule (TCA) can achieve. An effective, full-face phenol peel should therefore be used with an anesthetic (see Chapter 33). 

Phenol (unoccluded 1(X)% pure phenol) (Figs. 20.1-20.4) Phenol is commonly used to treat ingrown toenails. Furthermore, deep peels using phenol are one of the most effective chemical peeling methods for elderly skin tumor patients [10-13]. Phenol injures tissues from the papillary dermis to the upper reticular dermis [10]. Our previous results suggest that phenol quickly penetrates into the skin, and induces... 

The usual classification of chemical peels comprises superficial, medium and deep peels. For superficial peels, AHA, Jessner s solution, tretinoin, TCA in concentrations of 10-30% and most recently hpo-hydroxy add are used to induce an exfoliation of the epidermis. Medium-depth agents such as TCA (30-50%) cause an epidermal to papillary dermal peel with subsequent regeneration. Deep peels using TCA (>50%) or phenol-based formulations penetrate the reticular dermis to induce dermal regeneration. The success of peeling in darker skin is crudally dependent on the physician s understanding of the chemical and biological processes, as well as of indications, clinical effectiveness and side effects of the procedure (see Box 9.1). 

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