Phenol peels complications

The fear of arrhythmic complications is the main brake on the use of phenol peels today. It is therefore worthwhile studying this problem in detail. The conclusions that can be drawn from reading about these complications in medical literature help us to understand how to apply phenol with greater safety, though the possibility of arrhythmias occurring cannot be avoided. 

The question asked of the plastic surgeons was Have you seen any cardiac complications during a phenol peel The answers were as follows ... 

The injection can also be given 8 days after the phenol peel, if not done beforehand. Injecting botulinum toxin during the post-peel period of erythema and edema increases the risk of the toxin moving as well as the risk of temporary cosmetic complications caused by the toxin. The duration of the toxin s effect does not seem to change much, however. 

Insulin-dependent diabetes is an absolute contraindication to a phenol peel. Diabetes significantly increases the risk of secondary infection the vascular and/or immune disorders associated with this illness mean that complications are more of a probability than a possibility. Stabilized, non-insulin-dependent type 2 diabetes is not an absolute contraindication to a phenol peel. The doctor must take particular care with these patients to avoid secondary infections. 

A phenol peel should of course not be performed after myocardial infarction or cardiac decompensation. Unstable angina also rules out a phenol peel, as the stress associated with a peel could trigger an angina attack. No clear link has ever been established between a personal medical history of a heart condition, if currently stabilized, and the incidence of cardiovascular complications during a phenol peel. Apart from arrhythmias, to the best of my knowledge there is no mention in the literature of any serious heart problems occurring as a complication of a phenol peel. ... 

Of course, we cannot know for certain that such complications are always reported in scientific journals, even though any serious complications following cosmetic interventions always make headline news in the popular press and on TV. As far as 1 know, however, recently there have been no serious health problems resulting from a phenol peel. 

Squeamish patients will overwhelm the doctor with complaints, worries, questions and reproaches. It is better to test a patient s mental and physical resistance by first suggesting a painless peel without complications and then progressing onto a medium-depth peel before considering a phenol peel. Individual tolerance can be tested in this way, and the patients themselves gradually learn what a peel is and what it can do for them. 

Many phenol peel techniques require skin preparation before the peel to ensure that penetration is even and to reduce complications (see Chapter 2). No specific preparation is necessary before Lip Eyelid formula. 

Some authors recommend injecting 125 mg of solumedrol intravenously before starting a phenol peel injecting a steroid is said to reduce post-peel edema and to prevent some of the complications described above. However, I have not noticed any advantage from this injection. The aftereffects of the peel are similar with or without corticosteroids. However, it is worth considering an intravenous injection of prednisolone for patients who smoke and do not have any history of gastric ulcers. Smokers have an increased risk of laryngeal edema immediately after a full-face phenol peel. 

We will look at each complication in detail, how to prevent it and how to treat it. Systemic complications, exclusive to phenol peels, are dealt with in Chapter 28. 

In the era before antiviral medication, I observed four cases which developed mild atrophic scarring after herpes simplex complications. Two herpetic infections followed medium peels and two occurred following phenolic peels... 

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]. 

Bacterial and fungal complications in chemical peels are rare, since phenol is bacteriocidal and fungacidal. Patients with positive history of herpes simplex infection can be treated proph-ylactically with acyclovir or valacyclovir during the healing phase for 10 days. 

The permeability of the human epidermis to many phenolic compounds correlates with their lipophilic pattern. However, phenolic compounds appear to produce denaturation in the skin, and an additional increase in permeability is attributed to the resulting damage to the epidermis. Complications of topical phenol, notably cardiac dysrhythmias, including death, can be caused by phenol face peels (10). 

It is remarkable that no cardiovascular complications were recorded in this study. Medical publications report that when a person is exposed rapidly to a sulEcient quantity of phenol (in general, 3-4 g of phenol applied quickly to the face), abnormal heart rhythms may occur. These abnormalities appear 15-20 minutes after the beginning of the peel and are often rapidly reversible. If any arrhythmia had developed during these cases of poisoning, it would no doubt have occurred rapidly and disappeared again by the time the patient arrived at the hospital. This argues in favor of the autonomous reversibility of arrhythmias with phenol. The authors cautiously conclude The absence of serious toxicity and major chemical burns in this series does not eliminate concern with the corrosive and systemic risks of phenol poisoning . 

In 1973, Litton, Fournier and Capinpin published the results of a survey covering cardiovascular complications during phenol facial peels. In the 493 questionnaires... 

If there were a secret to safety, it would lie in a thorough knowledge and understanding of this type of treatment. For doctors to give patients a wide range of choice, they must know how to use at least the three main types of conventional peels correctly alpha-hydroxy acids (AHAs), trichloroacetic acid (TCA) and phenol (for phenol, the doctor should at least know how to apply it locally). For each type of peel, the doctor must be perfectly acquainted with its indications, results, limitations and complications to be able to choose the right product for a given patient and to be able to apply it correctly. The patient should be informed of alternative techniques, their possibilities, contraindications, side-effects and cost. 

The possibility of using phenol as a more superficial peel has been broached elsewhere in this book. Because of the relatively high risk of toxicity and complications, this agent should only be used for deep peels carried out under strict control. 

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