Occlusive mask removal

After the tape mask removal the exudate is cleaned by sterile saline. Spot peeling and retaping may be done if the skin looks underpeeled, particularly in areas with severe wrinkling. It is usually accompanied by a short-duration burning sensation. The tape is left for an additional 4-6 h and then removed by the patient. We cover the face with bismuth subgalate antiseptic powder for 7 days (Fig. 8.10). Other options include occlusive moisturizers, antibiotic ointments, and biosynthetic occlusive dressings such as Meshed Omiderm. 

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... 

Underneath the mask, the skin is coated in a thick liquid with a distinctive smell this liquid results from the liquefied epidermal layers mixed with inflammatory lymph (Figure 35.5). Good epidermal liquefaction seems to make for a good prognosis, although the final results will not necessarily be proportional to the amount of liquid found beneath the occlusion. After removing the mask, the face is very swollen and looks severely burnt, but for all that the patient does not feel much pain. The skin appears crumpled in places, as the edema develops rapidly beneath the rigid mask and the skin cannot stretch. This crumpled appearance soon disappears. The residual liquid is wiped from the rest of the face with a sterile cotton pad. 

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. 

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. 

This more aggressive protocol involves sandpaper abrasion prior to the application of Easy TCA solution and 12-24 hours occlusion of the post-peel mask cream. It causes severe erythema within the first few hours of occlusion. After the occlusion has been removed, the skin looks... 

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