Occlusive mask

Phenol entails the most complex post-peel care occlusive masks, healing masks and cosmetic care during the months following the peel. Chapters 25-36 are devoted to this technique. The expected downtime is between 7 and 15 days, depending on the formula used. The patient will have to wear camouflage make-up to hide any redness, which can last for several weeks or months. 

After leaving the solution to rest for 24 hours and filtering it, UV exposure was what made it effective Solutions not exposed to UV did not appear to work. The skin was also prepared by UV exposure, and the solution was applied five times, leaving each coat to dry before the next application. Urkov then applied an occlusive mask. This mask allowed the superficial layers to hyperhydrate by blocking transepi-dermal water loss (TEWL). The hyperhydration dissolved the salicylic acid that would have precipitated on the skin without occlusion and could not have penetrated, as only the acids in solution can readily penetrate the skin barrier. He then applied zinc stearate powder (which is antiseptic and anti-inflammatory). The erythema subsided in 5-6 days and exfoliation was superficial. The solution can be kept in the fridge for 10 days. 

The epidermal layers are dissolved down to the basal layer in 24—36 hours under an occlusive mask. Thereafter, the architecture of the cells returns to normal and the histological coloring evens out. After a peel, the palisade structure of the keratinocytes is more even. 

Experience of conventional" phenol peels also shows that a small percentage of patients complain of nausea or even vomiting shortly after a deep peel. This nausea and vomiting occur within a few hours after the application of an occlusive mask." The cause-and-effect relationship between these symptoms and excessive phenolemia has not been officially established. 

As well as improving the cosmetic results, using occlusion also slows down the absorption rate of phenol and reduces its toxicity. Occlusive masks must be applied carefully to avoid air bubbles or pools or phenol forming. 

A long-acting benzodiazepine greatly improves patient comfort. It makes the patient feel drowsy, which reduces facial movements and therefore helps keep the post-peel occlusive mask in place. Also, when a patient has taken 2.5 mg of sublingual lorazepam as premedication, they will feel much less pain immediately after the peel. A calm patient is a patient who does not complain, does not fidget, does not speak, does not smoke and does not scratch. 

The occlusive mask applied at the end of the peel will consist of either a single or a double layer, depending on what type of dressing is used. Sleek and Leukoflex can be used in a single layer. Leukoflex has an advantage over other brands in being transparent. Micropore can be applied in two layers, or a layer of Blenderm can be applied on top of the first layer of Micropore (Figure 32.3). 

Whichever dressing is used, the tape should be precut into 3-5 cm strips (Figure 32.4) and placed within easy reach, ready for the occlusive mask (Figure 32.5) to be applied at the end of the peel. 

The most common technique involves the use of occlusion for 24 hours. An assistant prepares the strips of occlusive tape, cutting them to the right size (about 3-5 cm long) so that the occlusive mask can be applied immediately after the peel. 

The occlusive mask is applied to the rest of the treated areas (for details, see Chapter 35). 

The doctor may find it easier and quicker not to apply an occlusive mask, but this is a hasty conclusion applying an occlusive mask is a simple procedure and can be done in the obligatory rest periods between each treatment area. No time is wasted. 

The occlusive mask improves patient comfort the skin liquefies beneath the mask, and the liquefied integuments do not drip on the skin. The occlusive mask prevents the skin from sticking to clothes or pillows. When an occlusive mask is put in place, the patient can apply a cooling cold pack to alleviate the painful burning sensation, whereas with the open technique, direct contact with the skin is not possible. 

UnKke trichloroacetic acid (TCA), whose effect is restricted by occlusion, the elfectiveness of phenol is improved by maceration. Stegman proved that applying an occlusive mask allows the phenol to penetrate more deeply and... 

Whichever technique is used instead of the occlusive mask, there is an increased risk of infection, injury, allergies or errors, and a transparent occlusive mask is recommended during the first 24 hours to improve the peel s effectiveness, reduce the need for patient participation in post-peel care and lower the risk of secondary infection. 

The occlusive mask must be perfectly even. The main pit-falls to avoid are as follows. 

The occlusive mask sometimes comes unstuck around the edges of the mouth, and lip wrinkles are among the most difficult to treat. Lack of maceration where the mask has come unstuck can lead to inadequate results (Figure 35.1). 

An occlusive mask that has come mostly unstuck after 24 hours the results of this peel will be inadequate. 

The occlusive mask can be put on the lower part of the face with the patient in a half-sitting position at the end of the peel to make it hold better. 

The anterior hairline is a special area. A first strip of Leukoflex is placed directly on the patient s skin, at the edge of the hairline. Any hair sticking out over this edge should be cut off so that it does not get pulled out when the mask is removed 24 hours later. A hairnet is placed on the patient s hair. An impermeable or plastic shower cap should not be used, as it holds the sweat on the scalp and makes the occlusion very uncomfortable for the patient. The (loose) elastic edge of the hairnet is positioned on the first strip of Leukoflex . A second layer of Leukoflex holds the elastic of the hairnet in place the net thus forms an integral part of the occlusive mask and can be used to pull the whole dressing off smoothly and painlessly when the time comes to remove the mask. 

A simple gauze pad can be used instead of a hairnet (Figure 35.2). The gauze should be cut close enough to the dressing for the patient to be able to brush or comb the hair, and at the same time there must be enough gauze to hold onto to remove the occlusive mask later. Around the eyes, the occlusion should completely cover the eyebrows... 

Immediate touch-up of the upper lip and chin after the occlusive mask has been removed after 24 hours. 

Urkov used zinc stearate as a healing powder for 5 days after removing the occlusive mask. 

Patients often complain that some hquid has leaked out from the bottom of the occlusive mask and that they have had to cover their necks. 

Phenol must be applied evenly. The depth of the peel depends on the number of coats and the type of solution used. Chapter 34 describes in detail the application methods needed to get an even result. It is extremely important to follow the application methods for each particular formula carefully. In all cases, any occlusive mask must be even and not form bubbles or areas of pressure. Any tears could carry phenol onto the neck (linear peel and increased probability of PIH). 

If there are air bubbles in the occlusive dressing, the phenol cannot macerate evenly, and some areas will be undertreated, whereas if the occlusive mask is too tight, scars can form where the severe edema that develops in the first few hours after a phenol peel causes too much local pressure. 

The occlusive mask does not usually go under the jaw, as the movements and traction to which the dressing will be subjected will cause the same phenomenon as described above. 

Special case of herpes under post-phenol occlusive mask... 

It is difficult to diagnose and impossible to monitor herpes outbreaks, large or small, beneath an opaque occlusive mask of bismuth subgallate or thymol iodide. If there is any hint of herpes, any acute pain between the 4th and 7th day after the phenol, the powder mask" should be removed immediately in order to examine the skin thoroughly. If the doctor s suspicions are confirmed, the herpes should be treated as described above. Once the diagnosis has been made, the powder mask should not be replaced, and the moist technique should be used instead, with regular application of an antibiotic cream (e.g. bacitracin) to avoid secondary bacterial infection. 

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