Keratoses phenol peels

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). 

Skin phototype is even more important when using phenol locally a locaP phenol peel can only really be applied on light skin phototypes that will not show any significant and visible difference in color on the eyelids and around the mouth. The same applies to patients with a lot of freckles, keratoses or lentigines, which only disappear from the areas treated with phenol but still remain in the surrounding areas. The difference in skin quality is also very visible. These patients should only be treated with a full-face peel. 

It is nevertheless possible for these patients to have a local phenol peel combined with a full peel to the papillary dermis. Combining Lip Eyelid with Unideep provides a phenol peel and a peel to even out skin with lentigines, keratoses or freckles. The two peels should be done in the same session the phenol first, followed immediately afterwards by Unideep on the rest of the face, around the area treated with phenol. 

Photoaging, actinic keratoses and lentigines. (a) Before and (b) after a peel to the papillary dermis with TCA (Unideep ) and phenol (Lip Eyelid formula) around the mouth and on the large lentigo on the left temple only, (c) Before and (d) on the 6th day after the peel. For more details, see Chapter 23. 

Keratoses peel solutions penetrate the keratoses slowly. This photograph shows the slow penetration of phenol through keratoses during a full-face peel. 

Seborrheic keratoses (Figure 30.12) are very common and are found on areas of skin that have been exposed to the sun as well as unexposed areas. The lesions are always benign, but can sometimes be difficult to distinguish from malign melanomas. Beyond a certain thickness, the kera-totic layer makes them unresponsive to peels, even to phenol. They can be treated by shave excision with a snare and radiofrequency (Elhnan unit) immediately before applying... 

Given the inherent risks of this combination, its indications are restricted to the treatment of keratoses or depressed scars, in which the dry ice, applied locally and combined with TCA, produces very good results, comparable to those of a phenol or Only Touch peel. 

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