Chemical peel with croton oil

Abstract

Chemical peels for skin rejuvenation preceded laser skin resurfacing. Various kinds of chemical peels are available. They reach various levels of skin depth from the epidermis to reticular dermis. The Baker-Gordon phenol peel, the gold standard since the early 1960s, provided the deepest and most extensive treatments with dramatic results (Plast Reconstr Surg 29:199-207, 1962). A “waxy” appearance and hypopigmentation after chemical peel may render these side effects “undesirable.” Fractional CO2 laser resurfacing has now become, in our opinion, the new standard of care for skin resurfacing. However, the cost of the laser delivery unit makes it financially burdensome on small cosmetic practices. Laser resurfacing is also associated with problems such as prolonged recovery from erythema and problematic long-term hypopigmentation. Hetter’s thoughtful analysis of the Baker-Gordon peel convincingly demonstrated that it was the croton oil that was the effective peeling ingredient (Plast Reconstr Surg 107:227-39, 2000; Plast Reconstr Surg 105:1061-83, 2000). By changing its concentration, Hetter showed that the peel depth could be controlled depending on skin thickness. In the old Baker-Gordon formula, 2.1 % croton oil was used, and it resulted in dramatic results. Nevertheless, it was also associated with hypopigmentation. Reducing the concentration to 0.1 %, for instance, allowed for predictable peeling of the eyelids without the resultant ectropion that would result from the older, higher concentration, formulation. As a cost-effective alternative to laser modalities, croton oil peel has given the plastic surgeon a safe, predictable, and reproducible treatment of skin dyschromia and mild-moderate rhytids. Chemical peeling should be performed under the technical control and responsibility of a physician with an understanding of the structure and physiology of the skin and wound healing. With the availability of other formulations that result in a relatively lower degree of peeling, the ultimate judgment regarding the appropriateness of any specific treatment must be made by the physician in light of all standard therapeutic protocols which are appropriate for the individual patient.