Phenol in Chemical Peels

Chemical peels are a cosmetic treatment used to improve the texture of facial skin by causing dead skin cells to slough and peel off leaving behind smooth skin and a more rejuvenated and revitalized appearance. They can be used to correct sun exposure and aging spots, smooth out wrinkles, and remove precancerous growths (Corey, 2005).

Chemoexfoliation has been around since the late 1800s; by the 1930s and 1940s, physicians began to perform clinical trials and tests to determine if it should be allowed in the medical community. As time has passed, chemical peels have become more intricate and more varied. According to the American Society of Plastic Surgeons, as of 2007, chemical peels were one of the most common cosmetic operations and accounted for 1.03 million procedures in the United States (Corey, 2005).

There are three categories of chemical peels: light, intermediate, and deep. However, there are numerous types of chemical peels that fall into these three categories including: alpha hydroxy acid (AHA), beta hydroxy acid (BHA), trichloroacetic acid (TCA), glycolic acid, kojic acid, retinoic acid, Baker-Gordon, Jessner’s, and phenol. For this project, the group focused mainly on phenol chemical peels. The chemical solution used for phenol chemical peels is the strongest because it is used for deep skin chemical peels (Corey, 2005). It consists of two active ingredients that when mixed together causes an intense reaction that induces the exfoliating effects of the peel, croton oil and phenol (croton oil is considered to be a vehicle for phenol and the depth of the peel is more dependent on the concentration of croton oil and not phenol). However, of the two ingredients, phenol has been documented as being very toxic to humans due to its ability to denature keratin and allow it to penetrate deeper into the skin (Tisler, 1997).

The organic compound phenol (also known as carbolic acid) is composed of a six-membered (phenyl group; C₆H₅-) aromatic ring, bonded directly to a hydroxyl group (-OH). It is soluble in water and slightly acidic, which requires careful handling. Phenol was discovered in 1834 when it was extracted from coal tar. It can be made from the partial oxidation of benzene by either the cumene (isopropyl benzene) process or the Raschig-Hooker process or as a product of coal oxidation. Phenol is produced on a large scale, as it is a precursor to many useful materials and compound (i.e. drugs, plastics, etc.) (Tisler, 1997).

The toxicity of phenol is significant. Phenol can easily be absorbed through the skin (especially if it penetrates deep enough), quickly metabolized by the liver and its enzymes, and then excreted by the kidneys through the urine. Overdoses are very likely to damage the liver and kidneys and may eventually lead to problems of the central nervous system and heart (i.e. myocardial irritability/arrhythmias). The toxicity of phenol may also occur due to the formation of phenoxyl radicals in the body and its disturbances of certain body systems (especially respiratory, circulatory, etc.) (Conning, 1970).

Chemoexfoliation is safe, for the most part. However, like all cosmetic procedures, a risk is always present (as in deep chemical peels). The phenol and the produced vapors are corrosive to the skin, eyes, and respiratory tract. There are different ways the organic compound can enter the body though (e.g. through skin, through respiration, or eating and drinking products tainted with phenol) and each mode of transportation behaves differently. Repeated, prolonged skin contact with phenol can cause dermatitis or second/third-degree burns (if not decontaminated with polyethylene glycol, isopropyl alcohol, or water). However, if phenol is inhaled, the vapor is likely to cause pulmonary edema (Conning, 1970). There are methods to limit the possible side effects such as giving IV hydration to patient before and during procedure, extending the time of the full face peel to more than hour, and monitoring patients with telemetry after procedure is completed (Corey, 2005).