Facial peeling

Patients with melasma (Eig. 2.3) applied topical sunscreens (sun protection factor 15) and 10% glycolic acid lotion at night for 2 weeks. They were then treated with 50% glycolic acid facial peels once a month for 3 consecutive months. At regular intervals and at the end of the follow-up period (3 months) after the last peel, the degree of improvement in pigmentation was assessed by measuring MASl (Melasma Area and Severity Index) [11]. 

Javaheri SM, Handa S, Kaur I, Kumar B (2001) Safety and efficacy of glycolic acid facial peel in Indian women with melasma. Int J Dermatol 40(5) 354-357... 

The safety and efficacy of a series of glycolic acid facial peels were investigated in 25 Indian women with melasma [16]. Patients were treated with 50% glycolic acid peels monthly for 3 months. Improvement was noted in 91% of patients with maximal clearing occurring in patients classified with epidermal melasma. Side effects were observed in one patient who developed brow hyperpigmentation. 

Peels are not indicated for hypertrophic scars. Some fine facial scars (from a face-Kft, for example) improve vastly after local application of some phenol peels others are improved by a combination of abrasion and peeling. Body peels produce fewer results and more problems that facial peels. 

The first kit (Figure 15.1) consists of 12 phials of base solution and three tubes of post-peel cream for 12 facial peels - enough to treat three patients on the basis of four peels per patient. The second kit (Figure 15.2) consists of two bottles of base solution for 24 peels - enough to treat six patients on the basis of four peels per patient, and a large tube of post-peel cream. 

Bottle of base solution. The 24-peel kit contains two identical bottles each bottle contains enough solution for 12 facial peels. 

The basic ETCA protocol (basic protocol to achieve scattered pinpoint frosting) is repeated four times," at weekly intervals for a facial peel and at 2-weekly intervals for a body peel. This repetition is in fact one of the peel s built-in safety features applying just one ETCA peel may not be enough and may cause complications. 

A schematic illustration of the repetition of ETCA treatment for facial peels is shown in Figure 15.16. Eight days is the average frequency the outside limits are a minimum of 5 days (if the condition of the skin allows) and a maximum of 15 days. 

Brown and Kaplan made use of the buffering property of oils in phenol solutions. Their formulation contained up to 95% phenol combined with oils. A patch test behind the ear had to be carried out before the facial peel. If there was skin necrosis, they reduced the strength of the phenol by gradually adding oil in small quantities until the right dose was found for the patient s skin. To increase the strength of the mixture, on the other hand, soap (saponified cresol) was added or the concentration of phenol was increased. 

In 1973, Litton, Fournier and Capinpin published the results of a survey covering cardiovascular complications during phenol facial peels. In the 493 questionnaires... 

Complications can take practitioners by surprise during any cosmetic procedure - and facial peels are no exception to this rule. 

Wexler MR, Halon DA, Teitelbaum A, Tadjer G, Peled IJ. The prevention of cardiac arrhythmias produced in an animal model by the topical application of a phenol preparation in common use for facial peeling. Plast Reconstr Surg 1984 73 595-8. 

More than is usually applied during a facial peel. 

After applying the phenol, the doctor applies an evening-out peel, either Easy TCA or Unideep , to the rest of the face. Both of these peels consist of an acid solution and a post-peel cream that stimulates healing, is antioxidant and tyrosinase-inhibiting. This special postpeel cream should be applied once only by the doctor at the end of the facial peel. When the phenol is used without occlusion and without impermeable dressing, the Easy TCA or Unideep post-peel cream is applied on the area treated with Lip Eyelid at the same time as it is applied to the rest of the face. 

Difference between a facial peel and a body peel... 

A few cases of toxic shock were reported after facial peels with Baker s solution in 1982, 1983 and 1987 and after rhinoplasty in 1983. Todd and colleagues described the first cases of toxic shock syndrome in 1978 as a result of the use of certain tampons, ft appears to be caused by an entero-toxin F and/or exotoxin C with the same molecular weight (22 000), secreted by Staphylococcus aureus. Other authors suspect that the two toxins are really one and the same. ... 

Figure 6.4 The facial peeling process. (A) Day 0 (B) day 1 (C) day 3 (D) day 5 (E) day 7 (F) day 10. With any of these peels the desquamation begins on the third day and, then, progresses across the face like a wave. By the seventh day the peel is close to the hairline. The patient Is reminded not to pull ott the scale ahead of schedule. Note the freshened complexion that comes trom underneath by the tenth day. The bleaching program must be reinstituted to prevent a recurrence of the dyspigmentation...

For thick lesions (like seborrheic or hypertrophic actinic keratoses), hyfercate or curette lesions first then apply the overall facial peel. TCA is helpful for hemostasis. 

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