Patient resorcinol

At the end of the peel some patients feel dizzy for a few minutes, probably due to the flushing that occurs secondary to resorcinol application... 

Sulfur, resorcinol, benzoyl peroxide, or salicylic acid Caut ous y use concomitant topical medications because of possible interactions with tretinoin. Significant skin irritation may result. It also is advisable to rest a patient s skin until the effects of such preparations subside before use of tretinoin is begun. 

Systemic allergic reactions have been reported in eight patients after topical application of a wart formulation containing resorcinol (3). All developed a marked eczematous, sometimes bullous reaction, localized to the site of application in four cases there were generalized urticaria and angioedema, in one pompholyx eczema, and in three generalized eczema with pompholyx. In aU cases there were positive patch tests with resorcinol. 

Prevention of the herpes simplex virus is essential for patients who have a history of the infection (a single incidence of herpes is enough). Herpes prevention is necessary with a peel to the papillary dermis. It is also worthwhile when a more superficial peel is usually accompanied by a severe inflammatory reaction, as is the case with resorcinol, classic AHAs and TCA-SAS. It is not necessary when using Easy TCA imder its basic protocol or Easy Phytic . General infection prevention measures should be taken, depending on the depth of the peel. For more information, see the discussion of infections in Chapter 37. 

Resorcinol in paste form is used in a very specific manner the paste is usually applied three times, once a day for 3 days in a row. Post-peel care is very important diuing the following week the skin should not be hydrated at all, as it has to dry out completely for the peel to be effective and, above all, the patient must not pull off or pick at the flaking skin. Only the doctor can safely cut off any strips of flaking skin with sterile scissors. Cosmeceutical creams for age spots, acne, aging or sagging skin, etc. should only be applied after the skin has flaked. Effective sun protection (UVA + UVB + HSP inducers) is absolutely essential for approximately 6 weeks after the peel. 

The best results are achieved when the skin has been prepared for 15 days beforehand see Chapter 2. If the skin has been prepared with tretinoin or alpha-hydroxy acids (AHAs), if the patient has used products (benzoyl peroxide) or techniques (scrub, or abrasion with a massage glove) that increase the permeability of the stratum corneum, the resorcinol paste should not be left on too long. 

There is one significant cloud on the horizon the allergy test itself can make a patient who was not previously allergic to resorcinol allergic. It is therefore not wholly predictive. 

The patient must be well hydrated to facilitate diuresis and elimination of the metabolites of the resorcinol. An intravenous drip of saline solution should be set up, but if this is not possible, the patient should be asked to drink several glasses of water before the resorcinol is applied. 

Resorcinol paste is compact and dilEcult to apply. It is easily softened by putting it in a bain-marie at 45° for around 10 minutes. If that is not possible, small blocks of paste should be applied to the patient s skin. Heat from the skin will slowly melt the paste and make it easier to spread, although the resorcinol may penetrate too deeply where contact time has been longer. 

First application (first day) contact time 10-25 minutes. A few minutes after the first application, the patient feels some heat and then a tolerable burning sensation. This sensation starts where the resorcinol has penetrated most rapidly. The cheeks are usually more permeable than the forehead. The areas where the patient first feels burning are the first to be cleaned of the resorcinol paste at the end of the peel. The sensation of acid burning can sometimes become intense, and a yellow serous fluid may be seen to weep through the partially lysed epidermis. In this case, the patient should be given an analgesic for the first night paracetamol (acetaminophen) plus codeine. 

The patient must not pull off the strips of peeling skin. At the most, they can be cut off with scissors, without pulling the skin at all. The skin is pink and sensitive underneath the resorcinol membrane. As soon as flaking starts. 

According to Unna, the resorcinol paste can be applied again as soon as flaking has finished. We are rarely called upon to repeat an application of resorcinol paste nowadays. The results of an Unna s paste peel remain modest in relation to the complexity of the treatment and the downtime involved, and patients are not prepared to accept these conditions. 

Although it belongs to the phenol group of chemicals, resorcinol has very different exfoliating properties and it is far less toxic than phenol itself. The routes of metabolic detoxification are mainly via the Hver and kidneys. As a precaution, patients with liver or kidney deficiencies should be ruled out, as well as patients with arrhythmia and women who are pregnant or breast-feeding. 

Thyroid injury after chronic skin application of resorcinol has been reported several times. In 1977, Katin and colleagues published a case of hypothyroidism following regular application of a 2% resorcinol cream in a chronic dialysis patient suffering from pruritus. The mechanism of action seems to be as follows the presence of a hydroxy group in the meta position in the resorcinol would block the metabolism of iodine by inhibiting the peroxidase needed to oxidize iodide into iodine, the only form that can be assimilated by the body. 

Allergies to resorcinol have been widely described. It is therefore wise to do a skin sensitivity test behind the ear 8 days before a resorcinol peel. Any contact with resorcinol can sensitize the patient (or the physician) to it, so the test... 

It is important not to confuse an allergy with the skin s natural response to the chemical peel applied behind the ear. A highly localized and normal skin reaction to the peel will occur erythema followed by flaking. The appearance of any blistering or pruritus contraindicates any further contact with resorcinol completely and definitively. If a patient is allergic, Unna s paste causes reversible facial eczema, with no cosmetic benefit. 

A few areas of mild erythema, which changes color with the cold, alcohol or emotion, can very occasionally last for several weeks. Erythema after a resorcinol peel is usually reversible without treatment, but requires preventive treatment against pigmentary changes, especially in high-risk patients (see the preceding paragraph and Chapter 37). 

If the results are considered inadequate, the patient might benefit from further peels. A maintenance resorcinol peel can be done every year, if indicated. According to Unna (quoted by Arouette ), under some circumstances, it is necessary to do several successive exfoliations that can be performed without interruption . 

Katin MJ, Teehan BP, Sigler MH, Schleifer CR, GUgore GS. Resorcinol induced hypothyroidism in a patient on chronic hemodialysis. Annals of Internal Medicine 1977 86(4) 447-9. 

Erythema is inevitable after a phenol peel (Figure 37.18). ft can sometimes be less severe and of a shorter duration if a corticosteroid is injected intravenously at the beginning of the peel. Its intensity varies from patient to patient, from light and imperceptible to severe and deep. Resorcinol is a potentially allergenic phenol derivative persistent, pruritic erythema after a resorcinol peel might be a sign of contact dermatitis. 

Edema comes from dermal inflammation, and peels that do not cause inflammation in the papillary dermis do not cause much edema. If the patient has an allergic reaction to one of the components used (e.g. resorcinol), then severe edema can set in rapidly, however. Any severe edema after a peel that does not go beyond the basal layer is most likely associated with an allergy or infection. 

Acne is treated by gently applying a cleansing agent several times a day to the skin. Vigorous scrubbing should be avoided. In addition, the patient can administer topical anti-acne medication such as keratolytics. These include benzoyl peroxide, resorcinol, and salicylic acid that dissolves keratin, the outer layer of the epidermis. 

Rucinol, a resorcinol derivative, is the first substance shown to inhibit both tyrosinase and TRP-1. In 28 melasma patients, a 12-week application significantly lessened pigmentation than vehicle, producing good to fair efficacy in 78% of patient population. It significantly reduces pigmentation scores compared to controls [82]. 

Frosch PJ, Burrows D, Camarasa JG, Dooms-Goossens A, Ducombs G, Lahti A, Menne T, Rycroft RJG, Shaw S, White IR, Wilkinson JD (1993) Allergic reactions to a hairdresser s series results from 9 European centres. Contact Dermatitis 28 180-183 Tarvainen K (1995) Analysis of patients with allergic patch test reactions to a plastics and glue series. Contact Dermatitis 32 346-351 Vilaplana J, Romaguera C, Grimalt F (1991) Contact dermatitis from resorcinol in a hair dye. Contact Dermatitis 24 151-152... 

The patient shown in Figure 8.22, a Caucasian with Fitzpatrick skin type III, was treated with a 1-minute Stone II peel followed by waterproof tape occlusion for 48 hours and 3-day blending resorcinol peel to neck. (The face was treated with Aquaphor ointment after tape removal, as was the neck after the 3rd day of five coats of resorcinol - one every 5 minutes for five coats on three consecutive days. The resorcinol is put on like glycolic acid, one even coat every 5 minutes for five coats and repeated 3 days in a row. On the 3rd day after the five coats of resorcinol have dried, either thymol iodide powder is applied to form a crust or Aquaphor ointment is applied throughout healing. Either occlusion method works well. 

The patient shown in Figure 8.24, a fifty-five-year-old Caucasian with red hair, Fitzpatrick I skin type, and looking older than her stated age, responded well to a 13-minute Stone VK peel and a 1-minute Stone II peel followed by tape and powder. Note that after 6 months she stiU had a ruddy complexion and some persistent perioral lines (Fig. 8.24B. Her neck was not treated (now she would have a 3-day resorcinol peel). The patient has not been seen in follow up beyond 6 months but it is assumed she would be lighter. 

When compared to 70% glycolic acid peels, no difference was found with respect to the frequency of side effects in patients of skin types IV-Vl. However, the phenolic compound, resorcinol, may cause some depigmentation jjroblems in skin types V and VI. 

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