Skin Peel Contraindications

Relative contraindications are determined by the skin type of the patient and the concern being treated. To optimize the procedure, some classifications are very useful, such as the Fitzpatrick classification.

Contraindications include the following:

• Active bacterial, viral, fungal, or herpetic infection
• Open wounds
• History of drugs with photosensitizing potential
• Pre-existing inflammatory dermatoses (eg, psoriasis, atopic dermatitis, pemphigus)
• Facial cancers, especially facial melanoma
• Uncooperative patient (patient is careless about sun exposure or application of medicine)
• Patient with unrealistic expectations
• For REFRESH peels, history of abnormal scarring, keloids, atrophic skin, or isotretinoin use in the last 12 months. The Refresh peel should not be done on patients with Fitzpatrick skin
types 5 and above.
• For GLOW peels, a patch tests should be carried out for patients with nut allergies.
• For Pure peels, a patch tests should be carried out for patients with Fitzpatrick skin types 5
and above.

Other considerations

Degree of photoaging damage
Patients with either severely damaged skin or excellent skin may not be the best candidates for chemical peels. Severely sun-damaged skin shows epidermal changes, elastosis, and collagen distortion in the mid-reticular dermis.
Superficial peels, even when performed in repetitive fashion, do not reach the affected histological level, and therefore have a minimal effect on severely photodamaged skin.
Smoking Patients must understand the necessity for smoking cessation. The dynamic action of puffing can worsen perioral rhytids, and the chemicals in the smoke can cause enzymatic reactions that weaken the skin and cause further wrinkling around the mouth and eyes.

Prior cosmetic surgery
Waiting several months following surgery that involves the face is recommended. Give the skin time to heal prior to subjecting it to chemical exfoliation. Compliance with pre-peel and post-peel treatment must be assured. The patient must be motivated enough to adhere to a daily regimen for a few weeks before and after the procedure.

Mental health
Patients who are mentally unstable may be overly self-conscious and may not be prepared for their aesthetic appearance immediately following the peel.

A thorough medical and drug history is very important. Medical conditions such as cardiac, hepatic, or renal disease may influence treatment decisions and the choice of peeling agents. Exogenous oestrogens, oral contraceptives, and other medications may
be photosensitizing and predispose patients to pigmentation complications after chemical peeling and worsening the skin discoloration that the chemical peel was intended to eradicate.

A history of herpes simplex requires antiviral prophylaxis from the immediate pre-peel period until re-epithelialization is complete. Acyclovir (400 mg) should be started 2 days prior to the peel and continued for 5 days after the peel to reduce the risk of recurrent herpes infection. Some dermatologists advise prophylaxis in all patients to avoid the risks of a herpetic outbreak. Any existing lesion must heal completely before undergoing a chemical peel.

History of scarring
Patients need to be asked if they have a history of hypertrophic scarring (medium deep peel). Many people who have hypertrophic scarring can develop keloids. This usually is found in patients with Fitzpatrick skin types 5 and 6 but can even develop in patients with skin types 1, 2, 3, and 4. REFRESH PEEL may stimulate keloidal development in patients who are inclined to develop keloids. Weak superficial peels can be considered in patients with skin types 1-6 because the penetration is only into the epidermis however a patch test is recommended.

A discussion between the practitioner and patient is necessary prior to a chemical peel.
Examples of before-and-after results should be shown, and the possibility of complications must be explained to the patient. Follicle unit density. Previous use of isotretinoin must be noted. Patients should wait until 6 months after the last dose of isotretinoin to reduce the risk of scarring. Patients who have had recent radiation treatment need to have a skin biopsy performed to ascertain the existence of hair follicle units, because these follicle units are where the re-epithelialization occurs.