Since 3500 BC, chemical peels (CPs) have been used to enhance the skin’s appearance. Today, CPs are an easy to apply, cost-effective treatment for skin conditions like acne, hyperpigmentation, scars and photo-aging. Still, some aesthetic practitioners avoid using CPs in Hispanic patients because complications are characteristic of mixed race and skin sensitiveness.
Hispanic or Latino skin does not behave like other specific race types. Unexpected reactions occur all the time. To avoid them, it is necessary to choose the appropriate peel for the suitable patient, and have the right plan of action to treat any adverse events (AEs) that could manifest during or after treatment.
In Margarita Island, Venezuela, where our speciality center, Aisthesis, is located, the weather is sunny most days, and a majority of the population is Hispanic or mixed race so we have a considerable amount of experience treating these skin types. Our medical staff has developed an easy, three-step approach we call “The 3Ps for Peelings”, a strategy to avoid the AEs associated with CPs.
Step 1: Prevention
The purpose of this step is to ensure selection of suitable patients for CPs by asking the right medical and personal screening questions. The focus of the inquiries should be on medication (prescribed/OTC and skincare) and work-life (work and leisure) habits.
Habits are defined by the Oxford dictionary as “a settled or regular tendency or practice”. They are automatic actions that patients perform that could interfere with treatment outcomes and cause unwanted manifestations.
Examples are the use of non-compatible OTC herbal supplements, changes in the prescribed skin conditioning program, or exposure to activities at or off work that might be contrary to recommendations.
In addition, if from your screening you determine the patient is suitable for a CP, a pre-conditioning skin program and specific instructions should be prescribed and explained in the office.
Step 2: Peel Selection & Compliance
Before selecting the proper CP, be sure the patient is willing to comply with treatment protocols and indications. Consider the possibilities of near-future social events such as parties, vacations, or birthdays that could inhibit recovery; do a debrief of the pre-conditioning skincare protocol the patient was prescribed (if the patient has fulfilled they will easily remember); then observe the skin to visually evaluate if the patient followed the protocol.
When choosing the proper CP for a Hispanic patient in the Caribbean, avoiding AEs is much more than just inhibiting melanin production because of the constitution of this skin type.
There are three relevant characteristics recommended that CPs should have to facilitate a speedy and well-expected recovery:
1. Fast keratinocyte replication, as with retinoid peels.
2. Mild irritation and appropriate skin hydration, as with lactobionic and lactic acid.
3. Melanin control supplemented with tranexamic or salicylic acid to regulate inflammation.
Step 3: Plan
Establish your plan to detect and treat early onset AEs as soon as they appear. The easiest way to identify them is with the help of your patient, so explain the procedure and the typical sensations and effects of the CP you are applying, to help curtail the impulse of the patient to exaggerate or hide significant symptoms that could alert you to an AE during or immediately post procedure.
Three warning signs of a possible AE during a CP treatment include:
1. Burning sensation: The patient should feel a tingling sensation. The the patient should not feel like their face is being ripped off or melting.
2. Inflammation: Mild erythema is normal. Prominent inflammation may turn into post-inflammatory hyperpigmentation.
3. Frosting: Is it a pseudo effect or a real frosting? The difference is that pseudofrosting goes away with just water (salicylic acid).
If you notice one or more of these indications, immediately start treatment to control inflammation with cold compresses and skin hydration; oral antihistamines and topical steroids should be prescribed twice for at least five to ten consecutive days.
In the presence or absence of AEs, the skin has been transformed and needs specific post-peel care and maintenance instructions. Make sure your patient fully understands and appreciates that post-treatment care involves much more than just avoiding sun exposure; and that they consent to abide by and fulfill the post-treatment care regimen you have developed for them.