COMPARATIVE STUDY OF PHENOL BASED CHEMICAL PEELING

Dr. Vijay SharmaDr. Vijay SharmaPresidentPresident

Federation of Restorative and Cosmetic SurgeryFederation of Restorative and Cosmetic SurgeryMumbai, INDIAMumbai, INDIA

Introduction

Chemical peeling or chemoabrasion means superficial destruction of epidermis and upper layer of dermis with the help of 'cauterent' applied to the skin. Chemical Agent: I use the basic formula given by Baker (1962),  Contents:  

Phenol (I. P.) 3mlDistilled Water 2mlLiquid Soap 8 dropsWith and without craton oil.

 In this series of 127 cases 53 were treated with the same formula (chemical agents with craton oil), rest all the patients were treated without craton oil.

Mode of action Mode of action is a most similar to emulsification of Dermis. The Coagulatory activity of Phenol destroys the epidermis and upper layer of dermis which remains in position as a scab and new growth of edpidermal cell, takes place within 5-7 days while dermal regeneration occurs within 2-3 weeks. Destruction of epidermis and upper layer of dermis results into the removal of rough, pigmented, uneven skin, new epithelisation of epidermis with diffuse tightening gives a smoother look. This firmness and elastic quality of skin are because of thickening of dermal papillary layer due to horizontally oriented collagen fibers; pinkness of skin can be explained by increased vascularity. Microscopic studies to check the depth of penetration of phenol by measuring the width of coagulated layer, which peels off in the form of fine scab, a depth of 0.3 to 0.5 mm was observed in this series of study.

Histological Changes: Histological studies have shown equalization of architecture of the collagen tissue in the dermal layer as well as reduction into the quantity of Melanin granules in the basal layer of epidermis. Indication:

Sr. No Indication No. of cases No. of sittings

1 Fine wrinkles due to ageing

57 One

2 Acne marks 12 Two

3 Deep acne marks 27 Two

4 Small pox marks 7 Two

5 Deep small pox marks 17 Three

6 Abnormal pigmentation 7 One

Technique or Procedure: A combination of tranquilizer and analgesics are given before fifteen minutes followed by small dose of Pentothol. The face washed thrice with the help of Savlon (Chlohexidine).Application of Antibiotic ointment for the eyes.

Single application of fresh Chemical solution over face-skin , followed by no dressing and continues blowing of air over the face is the standard procedure utilized on all these patients.Postoperatively sedatives were used frequently. Next day onwards application of dry "Neo-sporin" powder over the face till the scab comes off from the face. It takes around 7-12 days on an average. In my series I have not applied any type of dressing or paper tapes over the operated area. A cool breeze of air over the face by fan, helped the crust to dry up faster. Immediately after the application of chemicals, the coagulation of the protein in the skin layer shows a white coloration of the skin followed by light brown colour within first three days.

PRECAUTIONS:

I always give special instructions to be obeyed strictly and honestly as follows:

From Day One of Operation till scab peels off:1. Avoid talking, chewing or unnecessary jaw movements2. Take only liquids with the help of a straw3. Ensure a continuous flow of cool air over the face to keep it as dry as possible.4. Use a LISTERINE mouthwash twice daily or as advised.5. Take the prescribed medicine regularly.6. Cut your nails short and wear hand gloves at night to avoid unconsciously

scratching at your face in your sleep. From the day after peeling to 24 weeks:1. Avoid exposure to direct sunlight and/or a running T. V. screen or sharp / bright

electric light2. Wash your face very gently and dab it dry with towel as shown to you by your

doctor. Avoid rubbing it with the towel3. Apply a protective layer of moisturizing cream over your face at frequent

intervals.

COMPLICATIONS:

Sr. No. Complication Percentage

1 Irritation (a) With Catlar & Sleep Anaesthesia (b) With Anaesthesia

3%89%

2 Edema 98.4%3 Post Operative Itching 37%4 Delayed peeling (more than ten days) 18%5 Abnormal Pigmentation after peeling

(a)  Within six weeks (b) Within six to eighteen weeks (c) After twenty-four weeks

4.2%1.34%2.1%

6 Dissatisfaction 9%

PHENOL TOXICITY: Amount of phenol used for chemical peel does not have any toxic effects on patients unlike those seen after systematic absorption in large doses. Phenol has got the basic toxic effects on kidney, liver, medullary centre and myocardium, in the form of vasomotor collapse, convulsion, respiratory failure and sometimes death can occur if immediate treatment is not given. This mainly occurs with the heavy doses of phenol injection or large burns through carbolic acid. In this series of 127 cases, entire face was covered and no ill effect was observed in the postoperative period. Spectrophotmetric studies were done to check the systematic absorption of phenol one hour after the peeling, which revealed an average 0.54-milligram per 100ml of blood level, of phenol. None of the case had faced any serious toxic symptoms other than occasional immediate postoperative palpitation and tachycardia. Few of the patients showed the transient urinary signs like albumin, urea and granular casts after an interval of 2-4 days. All the patients had under gone complete medical checkup before and after the surgery.

Conclusions: Chemical peeling is a good skin surface leveling technique for selective patients who have wrinkles, uneven skin surface due to acne marks, or smallpox lesion, it has got limitations of staging with deeper uneven surface.

Sr. No No. of Cases Percentage of Success 1 Fine wrinkles due to ageing 57 68.9%2 Acne marks 39 36.4%3 Small-pox 24 43.7%

Some important precaution of avoiding exposure to the light is must, and no smoking. In certain percentage of patients, hyperpigmentation due to lack of care by exposing to light or smoking has been observed and once the pigmentation is developed then it may take a long time to go, for which a repeat peel can be advised only after 24 weeks.

Result of two sittings of Chemical Peeling at a interval of 6 months for uneven skin surface due to multiple acne pits.

Results

Result of one sitting of Chemical Peeling at a interval of 6 months for uneven skin surface due to small pox scars.

Results

Result of one sitting of Chemical Peeling for uneven pigmentation of skin surface

Results

Result of two sittings of Chemical Peeling for uneven pigmentation of skin surface

Results

Result of three sittings of Chemical Peeling at an interval of 6 months a each, for uneven skin surface due to small pox.

Results

Result of three sittings of Chemical Peeling at an interval of 6 months a each, for uneven skin surface due to acne pits.

Results

Thank youThank youDr. Vijay Sharma, M.D.Mumbai, INDIA