Phenol peels medications used

Phenol is a benzyl alcohol and a major oxidized metabolite of benzene that was introduced into medicine as an antiseptic (1). Although it can be prepared in an aqueous solution or in glycerine, it appears to be more effective when mixed in aqueous compounds. At a concentration of 0.2% it is bacteriostatic and at over 1% bactericidal (2). In addition to its uses as an antiseptic and disinfectant, phenol is also used as a sclerosant, as a local anesthetic on the skin, and as an analgesic, by injection into nerves or spinally, but its use was limited by severe adverse effects. Current medical uses include cosmetic face peeling, nerve injections, and topical anesthesia. It is also an ingredient of various topical formulations, and is used as an environmental disinfectant. 

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. 

For more than 50 years, lay peelers used phenol in full-face peels for cosmetic purposes without any medical monitoring. Cases of deaths related to phenol peels date from this era and up until the 1960s. 

A few doctors have been known to talk (sometimes proudly) of conduct that has more to do with greed than good medical practice they try to economize on the volume of peel solution by whatever means they can. Technically, it is of course possible to use less solution for a full-face peel, but this kind of misplaced economy is not to be recommended. The efficacy of a phenol peel is also dependent on the total quantity of phenol that is applied to the skin and that reaches the dermis. If too little phenol is applied, the results will be inadequate and in the long run it will cost the doctor more to do touch-ups than to apply the right amount of good quality solution in the first place. As in many other areas, false economies do not make a fortune. 

Medicine has made wide use of phenols in many indications, as we shall see later in this book. Medical publications on peels aboimd in terms that are no longer in use and names of outdated molecules, which makes some texts difficult to read. It is therefore worthwhile taking a quick look at what these terms and compoimds correspond to. 

According to the classification of A. Tenenbaum, which is described later in this chapter, peelers should be careful with the dangerous distinction between so called cosmetic , peelings for acids with pK, > 3 and medical , peelings for acids with pK, < 3, because some adds like salicylic acid with a pK, near 3, as the phenol, toxic substance with a pKa > 3 need to be exclusively used by trained physicians. 

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