Chemical Peeling (How to deal)

ًDermatology and venerology center

Dr. Wael Nabil

Chemical peeling sheet

Date:----------------------------------------------------------------------------------

Patient name: -----------------------------------------------------------------------

Age:-----------------------------------------------------------------------------------

Clinical skin description:

Diagnosis:--------------------------------------------------------------------

Skin type:---------------------------------------------------------------------

Actinic degree:--------------------------------------------------------------

Sebaceous degree:-----------------------------------------------------------

Photographs taken:----------------------------------------------------------

Size of area peeled:----------------------------------------------------------------------------------------------------------------------------------------------------------

General evaluation of the patient:

History:

1- Pregnant or not? Adrenaline in the local anethetic should be avoided in the pregnant woman.

2- Taking any medication:

a. Local anesthetics may produce severe reactions in patients taking monoamine oxidase inhibitors

b. Aspirin pre or perioperatively may increase the risk of hematoma

3- Known allergy to the local anesthetics e.g. during dental anesthesia.

4- Liver disease: avoid amide group in patients with liver disease

5- Cardiac disease: adrenalin in the local anesthetic should be avoided in cardiac patients.

6- Hypertension: patients treated with non selective beta blockers should avoid adrenalin in the local anesthetic which may produce severe arteriolar spasm

7- Diabetes: adrenalin should be avoided as much as possible and contraindicated in the peripheral areas of less vascularity eg. Fingers, toes and penis.

8- History of glaucoma or eye headache: adrenalin is contraindicated in patient with glaucoma

Examine the patient for:

1- Bl. Pr.:

a. Cardiac disease

b. Liver disease

c. Renal disease

Investigate the patient for:

a. CBC

b. Liver functions

c. Renal functions

d. Electrolytes

e. Blood sugar

Preoperative prophylactic treatment:

1- corticosteroids may be needed

2- preoperative retin A

3- preoperative acyclovir in a dose of 200mg 3times daily.

4- Preoperative antihistaminics to prevent laryngeal edema that may occur after phenol peeling.

5- Avoid smoking for 2 weeks before and 2 weeks after phenol peeling (option)

6- Preoperative skin cleaning:

a. Day before the operation

i. Make up removal

ii. Shaving of the facial hair

iii. Washing the face with water and soap

b. Morning of the operation

i. Washing the face with water and soap

7- Preoperative skin degreasing:

--------------with alcohol--------------------------------------------------------------------------------------------------------------------------------------------------------------------

Preoperative analgesia:----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Anesthesia:

Local anesthesia:

Regional anesthesia

Ring anesthesia

Nerve block

General anesthesia:

Intravenous fluids (in deep phenol peeling):

1- To prevent cardiac, renal and hepatic toxicity

i. 500cc of lactated ringer’s solution prior to the operation

ii. 500cc of lactated ringer’s solution during the operation

iii. 500cc of lactated ringer’s solution after the operation

2- To prevent hypoglycemia: 250cc-500cc dextrose in water

Chemical agents and mode of application:-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Location (Diagram):

Keloid former:----------------------------------------------------------------------

Operative time:---------------------------------------------------------------------------------------------------------------------------------------------------------------

Postoperative condition:-----------------------------------------------------------

Postoperative dressings:-----------------------------------------------------------

Postoperative erythema and pruritus:

It is normally 30 days in superficial peeling, 60 days in medium depth peeling and 90 days after deep peeling. It is prolonged if topical retinoin is used prior to or after peeling and also if systemic isptretinoin is used prior to peeling (do not use isotretinoin after peeling because it delays healing). Prolonged erythema can be treated by elocon lotion.

Postoperative medication:---------------------------------------------------------

Attending physician:---------------------------------------------------------------

Assistant:----------------------------------------------------------------------------

Instructions to the patient:

The following can occur after peelimg and is normal and should not disturb you:

1. Erythema

2. Vesiculation

3. Peeling

4. Pruritus

5. Enlarged pores which is temporary

The following may occur after peeling and you should visit the doctor immediately:

1. Hyperpigmentation

2. Scarring

3. Atrophy

4. Texture changes

To avoid hyperpigmentation:

1- avoid exposure to sunlight for 2 weeks

2- put sunscreen for 6 months at least

3- nothing on the face except emollients and sunscreens

4- no contraceptives for 6 months after peeling---deviate to another contraceptive method if a must

5- no estrogens for 6 months after peeling

6- no tetracyclines for 6 months after peeling

7- no meladonine for 6 months after peeling

8- no makeup until the area has been resurfaced

9- no straining or carrying heavy objects after the operation

Postoperative taping:

a- Type of taping:

b- Period of taping:

c- Removal of taping:

Postoperative prescription:

1. Sunscreen

2. Panthenol

3. Isotretenoin

4. Betadine skin cleanser

5. Vaseline

6. BPP ointment

7. Skin respiratory factor

8. Vigilon dressing (hydrocolloid dressing)

9. Removal of milia with scalpel blade No. 11

Additional comments:--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------