Post-peeling Care and Complications

Following the peel the skin is carefully observed for any complications such as hyperpigmentation and infection. Results are maintained with serial peels and by using at-home tretinoin or glycolic acid, as well as by sun avoidance. 

Moreover, some studies have demonstrated that glycolic acid could cause an increase in the level of skin damage in a dose- and time-dependent manner. Lower doses (1 and 3 mg/cm ) of glycolic acid caused erythema and eschar at most, whereas higher doses (5 and 7 mg/cm ) of glycolic acid caused redness, edema and necrotic ulceration. 

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Post-peel care is essential to achieve optimum results and avoid complications. 

Bismuth subgallate (BSG) is a yellow powder that makes post-peel care easier and spares patients having to apply complicated localized treatments themselves, which could cause infection (see also Chapter 34). A generous amount of BSG is sprinkled directly onto the moist areas of skin where the epidermis has been destroyed, ft can also be spread on with a gloved hand or sterile swab. 

Trichloroacetic acid (TCA) in a simple aqueous solution (TCA-SAS) is the peel most widely used to partially or completely remove the papillary dermis. Strict pre-peel preparation is required to even out penetration, reduce melanocyte activity and accelerate post-peel re-epithelial-ization. The main purpose of post-peel care is to coimter complications (see Chapter 14). 

Post-ETCA care consists simply of asking patients to protect their skin from the sun (Melablock -HSP) and to apply the most suitable cosmeceutical for their particular problem (see Chapter 3). They should start the very day after the first of the four peels and continue until the end of the 6th week after the last peel. The post-treatment care after a TCA-SAS peel is more complex and needs much closer monitoring, as the risk of complications is much higher. Follow-up monitoring after a TCA peel to the papillary dermis is described in Chapter 23. 

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