uses a phenol solution to achieve this result,
which is appropriate for treating moderate facial
blemishes, acne scars, sun damage, actinic kerato-
sis, and most wrinkles. The application procedure
takes about an hour, before which the dermatolo-
gist generally administers a sedating medication.
Following the phenol application the dermatolo-
gist coats the treated area with petroleum jelly or
other protective covering to reduce discomfort.
The treated area is immediately raw and exposed,
with scab formation in about 48 hours.
Swelling and discomfort are significant for a
week or two after a phenol peel, and most people
cannot participate in any regular activities during
this time and may require assistance if the
swelling causes their eyes to close. Proper care
during healing is essential, and typically requires a
regimen of ANTIBIOTIC MEDICATIONSand ointments
to help keep the healing tissue moist and supple.
The treated skin remains red and shiny for up to
three months. Full healing takes four to six
months, though most people can return to most
normal activities in about three weeks.
The effects of a phenol peel typically last sev-
eral years. The skin commonly loses its ability to
produce melanin, however, making sunscreen and
protective clothing such as a broad-brimmed hat
essential to prevent sun damage and SUNBURN
when outdoors. Most dermatologists recommend
applying sunscreen daily, after healing, as a rou-
tine preventive measure. The loss of melanin also
results in a permanently lighter pigmentation of
the treated area. Because of this, people who have
dark skin should not undergo phenol peels.
Risks and ComplicationsThough chemical peels can produce smoother,
more youthful looking skin, they do so by first
damaging the skin so it must repair itself. The risks
of chemical peels include infection, scarring, and
irregularities in pigmentation after healing. Some
people have adverse reactions to the chemical
solutions. People who are prone to cold sores or
FEVERblisters are likely to develop them during the
healing phase; many dermatologists prescribe
ANTIVIRAL MEDICATIONSto prevent these viral out-
breaks from occurring. Phenol may exacerbate
ARRHYTHMIA(irregularity of the heartbeat) in peo-
ple who have arrhythmia disorders.
See also AGING, INTEGUMENTARY CHANGES THAT
OCCUR WITH; BLEPHAROPLASTY; BOTULINUM THERAPY;
COLD SORE; DERMABRASION; LASER SKIN RESURFACING;
PLASTIC SURGERY; RHINOPLASTY; RHYTIDOPLASTY; SCAR;
VITILIGO.chloasma A pattern of hyperpigmentation, often
temporary, that typically affects the face.
Chloasma, also called melasma, develops with ele-
vated blood levels of ESTROGENS, such as occurs
during PREGNANCY, with some oral contraceptive
(birth control pill) formulations, and in chronic
LIVERdisease. When the cause is hormonal, the
hyperpigmentation fades when HORMONE levels
return to normal. Chloasma may also develop in
men or women who have liver conditions such as
CIRRHOSISor HEPATITIS. The melanocytes (melanin-
producing cells) in the affected areas of skin over-
produce melanin, the pigment that gives SKINits
color. The hyperpigmented areas have clearly
defined borders and often appear in symmetry,
resulting in a masklike appearance.
The doctor diagnoses chloasma on the basis of
its appearance and correlation with factors such as
pregnancy or liver disease. Topical solutions such
as hydroquinone and tretinoin (Retin-A) help fade
the chloasma in some people, though pregnant
women should not use these treatments. Both
medications have potentially serious side effects
and are for short-term use only (eight weeks or
less). As sun exposure intensifies melanin produc-
tion, dermatologists recommend wearing sun-
screen (sun protection factor [SPF] 30 or greater)
and shading exposed areas of skin from the sun as
much as possible. Chloasma is primarily cosmetic
and does not present a threat to health other than
that of any underlying condition. Most chloasma
resolves on its own when the underlying cause
health condition changes.
See also MELANOCYTE; ROSACEA; SUN PROTECTION.corns Growths of thickened SKINon the tops and
sides of the toes. Corns result from accumulations
of keratocytes that develop in response to
repeated pressure, typically from shoes that are
too tight, and are the body’s effort to protect the
skin and underlying tissues. A corn has a hard
inner core with a surrounding ring of thickened
though soft skin. Corns often hurt because theycorns 145