Chemexfoliation--indications and cautions

Chemexfoliation (chemical peeling) is being used to obtain both therapeutic (e.g., actinic keratoses) and cosmetic (e.g., removal of fine facial rhytides) benefits. Phenol, one of the most widely used agents for inducing cutaneous exfoliation, may induce cardiac arrhythmias and is toxic to the liver and kidneys. Trichloroacetic acid is not significantly absorbed and therefore does not produce systemic complications. Both phenol and trichloroacetic acid may produce hypertrophic scars and/or keloids and pigmentation irregularities, may accentuate preexisting abnormalities (e.g., telangiectasias, nevi, and pores), and may be associated with a flare of latent herpesvirus infection. Prolonged erythema of the treated areas and persistent rhytids have been reported with both agents.