Peeling phenol-based

Since deep chemical peels are based on phenol-containing solutions, it seems that the history of this procedure starts at the moment of car-... 

Most of the credit of phenol-based peels during the late 1940s and early 1950s is attributed to lay operators. Their illegal work was probably one of the reasons for rejection and skepticism related to the procedure by medical profession in those years. 

So far no controlled study has been conducted to compare clinically and histologically between the various peeling formulations. However, a few ideas regarding phenol-based... 

Originally, the ideal patient for deep chemical peel was a blond, blue-eyed woman of fair complexion. Our experience shows that phenol-based peels can be safely performed on olive- and dark-skinned patients with dark eyes... 

Phenol-based peel can be performed as a full-face or partial procedure. If only one cosmetic unit is peeled with phenol-based solution, it is strongly recommended to perform medium depth peel on the rest of the facial skin. Full-face peels should be carried out under full cardiopulmonary monitoring with intravenous... 

Full-face phenol-based peels are performed under cardiopulmonary monitoring with intravenous hydration... 

Results of phenol-based peels for various indications are shown in Figs. 8.11,8.12,8.13, 8.14 and 8.15. 

The most important potential complication of phenol-based peels is cardiotoxicity. Phenol is directly toxic to myocardium. Studies in rats have shown a decrease in myocardial contraction and in electrical activity following systemic exposure to phenol [i6]. Since fatal doses ranged widely in these studies, it seems that individual sensitivity of myocardium to this chemical exists. In humans neither sex/age nor previous cardiac history/blood phenol levels are accurate predictors for cardiac arrhythmia susceptibility [17]. 

Therefore, full-face phenol-based peel should always be performed under full cardiopulmonary monitoring. The average lag time for the onset of the arrhythmias was 17.5 min from the beginning of the peel, and they are usually not delayed for more than 30 min after the peel. Cardiac arrhythmias are more common while applying the solution on the thin skin of eyelids. In this area skin absorption is maximal therefore, application should be performed extremely cautiously. If arrhythmia occurs, the application of phenol should be stopped until... 

Fintsi Y (1997) Exoderm—a novel phenol-based peeling method resulting in improved safety. Am J Cosm Surgery 14 49-54... 

Exoderm phenol-based peeling in olive and dark skinned patients. Int J Cosm Surgery Aesthet Dermatol 200i 3 173-178... 

Results of a combination of phenol-based peel with abrasion and subcision are shown below (Figs. 9.9,9.10,9.11,9.12,9.13,9.14 and 9.15). 

In cases of patients with olive skin (Fitzpatrick Results of phenol-based peels for various inskin type 3 or 4), the application of Kligman dications are shown in Figs. 8.11,8.12,8.13, 8.14 preparation is recommended to prevent reac- and 8.15. tive hyperpigmentation. 

Since deep chemical peels are based on phenol-containing solutions, it seems that the history of this procedure starts at the moment of carbolic acid discovery in 1834 by the German chemist Friedlieb Ferdinand Runge. The name phenol had been coined in 1841 by Charles Frederick Gerhardt. Nowadays, phenol is prepared synthetically in a process that utilizes chlorobenzene as a starting point. 

But the mainstay of therapy for skin resurfacing continues to be chemical peels together with abrasion [37 2], Chemical peels in use to improve facial scarring include alpha-hydroxy acid peels, trichloroacetic acid, and deep phenol-based methods [43 8], In this chapter, we discuss deep chemical peels for post-acne scars treatment. 

The usual classification of chemical peels comprises superficial, medium and deep peels. For superficial peels, AHA, Jessner s solution, tretinoin, TCA in concentrations of 10-30% and most recently hpo-hydroxy add are used to induce an exfoliation of the epidermis. Medium-depth agents such as TCA (30-50%) cause an epidermal to papillary dermal peel with subsequent regeneration. Deep peels using TCA (>50%) or phenol-based formulations penetrate the reticular dermis to induce dermal regeneration. The success of peeling in darker skin is crudally dependent on the physician s understanding of the chemical and biological processes, as well as of indications, clinical effectiveness and side effects of the procedure (see Box 9.1). 

Since carchotoxidty is a dreaded compfication of systemic phenol absorpticm, phenol-based peels are performed... 

It is vital to understand that each kind of test evaluates only one factor. The shear test cannot assess durability, and the peel test cannot ensure complete cross-linking of the resin. Perhaps the worst violation of this principle is the use of ultrasonic inspections to over-rule failure to pass the coupon tests for parts that are deemed too expensive to scrap. There are never any written specifications allowing this, but there are also no written instructions prohibiting material review boards from making such decisions. Fortunately, since the introduction of phosphoric-acid bonding and phenolic-based adhesive primers, the processes have become more robust than the testing techniques and such decisions have not created a safety problem. 

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