frosting and blanching: understanding the difference

Many times these terms are used incorrectly by clinicians, and it is important to understand the difference.

Superficial frosting is a crystal residue of salicylic acid that accumulates on the surface of the skin and can be wiped away.  Although it is very fine in texture, these crystals can be seen when using Jessner’s solutions, the PCA Peel^® formulas and solutions containing salicylic acid. Many times the crystals are so fine they are barely visible to the naked eye, but they will fluoresce under a Wood’s Lamp, which makes it helpful to check for even application of the peel formulation.

Protein coagulation, also referred to as blanching usually occurs from deeper peeling, such as medium depth or deeper. A full-face blanch may be performed by physicians to treat deep wrinkling or scarring, but should not be performed by skin care clinicians who are not physicians or working under the advisement of a physician. Blanching of this nature will result in open skin and a physician-recommended occlusive lubricant should be applied to keep the area protected and moist.

On occasion, spot-blanching may occur when any peel has penetrated more deeply in areas where the skin is more sensitive (a patient may forget to inform the clinician of a recent waxing) or where an extraction was performed.  This area will appear very red initially, and then appear white.  This cannot be wiped off, as with frosting, and may or may not cause discomfort to the patient.  Advise the patient that they may peel more and will probably have some darkening at the blanch site, and to keep the area hydrated, use SPF and do not pick or pull at any exfoliating skin.

Keep in mind that if a patient’s peel penetrates deeper in specific areas, those areas will have a pH closer to blood (7.3-7.4) than intact skin (5.5).  Products must be chosen carefully to accommodate for this change in pH.  Once the area is re-epithelialized (approximately 48 hours) the patient may introduce Hydrating Serum and Silkcoat Balm^®. To create an environment that can effectively produce natural moisturizing factor (NMF).  Patients who experience minor surface blanching may continue using the PCA SKIN^® Post-Procedure Solution.

why do I need to stay cool after a chemical peel?

PCA SKIN recommends remaining cool for 48 hours post-peel… buy why?

The epidermis is comprised of several layers known as the basal layer, squamous layer, granular layer and the cornified layer.  When a chemical peel is applied, even if it’s very superficial (stratum corneum only), it can cause a separation of these layers.  If your patient sweats for any reason, either from a work out, getting into a hot vehicle, playing golf or sitting on the patio, water can become trapped between these layers, which can lead to blistering.  Blistering can then cause hyperpigmentation, depending on the severity.

Another reason for staying cool is that internal heat can also lead to hyperpigmentation, which is especially a concern for those with melasma.

Many clinicians choose alternative treatments during the summer months due to the increased chances of thermal heat or sweating.  Others will offer chemical peel treatments later in the day, so the patient has less UV-exposure than they would at an earlier time.

Get to know your patients’ lifestyles, workout schedules, jobs (in case they work in a hot kitchen), and even their vacation schedule.  Taking note of this will enable you to treat their skin accordingly and avoid any heat-related complications post-treatment.