An examination of the phenol-croton oil peel: Part II. The lay peelers and their croton oil formulas

From the turn of the century, lay face peelers, known as "skinners," ran "beautifier" salons. Beginning in the 1920s, lay peelers were using croton oil-phenol formulas in Hollywood. These persons were renowned, made a good living, and treated many, if not most, of the leading "stars" of the day. They had a treatment, a "secret," that physicians did not. Physicians brought their own wives to the peelers for their expertise. The leading lay peel personalities from the 1920s through to our time are presented. The lay peelers dominated the field until the 1960s, when legal attacks on them, often directly instigated by the newly educated physician peelers, put them at a legal disadvantage. Nevertheless, there was considerable interaction with many plastic surgeons along the way. Some plastic surgeons came into possession of the techniques and some also into knowledge of the ingredients in a formula. The author has presented the recipes of four of the renowned lay peelers, two from Hollywood, Gradé and Kelsen, and two from Miami, Coopersmith and Maschek. These recipes all have 80 to 90 percent less croton oil than the "classic" Baker formula and, therefore, wound less deeply. The Hollywood formulas were used on many celebrities both inside and outside the film world from the 1920s to the early 1990s. These lay recipes are cumbersome to prepare. The author has simplified the preparation of these lay recipes by using USP liquid phenol instead of crystals. These simple formulas are provided in a table and are as easy to prepare as the Baker formula.     

An examination of the phenol-croton oil peel: Part I. Dissecting the formula

This article investigates which ingredients are the active ones in the most popular peel formula. The benefits of the "phenol" peel have been attributed to the effects of phenol on the dermis. Baker published a simple peel formula in 1962 that became a classic that has been used since by almost all plastic surgeons and dermatologists. Brown et al., in 1960, passed along a set of dogmas: (1) phenol is the active ingredient; (2) phenol peels more deeply in lower concentrations; and (3) adding a surface tension-lowering agent increases the peel. This article seeks to dissect the Baker formula by removing the croton oil. A patient was peeled serially with 18% phenol, 35% phenol, and 50% phenol solutions containing Septisol (surface tension-lowering agent) but no croton oil. This showed that increasing concentrations of phenol caused more clinical tissue reaction as evidenced by edema and erythema, but no significant dermal injury was seen. USP 88% phenol without Septisol did cause injury to the dermis. To test the effect of croton oil in the formula, the patient's face was peeled with two variations: the perioral area was peeled with 50% phenol to which croton oil was added to a strength of 2.1% and the remainder with 50% phenol without croton oil. The perioral area showed vesiculation, slough, and dermal exposure characteristic of a deep peel requiring 11 days to heal. The remainder of the face treated with 50% phenol without croton oil showed only edema and erythema without significant dermal injury. This experiment shows that the main postulates of Brown et al.--that phenol in lesser concentrations peels more than in higher concentrations and that phenol is the sole agent--are not true. In a fourth peel, a 0.7% concentration of croton oil in 50% phenol was applied to the parts of the face not peeled with croton oil in the third peel. The areas peeled with 50% phenol with 0.7% croton oil healed in 7 days, whereas the treatment with 50% phenol with 2.1% croton oil required 11 days. Deconstructing the Baker formula reveals fallacies in the four-decade-long belief system regarding these peels. The serial peels performed in this study show that increasing concentrations of phenol without croton oil cause increasing skin reaction but insignificant peeling effect. The addition of croton oil to 50% phenol, however, causes a marked increase in the depth of peeling into the dermis. Lowering the concentration of croton oil caused a lesser burn, as evidenced by fewer days to heal. The depth of the peel, therefore, seems to be more dependent on the concentration of croton oil than phenol. This will be further explored in Parts II, III, and IV.     

An examination of the phenol-croton oil peel: part IV. Face peel results with different concentrations of phenol and croton oil

In Part IV of this examination of the phenol-croton oil peel, the author presents peeling solutions using phenol in concentrations between 16% and 50% as the carrier for croton oil. Previously, in Part I, the author showed that phenol alone in concentrations of less than 50% has no significant peeling effect on the skin in the absence of taping. All of these formulas are dependent on the addition of croton oil for their peeling action. A topographic map of the face is presented that divides the face into the zones that the author believes are best treated with different strengths of croton oil. Five patients peeled between late 1992 and late 1995 were chosen as examples to illustrate the effect of different strengths of croton oil between 0.25% and 2.78%. The author has documented their immediate postoperative course photographically to show the effect of the different concentrations. It is clinically apparent that peels using croton oil between 0.25% and 0.5% generally heal within 7 days; peels between 0.6% and 1.0% usually heal within 9 or 10 days, and peels using concentrations higher than 1% heal later and have some risk of pigmentation loss. Peels using croton oil concentrations at 2% and above almost always have pigmentation loss and have healing delays in areas other than the thick skin of the lower nose and perioral area. The practical clinical formulas distributed at the time of the presentation of this article at the 1996 Annual Meeting of the American Society for Aesthetic Plastic Surgery in Orlando, Florida, entitled "Heresy Phenol Formulas--1996," are provided here. These have been used in both the United States and Europe over the past few years. A metric standard for drop size is suggested at 0.04 ml. This relates to the drop size used clinically over the years to measure croton oil. The adoption of this unit will make formulas around the world easier to calculate and compare. The author has produced a metric formula using the suggested standard size drop for croton oil. This uses 35% phenol as the carrier and provides the same range of treatment dilutions as the 1996 "Heresy Phenol Formulas." The need for research into "carriers" and solvents for croton oil is pointed out. Despite what is not known about how it works, the combination of croton seed extract and phenol has been a success story in providing facial rejuvenation from the 1920s to the present. The croton oil-phenol peel in its many formulas still sets the standard for facial rejuvenation.     

Quantitative and qualitative effects of chemical peeling on photo-aged skin: an experimental study

Chemical peel reverses the visible stigmata of photo aging in human skin. The qualitative and, in particular, the quantitative changes in the dermis that effect this transformation are unclear. This study used a recognized photo-aged animal model, the Skh:HR-1 hairless mouse, to quantify and qualify the changes that occurred in collagen and glycosaminoglycan content after chemical peel. One hundred Skh:HR-1 hairless mice were photo-aged by use of chronic ultraviolet B irradiation for 14 weeks. After irradiation the animals were randomly distributed into five groups of 20 mice each: group 1, control; group 2, 50% glycolic acid peel; group 3, 30% trichloroacetic acid peel; group 4, 50% trichloroacetic acid peel; group 5, phenol peel (Baker-Gordon formula). The respective peeling agent was applied to the dorsal skin of each animal while it was fully anesthetized. Punch biopsies were taken at several times after peel for histological and biochemical analysis. Glycosaminoglycan content was assessed at 14, 28, and 60 days using a colorimetric assay. Collagen content per unit volume increased initially 3 days after the procedure in all chemical peel groups, declining on day 7, and peaking again on day 28. Significant elevations (p < 0.04) were seen in the 30% trichloroacetic acid, 50% trichloroacetic acid, and phenol peels on days 3 and 28 in comparison with controls. This increase in collagen content was not maintained and returned to control values by 60 days. Glycosaminoglycan content per unit volume was elevated initially after peel with significant elevation (p < 0.02) in the 50% trichloroacetic acid and phenol groups on days 14 and 28. This increase in glycosaminoglycan content was not maintained beyond 28 days and declined to control values by day 60 in all groups. Histological examination demonstrated an increase in dermal thickness in the 50% trichloroacetic acid and phenol groups in comparison with controls by day 60. Under polarized light all chemical peel groups at day 60 demonstrated a reorganization of collagen in the reticular and papillary dermis. The elastotic masses that are pathognomonic of photo aging were present in the control group but were absent in the peel groups and demonstrated a reorganization of the elastic fibers in the dermis. This effect was deeper in the dermis in the deeper peel groups (50% trichloroacetic acid and phenol peel). The beneficial effects of chemical peel were due to a combination of two findings; a reorganization in dermal structural elements and an increase in dermal volume. These effects were more pronounced in the deeper peel groups.     

Adjunctive treatment of congenital pigmented nevi with phenol chemical peel

The purpose of this study was a retrospective evaluation of the treatment of congenital pigmented nevi using the phenol chemical peel technique. Patients were treated with standard Baker formula in the operating room under general anesthesia or intravenous sedation with continuous electrocardiogram monitoring. A total of 20 patients were reviewed (13 girls and 7 boys, mean age 3.8 years). Eight patients had nevi located on the face, five patients had trunk lesions, and three patients had lesions on the thighs. Two patients had nevi located on both the face and the trunk, and two patients had involvement of the face, trunk, and thigh. Three of the above patients had the classic "bathing trunk" distribution of the nevi. A test area was peeled in four patients, and in five patients preoperative biopsies were performed to rule out malignancy before initiation of therapy. An average of 2.6 treatments were performed per patient. Two patients had adjunctive dermabrasion to increase the depth of peel and to contour surface irregularities. The length of follow-up ranged from 6 to 84 months with a mean of 28 months. Healing of the wounds occurred within 2 to 3 weeks postoperatively. Seventy-five percent of patients had satisfactory cosmetic improvement in the appearance of the lesions following treatment. Four patients had recurrence of the pigmentation after an initial lightening response, three of whom had their nevi subsequently excised. There was no incidence of hypertrophic scarring or cardiac and/or renal complications. There was one death from complications of leptomeningeal melanocytosis. Chemical peeling of congenital pigmented nevi is an acceptable alternative method of therapy for those lesions that are too large for excision and primary closure or for lesions in which excision would result in unacceptable scars in areas such as the face.     

Cardiac arrhythmias during phenol face peeling

Thirty-nine percent of 54 phenol face peel patients treated rapidly developed some form of cardiac arrhythmia. When half the face was treated on consecutive days, only 22 percent of 100 patients developed cardiac arrhythmias and these were less severe. Serum phenol levels varied from 4.4 to 337.1 mg/L. Neither age, sex, nor previous cardiac history were accurate predictors of cardiac arrhythmia susceptibility. There was no predictable relationship between serum phenol level and the appearance of cardiac arrhythmia. The duration of the cardiac arrhythmias (2 to 19 minutes) suggests that the risk of cardiac arrhythmia in phenol peeling can be reduced by dividing the face into several units and spacing the application of phenol to each unit 20 minutes apart.     

Enumeration of petroleum-degrading microorganisms.

A variety of factors, including concentration of oil, antibiotics, dyes, and inoculum washes, were examined to determine their effect on the total counts of microorganisms on oil-containing media. The media found to be best for enumerating petroleum-degrading microorganisms contained 0.5% (vol/vol) oil and 0.003% phenol red, with Fungizone added for isolating bacteria and streptomycin and tetracycline added for isolating yeasts and fungi. Washing the inoculum did not improve recovery of petroleum degraders. Specifically, silica gel-oil medium and a yeast medium are recommended for enumeration of petroleum-degrading bacteria and yeasts and fungi, respectively. It is suggested that counts of petroleum degraders be expressed as percentage of the total population rather than total numbers of petroleum degraders per se. Incubation temperature and presence of oil was found to influence the numbers of petroleum-degrading microorganisms at a given sampling site.     

Patterning, prestress, and peeling dynamics of myocytes

As typical anchorage-dependent cells myocytes must balance contractility against adequate adhesion. Skeletal myotubes grown as isolated strips from myoblasts on micropatterned glass exhibited spontaneous peeling after one end of the myotube was mechanically detached. Such results indicate the development of a prestress in the cells. To assess this prestress and study the dynamic adhesion strength of single myocytes, the shear stress of fluid aspirated into a large-bore micropipette was then used to forcibly peel myotubes. The velocity at which cells peeled from the surface, V(peel), was measured as a continuously increasing function of the imposed tension, T(peel), which ranges from approximately 0 to 50 nN/ micro m. For each cell, peeling proved highly heterogeneous, with V(peel) fluctuating between 0 micro m/s ( approximately 80% of time) and approximately 10 micro m/s. Parallel studies of smooth muscle cells expressing GFP-paxillin also exhibited a discontinuous peeling in which focal adhesions fractured above sites of strong attachment (when pressure peeled using a small-bore pipette). The peeling approaches described here lend insight into the contractile-adhesion balance and can be used to study the real-time dynamics of stressed adhesions through both physical detection and the use of GFP markers; the methods should prove useful in comparing normal versus dystrophic muscle cells.     

Anti-inflammatory activity of compounds isolated from the aerial parts of Abrus precatorius (Fabaceae).

Two triterpenoid saponins 1 and 2 isolated from the aerial parts of Abrus precatorius and their acetates derivatives, 3 and 4 have been tested for anti-inflammatory activity using the croton oil ear model. All the compounds exhibited anti-inflammatory activity but the acetates showed greater inhibition than the parent compounds.     

Structural Study of 12-epitriptriolide Isolated from Tripterygium wilfordii

A new diterpene bisepoxide, 12-epitriptriolide (L1) was isolated from the leaves and roots of Tripterygium wilfordii Hook f. and from the marketed drug "Total Glycoside of Tripterygium wilfordii". This compound was crystallized from CHC13 as colorless needles,mp 267.5-269.5 C. Its molecular formula is C20H26O7. The structure was identified on the basis of spectral data (IR, MS, UV,1H-NMR,13C NMR, 2D-NMR,13C-NOE, NOE difference spectroscopy and selective long-range DEPT NMR) analyses. 12-epitriptriolide was shown to have a potent anti-inflammatory action. Its effective dose was 40 mg/kg with the murine model of ear swelling induced by croton oil while that of triptriolide was 70 mg/kg . The results showed that the action of the structure in connection with 12-αOH was about 2 times stronger than that of 12-βOH. 12-epitriptriolide showed no immunosuppressive and antifertility (male) actions in mice and had low toxicity (LD50>250 mg/kg ) in experimental animals. The preliminary assay for the structure-activity relationship revealed that the epoxide group on C12.13 of diterpene from T. wilfordii was one of the key positions associated with immunosuppressive and antifertility actions and toxicioty.     

Enhanced crude oil biodegradability of <Emphasis Type="Italic">Pseudomonas aeruginosa</Emphasis> ZJU after preservation in crude oil-containing medium

This study investigated the enhanced crude oil biodegradability of Pseudomonas aeruginosa ZJU, a strain isolated from the Shengli oil field (Shandong Province, China), after preservation in a crude oil-containing medium. This strain previously could not emulsify crude oil during preservation, but after switching to a subculture in a glycerol medium for passages, it expressed increased biodegradation of crude oil within the first six passages and this biodegradation sharply decreased after the seventh passage. It is noticed that about 70% of crude oil was degraded by Pseudomonas aeruginosa ZJU in the third passage while this biodegradability was less than 19% in the seventh passage. Similar to the trend on biodegradation of crude oil, rhamnolipid production increased during the first six passages and later sharply decreased. Thus, it seems that biodegradability was proportionally related to the rhamnolipid productivity in each passage in glycerol medium. Interestingly, both rhamnolipid production and crude oil biodegradation were maintained if this strain was continuously preserved in crude oil and could be retrieved if this strain was then re-preserved in crude oil-containing medium for seven days after the significant decline in these two characteristics previously observed in the seventh passage.     

Central modulation of croton oil induced subacute inflammation in rats

Earlier studies from this laboratory have indicated that CNS exerts a modulatory influence over acute inflammation in rats. The present study examines the existence of a similar modulatory effect of CNS on a subacute inflammatory paradigm, the croton oil-induced granuloma pouch in rats. The inflammatory exudate, collected on 6th day after croton oil administration, was found to be substantially less in intracerebroventricular (icv) cannulated and artificial cerebrospinal fluid administered rats as compared to their uncannulated saline (ip) administered counterparts. This effect may be due to stress induced by cannulation. Centrally administered pharmacological agents which attenuate central monoaminergic, cholinergic or prostaglandin systems had insignificant effects on the inflammatory exudate. However, induced increase in central noradrenergic activity was found to attenuate the inflammation when the treatment was done before, but not 48 hr after, the induction of the inflammation. In contrast, induced increase in central serotonergic activity had no effect on the volume of the inflammatory exudate at either time period. Steady state levels of rat brain noradrenaline and serotonin, but not dopamine, were enhanced by the inflammatory procedure. However, these effects may be attributed to the stress induced by croton oil inflammation. The investigation indicates that the modulatory influence of CNS remains limited to the acute phase of inflammation, being exerted mainly by the central noradrenergic system. Once the inflammation has progressed, this modulatory influence of CNS is no longer apparent.     

Calcium-dependent stimulation by a phorbol ester (PMA) of thymic lymphoblast DNA synthesis and proliferation

PMA (phorbol myristate acetate, i.e., 12-0-tetradecanoyl-phorbol-13-acetate) a tumor-promoting ester from croton oil, at its most effective concentration of 0.05 μg per milliliter, rapidly (within one hour) induces a large fraction of the lymphoblasts in suspended thymic lymphocyte populations to start making DNA, and these stimulated cells later progress into mitosis. This stimulatory PMA action is probably mediated by calcium because it disappears when calcium is omitted from the medium, and PMA strikingly increases the sensitivity of the lymphoblasts to calcium's stimulatory action.     

转化生长因子β mRNA在佛波酯刺激的小鼠表皮和化学性诱发的小鼠皮肤肿瘤中的高水平表达

转化生长因子β是一种细胞多功能调节肽,目前研究认为其和促癌过程有密切关系。本文利用Northern印迹分析技术研究了TGF-β mRNA在促癌物佛波酯刺激的小鼠表皮和化学性诱发的小鼠二阶段皮肤肿瘤中的表达情况。结果证明,巴豆油2—20 μL和TPA 5—40nmol一次局部涂用于小鼠皮肤,均可明显增加小鼠表皮TGF-β mRNA,呈较好的浓度依赖性。TGF-β mRNA表达在二甲基苯蒽(DMBA)和巴豆油诱发的二阶段小鼠皮肤乳头瘤和癌中均高于正常和瘤旁表皮。所检测到的TGF-βmRNA为2.5kb和1.9kb二种条带,但以2.5kb为主。     

The prevention of cardiac arrhythmias produced in an animal model by the topical application of a phenol preparation in common use for face peeling

We have shown in an animal model that complex ventricular arrhythmias produced by topical application of a phenol preparation that is used in face peeling can be prevented by a brisk diuresis at the time of application or by gradual application of the phenol preparation. We recommend that continuous cardiac monitoring and recording be performed in patients having topical phenol applications in order to determine the true incidence of cardiac arrhythmias and to ascertain if they are prevented by a forced diuresis, by the gradual application of the preparation, or by a combination of both.     

Copper and boron fixation in wood by pyrolytic resins

A phenol-formaldehyde (PF)-resin designed to penetrate wood and immobilize copper and boron in wood cells for protection against decay was investigated. The phenol portion of the PF-resin was partially substituted with pyrolysis oil derived from softwood bark. The objective was to reduce the environmental impact associated with the production of petroleum-borne phenol, as well as to improve the product economics. Leaching tests were conducted with three different formulas of resins containing 50%, 75% or 85% by weight of pyrolytic oil on a total phenol basis. The leachates were analyzed for the presence of copper by atomic absorption spectroscopy while inductively coupled plasma spectroscopy was used for boron detection. Copper leaching was reduced up to 18 times when comparing the treatments with and without the resin. Preservative leaching varied between wood species as well as between the resins containing different concentrations of pyrolytic oil. The organic leachates were measured using gas chromatography and mass spectroscopy. Trace amounts of organics, mostly acetic acid, were found in the leachates.     

Visualization of enzymatic hydrolysis of cellulose using AFM phase imaging

Complete cellulase, an endoglucanase (EGV) with cellulose-binding domain (CBD) and a mutant endoglucanase without CBD (EGI) were utilized for the hydrolysis of a fully bleached reed Kraft pulp sample. The changes of microfibrils on the fiber surface were examined with tapping mode atomic force microscopy (TM–AFM) phase imaging. The results indicated that complete cellulase could either peel the fibrillar bundles along the microfibrils (peeling) or cut microfibrils into short length across the length direction (cutting) during the process. After 24 h treatment, most orientated microfibrils on the cellulose fiber surface were degraded into fragments by the complete cellulase. Incubation with endoglucanase (EGV or EGI) also caused peeling action. But no significant size reduction of microfibrils length was observed, which was probably due to the absence of cellobiohydrolase. The AFM phase imaging clearly revealed that individual EGV particles were adsorbed onto the surface of a cellulose fiber and may be bound to several microfibrils.     

Antimicrobial efficacy of Achillea ligustica All. (Asteraceae) essential oils against reference and isolated oral microorganisms

The aim of this study was to verify the effectiveness of Achillea ligustica essential oils against several oral microorganisms in comparison with a commercial essential oil-containing mouthrinse (Listerine(?)) and clove oil (containing 89% eugenol). The inhibition efficacy of A. ligustica essential oils alone and in combination with Listerine(?) was evaluated by the micro-dilution method. The most susceptible microorganisms were Bacillus cereus, Streptococcus pyogenes, and Candida albicans. The efficacy was similar to that of the clove oil. The antiseptic mouthwash Listerine(?) did not exert a strong inhibition on microbial strains tested, whereas its effectiveness increased significantly when essential oil was added. The study provides additional evidence for the in vitro inhibitory activity of A. ligustica essential oils on several pathogens, suggesting their usefulness in mouthrinse formulations as an adjunct to mechanical oral hygiene regimens. Essential oil-containing mouthrinses can be beneficial, safe components of daily oral health routines, representing an efficient and without side effect alternative to prevent and control oral infections.     

Anti-inflammatory activity of amylin and CGRP in different experimental models of inflammation

The anti-inflammatory activity of amylin was studied in different models of inflammation, and compared to that of CGRP. Both peptides were active against mouse ear oedema induced by croton oil and acetic acid-induced peritonitis in the rat. CGRP was more potent than amylin in both models. Pretreatment with CGRP 8–37 fragment blocked the anti-inflammatory activity of both peptides in croton oil ear oedema. No anti-inflammatory activity was evidenced against serotonin-induced rat paw oedema and plasma protein extravasation induced by dextran in rat skin. Our results suggest that amylin exerts anti-inflammatory activity only in inflammatory models characterized by a vascular component. This effect appears to be mediated by the involvement of CGRP receptors.