Phenol in dermatology: updated evidence on efficacy and safety

Phenol, or carbolic acid, is an organic compound with caustic and antiseptic properties widely used in dermatology. Since its introduction as an antiseptic in the 19^th century, its use has expanded to various areas of medicine, including the treatment of dermatological conditions such as vitiligo, warts, guttate leukoderma, hidradenitis suppurativa, angiosarcoma, acne scars, alopecia areata, onychocryptosis, and actinic keratoses. In deep peels, phenol stands out for its effectiveness in skin rejuvenation, promoting intense and sustained neocollagenesis, with unparalleled results. Its ability to alter dermal structure makes it an essential therapeutic tool in various dermatological approaches. However, its use requires extreme caution due to its rapid cutaneous absorption and unique toxicokinetic profile. The substance can induce serious complications, such as cardiac arrhythmias, renal failure, neurotoxicity, and multiple organ failure, especially when applied to large areas or with inadequate techniques and formulations. Historical and contemporary studies report cases of fatal poisoning due to cutaneous exposure to phenol, highlighting the need for strict precautions in its use. To minimize these risks, it is essential that procedures be performed by highly trained physicians, with constant monitoring and controlled application, to ensure safety and maximize the therapeutic benefits of this substance, whose efficacy is widely recognized.