Aesthetic Dermatology MCQ - Deep Chemical Peels

A 60-year-old woman with severe actinic damage and deep perioral rhytides is planned for a deep chemical peel. The procedure involves cardiac monitoring and fractionated application of the peeling agent to limit systemic absorption. Which of the following agents is MOST characteristic of a deep chemical peel?

A. Glycolic acid 50%
B. 20% Trichloroacetic acid
C. Phenol (Baker–Gordon formula)
D. Jessner’s solution
E. Salicylic acid 30%

Correct Answer:
C. Phenol (Baker–Gordon formula)

Explanation:
Deep chemical peels reach the mid-reticular dermis and are used for:

• Severe actinic damage

• Deep rhytides (especially perioral)

• Some cases of acne scarring

Phenol (Baker–Gordon formula) is the classic deep peel agent. It causes direct cytotoxic injury (toxic action) to keratinocytes and fibroblasts, followed by dermal remodeling and new collagen formation.

Important considerations:

• Requires cardiac monitoring due to risk of phenol-induced arrhythmias

• Fractional or staged application to limit systemic toxicity

• Risk of scarring, hypopigmentation, and prolonged recovery

• Contraindicated in patients with significant cardiac, renal, or hepatic disease

Other options:

• A. Glycolic acid 50%: Superficial AHA peel (epidermis only).

• B. 20% TCA: Superficial to light peel (not enough depth).

• D. Jessner’s solution: Superficial combination peel.

• E. Salicylic acid 30%: Superficial metabolic peel.

Key Point:
Phenol peels are the gold standard for deep chemical peeling, but they require careful patient selection, ECG monitoring, and post-procedure care due to systemic toxicity and high risk of pigmentary alteration.