What’s the Deal with Phenol Peels?

Skincare Anarchy
5 min readNov 30, 2023

By: Amy Niu

Chemical peels (also known as chemexfoliation or derma-peeling) are cosmetic procedures in which chemical agents of varying strengths are applied to the skin. According to Castillo and Keri (2018), this process induces exfoliation. After a chemical peel, the dermal and epidermal layers are regenerated from the adjacent epithelium, resulting in improved skin texture and appearance [1]. Castillo and Keri (2018) note that there are three types of chemical peels — superficial, medium, and deep. Dermatologists decide which type of peel is right for a patient based on a physical exam and past medical history [1].

According to Samargandy and Raggio (2023), most of the contraindications (situations in which the procedure must be avoided, according to MedlinePlus) for chemical peeling pertain mostly to medium and deep peels, but there are some that pertain to all types. These are darker skin types, active infection, open lacerations or wounds in the area to be treated with a peel, history of allergic reaction to a peel, active treatment with isotretinoin and the presence of body dysmorphic disorder [2]. Contraindications that are specific to medium and deep peels, including phenol peels, are: isotretinoin use within the past six months, pregnancy or breastfeeding, psoriasis, connective tissue diseases, atopic dermatitis, poor wound healing, recent facial surgery, uncontrolled diabetes or immunosuppression, malnutrition, protein deficiency, chronic glucocorticoid use, smoking, prior exposure to radiation therapy and predisposition to formation of keloids [2].

Castillo and Keri (2018) raise the Fitzpatrick skin type scale as a useful tool for determining the preoperative risk of post-treatment response and complications, though the scale was originally developed to classify patients based on their skin color and ability to tan [1]. Castillo and Keri (2018) argue that patients with dark skin such as Black, Asian, and Hispanic/Latino people (those with Fitzpatrick skin type IV-VI) should avoid deep chemical peels and emphasize pre-treatment preparations due to greater risk of post inflammatory hyperpigmentation and scarring. Likewise, the researchers note that risk of hyperpigmentation and scarring following a chemical peel is low for Caucasian patients (those with Fitzpatrick skin type I-III) [1]. Samargandy and Raggio (2023) agree with this assessment, noting that patients with darker skin types and those with a history of hypertrophic scar formation are at greater risk of complications following chemical peels. In addition, patients with renal or hepatic disease should not undergo phenol peeling, as phenol is metabolized by the liver and excreted through the kidneys [3]. Also, pregnant women should avoid all medium and deep chemical peels due to high risk of chemical absorption and damage to the fetus [1].

The American Society of Plastic Surgeons writes that phenol is the strongest chemical used for chemical peels, and it can penetrate down to the lower dermal layer of skin [4]. Samargandy and Raggio (2023) write, “Phenol is commonly used to treat various conditions such as photodamage, rhytides, acne scars, xanthelasma, actinic keratoses, actinic cheilitis, and lip augmentation.”

Samargandy and Raggio (2023) note that a specialized team must be present for cardiac monitoring because phenol peels carry with them the risk of cardiotoxicity. The team must also attend to fluid administration and advanced cardiac life support [2]. An anesthesiologist must be present to administer general anesthesia if used [2]. General anesthesia may be used for deep chemical peels or in the case of a highly anxious patient [2].

According to the American Society of Plastic Surgeons, there are four steps to the chemical peel process following pre-treatment: first, a plastic surgeon provides the client with a sedative and a local anesthetic to numb the face; second, after an appropriate amount of time, the surgeon brushes phenol onto the client’s face; third, the surgeon applies water to neutralize the phenol; lastly, the surgeon applies ointment, tape, or gauze to prevent dryness and pain [4]. Samargandy and Raggio (2023) write, “During a phenol peel procedure, phenol is typically applied only on a small portion of the skin at a time. The patient’s face should be divided into sections and treated for approximately 15 min each.”

Samargandy and Raggio (2023) list a variety of post-treatment instructions for deep chemical peels. Patients should avoid picking at the skin that was treated with phenol [2]. When washing their faces, patients should use a patting motion instead of rubbing, and they should select a gentle cleanser [2] They should also avoid using a washcloth; instead, they should gently dry their faces using a patting motion with a towel [2]. For one to two days after undergoing a deep chemical peel, patients should apply an ice pack or a bag of frozen vegetables to the affected skin for 10 minutes every hour [2]. Phenol peel patients should apply unscented, bland moisturizer to the treated skin three to five times a day to promote skin healing [3]. Soleymani et al. (2018) recommends applying mupirocin ointment for the first few days after a phenol peel to prevent bacterial superinfection. In addition, Samargandy and Raggio (2023) note that patients should apply gauze soaked in a solution of one teaspoon of white vinegar and two bottles of water to their faces for 10 minutes every hour. The application of the soaked gauze helps reduce bacterial growth on moist skin in the process of healing [2]. Samargandy and Raggio (2023) emphasize the importance of avoiding exposure to sunlight following a chemical peel.

Samargandy and Raggio (2023) write, “Deeper peels are associated with increased therapeutic effects and more significant risks.” Castillo and Keri (2018) caution that phenol peels comes with a high risk of systemic toxicity. This includes cardiotoxicity, hepatotoxicity, and nephrotoxicity [1]. Other serious complications specific to phenol peels are corneal damage, respiratory depression, laryngeal edema, and herpes simplex virus reactivation [1].

Given the high risk of complications with phenol peels, prospective chemical peel clients may want to use gentler chemical peels that can be done at home to treat acne vulgaris, wrinkles, sun damage and other facial aesthetic issues. Salicylic acid, Jessner solution and glycolic acid are three superficial chemical peels that present a substantially lower risk of systemic toxicity and other side effects [2]. Additionally, superficial chemical peels are suitable for all different skin types [2].

Chemical peel patients must always be informed of the risks and processes of the procedures they are looking to undergo so they can make informed decisions about how to best care for their skin.

Works Cited:

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053170/

[2] https://www.ncbi.nlm.nih.gov/books/NBK547752/

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122508/

[4] https://www.plasticsurgery.org/cosmetic-procedures/chemical-peel/deep

[5]https://medlineplus.gov/ency/article/002314.htm#:~:text=A%20contraindication%20is%20a%20 specific,or%20procedures%20are%20used%20together.

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