Scars phenol peels

The best results are achieved in macular scars. Ice pick and rolling scars cannot disappear completely and need sequential peelings combined with homecare treatment with topical retinoids and alpha hydroxy acids. For the deepest ice pick scars, phenol peels can be very useful but require monitoring. 

Peels are not indicated for hypertrophic scars. Some fine facial scars (from a face-Kft, for example) improve vastly after local application of some phenol peels others are improved by a combination of abrasion and peeling. Body peels produce fewer results and more problems that facial peels. 

TCA has some effect on shallow scars, but can only improve the general condition of the skin and cannot get rid of scars altogether. TCA can be combined with sandpaper abrasion (see the discussion of abrasive peels in Chapter 15) or scar subcision before the acid is applied. Even a phenol peel cannot always guarantee to heal acne scars. High concentrations of TCA can be directly applied on acne scars, levelly, with good results. 

Along with laser and abrasion treatment, a full-face phenol peel is certainly one of the best options for treating facial scars. It is not completely effective, however, and it is often necessary to use chemabrasion - that is, a combination of a phenol peel followed (immediately or the next day) by abrasion with a diamond fraise or sandpaper. See Chapter 30 for more information on the treatment of acne scars and phenol peel face lifts. 

A phenol peel always causes severe edema in the eyelids. Scarring, however, is very rare. 

Acne scars treated with a full-face phenol peel (Exoderm ). On the 8th day, there is a distinct improvement in the structure of the skin wrinkles have disappeared, along with small active acne lesions. However, the improvement in the acne scars remains limited. 

Normal face-lift scars are not usually too unsightly, but some patients want a treatment to soften them or get rid of them completely. A full-face phenol peel is the best option (Figure 30.19), but a local application of phenol precisely on the scar is also a possibility, in combination with another more superficial peel (to the papillary dermis, the Grenz zone or the basal layer). Standard scars from an upper blepharoplasty do not seem to respond as well to a... 

Phenol is applied up to the lower limits set before the start of the peel this forms the demarcation line (Figure 34.14). The skin on the neck is structurally different to that on the face it has fewer appendages and pilosebaceous imits. After a deep peel, the skin regenerates from these appendages. A phenol peel on the neck carries an increased risk of scarring. What is more, the usual post-peel facial edema tends to extend downwards to the neck, and if the neck is treated... 

Corticosteroids by the systemic route will only be needed very rarely to treat erythema. They can be administered in a single and preventive injection at the start of a phenol peel. Promethazine can be recommended, at a maximum dose of six times 25 mg/day, when the erythema causes pruritus and reflex scratching that could lead to unsightly scars, infections or dyschromia. 

If there are air bubbles in the occlusive dressing, the phenol cannot macerate evenly, and some areas will be undertreated, whereas if the occlusive mask is too tight, scars can form where the severe edema that develops in the first few hours after a phenol peel causes too much local pressure. 

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. 

Park JH, Choi YD, Kim SW, Kim YC, Park SW (2007) Effectiveness of modified phenol peel (Exoderm) on facial wiinkles, acne scars and other skin problems of Asian patients. J Dermatol 34 17-24... 

Skin Facial scarring can occur as a result of the use of phenol to peel the skin, particularly if it is preceded by CO2 laser treatment first, perhaps because the depths at which the phenol peel and laser ablation acts are additive when the laser is applied first and perhaps because the laser causes loss of the epithelial barrier, allowing the phenol solution to perfuse deep into the dermis and causing further tissue damage [29" ]. However, hypertrophic scarring has been described after a phenol peel alone in a 75-year-old woman [30 ]. 

Kim DW, Ahn DS. Delayed wound healing and scarring after combined ablative laser and phenol peel treatment. J Plast Reconstr Aesthet Surg 2010 63(5) e484-5. 

Katz TM, Glaich AS, Goldberg LH, Friedman PM. 595-nm long pulsed dye laser and 1450-nm diode laser in combination with intralesional triamcinolone/5-fluorouracil for hypertrophic scarring following a phenol peel. J Am Acad Dermatol 2010 62(6) 1045-9. 

Scarring was the second most common com-plicahon reported, with the most frequent sites being the lip, chin, and perioral areas [315]. Thirteen percent of these plastic surgeons had experienced systemic cardiac complicahons (tachycardia, arrhythmias, premature ventricular contractions (PVCs), paroxysmal atrial tachycardia (PAT), and hypertension) during phenol peeling [315]. Of these, tachycardia was the most frequent [315]. An 11-year-old boy treated with phenol for xeroderma pigmentosum developed multifocal ventricular arrhythmias with heart rates up to 220 beats/min [329]. 

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