Phenol peels toxicity

Lip Eyelid formula is a phenol peel that I first developed to increase dermatological safety and to achieve results without any occlusion on the sensitive skin of the eyelids. The same solution was then applied to the wrinkles around the mouth and then to the whole face, but with 24 hours occlusion in these two indications. It is an oil solution of phenol at over 60%. Four different oils are used in the various stages of the product s preparation. The aim of the oily formulation is to slow down the penetration of the phenol through the skin and to improve dermal and epidermal maceration. It limits the toxicity of phenol by saturating the biochemical hepatic detoxification pathways more slowly. 

Moderate (tame) its systemic toxicity. Different substances have been combined with phenol to reduce its adverse effects. It should be noted that the only demonstrated way to avoid cardiac toxicity lies in the application technique for a full-face phenol peel. 

When phenol is dumped into river water, it is very toxic to aquatic fauna and lethal at a concentration of 1 ppm. The genuine toxicity of phenol and the almost apocalyptic descriptions of its side-effects, which can even lead to death by cardiovascular collapse, severely limited its cosmetic use imtil the second half of the 1990s, especially in Europe. English-language publications, for their part, state that, even so, a phenol peel is one of the most frequently used techniques in the treatment of photoaging . ... 

During a full-face phenol peel, 2.5-5 ml of phenol solution is usually applied on the skin. The conventional formulas (Litton and Baker) use concentrations of around 50%. Applying 3-4 cm of solution therefore leaves 1.5-2 g of phenol on the skin. It is important to be aware of the fact that the toxicity of phenol solutions appears to be paradoxical, as, up to a certain point, diluted solutions can be more toxic than concentrated ones. Publications report that simple aqueous dilutions of 2 parts phenol to 1 part water (i.e. solutions with a concentration of around 33% ) are usually the most dangerous. Some phenol peel formulations still use this concentration, however, confusing speed of penetration with cosmetic effectiveness. 

Baker s point of view is fully shared by Cortez, who, in a retrospective study of hundreds of phenol peels that he carried out between 1983 and 1990, did not observe any cardiac toxicity when the precautions for use were followed. 

Some cases of hepatic and renal toxicity after severe poisoning with phenol derivatives have been reported in the literature, but I have not been able to find any such record in medical publications dealing with phenol peels. 

There are many drawbacks to using this product in a full-face phenol peel its slow onset of action requires patience, and the nerve block takes about 30 minutes to set up but lasts 180-360 minutes. This product is painful to inject. The doses required to produce a nerve block of the whole face are lower than the neurotoxic doses, but not by much. As we saw above, the dose required for the face is at least 50 mg, while the toxicity threshold starts at 80 mg and the maximum allowed dose is 150 mg. As we saw in Chapter 28, Lalanne s experiment clearly shows that perivascular injections, even when the blood vessels have been properly dissected and are in plain view, can be followed by... 

Thymol (thymic acid) is extracted from essence of thyme. It is four times more bactericidal than phenol and ten times less toxic. Thymol iodide is used on burns in the same way as iodoform, but has the advantage of not being absorbed and not having any odor. It is less irritating on wounds and mucous membranes than dithymol diiodide or aristol. Thymol iodide powder, an antiseptic that is used often after a phenol peel, physically alters the selective permeability of plasma membranes. It is nevertheless a protoplasmic poison that denatures enzyme proteins and is also an allergen. 

Histological sections taken after phenol peels show that melanocytes are still present, though many of them are inactive. Clinically, fewer melanocytes are rendered inactive with the latest formulas (e.g. Lip EyeHd ). This means that long-term prognosis for sun exposure can be better with these peels than with older phenol formulations and that a few months or even a year after the peel, it is often difficult to see a demarcation Hne. The melanocyte toxicity of phenol means the practitioner must choose the product most suited to the patient s complexion. 

Treatment is aggressive and requires hospitalization. Patients should be taken to hospital as soon as there is any suspicion of toxic shock (raised temperature) and before any other symptoms appear. The symptoms of infection are often hard to spot there was no visible sign of infection beneath the thymol iodide powder before the start of toxic shock described in the 1980s after a phenol peel (Baker s solution). Toxic shock syndrome can come like a bolt from the blue. In the cases described, the skin recovered normally and no scars were left after recovery. 

Recently, some phenol formulas have been presented as allowing a full-face peel without any anesthetic. A phenol peel that can be applied to the whole face without any type of anesthetic is a more superficial phenol peel that does not induce regeneration of the reticular dermis of the same quality as the classic phenol peels. Less pain goes hand in hand with inadequate results the results of this type of phenol peel are the same as for a TCA peel to the papillary dermis and may not have much effect on wrinkles. The pain caused by these peels is also the same as for a TCA peel to the papillary dermis. It is pointless to put a patient through the risks of phenol toxicity only to get the results that a simple, non-toxic molecule (TCA) can achieve. An effective, full-face phenol peel should therefore be used with an anesthetic (see Chapter 33). 

A combination of paracetamol (acetaminophen) plus codeine is especially well suited to post-peel pain, but should not be used in the hours following a phenol peel, as paracetamol (a phenol derivative) goes through the same detoxification pathways as phenol, which could create metabolic competition and the risks of toxicity associated with phenol might be increased. Preventive administration of benzodiazepines (lorazepam 2.5 mg before the peel and on the night of the peel before going to bed) relieves the anxiety caused by these unpleasant sensations and reduces the need for analgesics after the peel. In case of very severe, localized pain (extremely rare), a nerve block could be used. 

Although rare, toxicities can occur with resorcinol, salicylic acid and phenol peels. 

Phenol peels are categorized as deep peels. Similar to TCA, phenol works through protein denaturation and coagulation. However, phenol differs from TCA in that it penetrates quickly to the level of the reticular dermis. Phenol is partially detoxified by the liver and excreted through the kidneys. Percutaneous absorption of phenol can lead to rapid elevation of serum phenol levels, resulting in systemic toxicity and cardiac arrhythmias. Therefore, all patients should be cleared from a cardiac, hepatic, and renal standpoint preoperatively. In addition, intraoperative cardiac monitoring is imperative. 

Although 50% TCA with or without proprietary additives is less toxic than phenolic peels, its unpredictability makes it unsuitable for routine use. Phenolic peels, despite... 

Phenol is toxic when used in high doses. Phenol is metabolized in the liver and excreted by the kidneys. Although it has the potential to cause hepatorenal toxicity, this is not usually seen in chemical peels because the dose absorbed is not high enough. The most common systemic effect seen with phenol peeling is cardiotoxicity. The majority of phenol is absorbed within the first 30 minutes of its application. Thus, higher doses over a short amount of time are more likely to have systemic effects. The toxicity produces arrhythmias despite prior normal heart function. The occurrence of these arrhythmias is not... 

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]. 

Oral poisoning after accidental phenol ingestion has caused fulminant central nervous system depression, hepatorenal and cardiopulmonary failure [20]. No hepatorenal or central nervous system toxicities with properly performed chemical peels have been reported in the literature [21]. 

If we leave aside these variables, we can fit the dilferent types of peels into their appropriate slots. This is just for the beauty of the exercise however, as the variables stiU need to be taken into account. It is clearly possible to perform a superficial or medium peel using phenol. But, given the inherent toxicity of phenol, what would be the point What is more, 70% unbuffered glycolic acid that is left for 10-15 minutes on a thin, sensitive skin that has been prepared with retinoic acid can result in a cosmetic disaster. It is possible to carry out good-quality, deep peels with TCA, but the risks can be greater than if phenol is used correctly. 

Ayres achieved a medium-depth peel by combining phenol and trichloroacetic acid (TCA). These two formulas are no longer used today, as there are many other modern peel solutions that provide effective medium-depth peels using other molecules, such as TCA, that are not potentially toxic. 

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