Practice What You Preach: A Clinician's Guide to Chemical Peels

Leonid Rogozov, MD, Barry Marshall, MBBS, Hershel Dobkin, MD, FAAD -- What do these giants of medical history and innovation all have in common? They were all bold enough to forego an IRB approval and take medical progress into their own hands!

Pre-chemical peel

Rogozov removed his own appendix while stuck in an Antarctic research station. Marshall ingested a broth of Helicobacter Pylori and showed that this bacterium can lead to peptic ulcers. And that brings us to the real star of the historical show, Hershel Dobkin, board-certified dermatologist.

I, Hershel Dobkin, performed the infamous Jessner’s Solution and Trichloroacetic Acid (TCA) 35% “medium” depth chemical peel on myself. Why did I do it you may ask? In a nutshell, I wanted to have cool before, during, and after pictures to show patients interested in the procedure. Did I want to remove actinic keratoses, wrinkles, or blemishes on my mildly aged 33-year-old skin? Debatable.

Immediately post-peel

I can’t speak for other dermatologists, but to be able to point to a picture of yourself enduring the exact procedure you are educating a patient on, carries an extra bit of empathetic weight to it.

So, let’s set the stage for the peel. I waited until the end of an afternoon clinic, the day before a week staycation. I gathered the acetone, Jessner’s, and TCA by the sink. Now I know what astute observers of this article are thinking -- this is dangerous since I am standing and at the mercy of gravity with potent medical grade acids, as opposed to laying recumbent. Austin Powers, the international man of mystery, and I have the same middle name, Danger. Oh, I also forgot to use fans and ice packs to take the edge off, or a trusty medical assistant to reassure me every 10 seconds that everything is fine.

Day 4 post-peel

I did my best not to inhale the acetone, the Jessner’s solution just barely tingled, but the TCA is where the real magic happened. Once my face confluently frosted like Elizabethan era white makeup, and despite the thick layer of numbing cream I had applied, my face tingled and burned more than the worst shingles case I saw as a dermatology resident. How long did this last you may ask? Two to three hours. Not even the most delicious xanax or cold compress could have tamed this grease fire burn, although those would’ve been nice and something to consider for regular patients.

Aside from waking up sticking to my pillow with a layer of “corn flakes,” the first week after the procedure went well-minus the raging bilateral eyebrow and perioral impetigo that developed on day 4, which was quickly vanquished by a course of cephalexin.

3 weeks post-peel

My procedural timing was slightly questionable as I had bought tickets months previously to a Star Wars themed burlesque show that coincidentally occurred on day 4 post peel. As an avid Star Wars fan and nerd, I was not going to miss this show despite wearing a mask of my own skin with a nearly swollen shut left eye. I dressed as nice as I could with a blazer, mock neck, and slacks so as to appear as classy as possible despite my alien monster-like facial status.

2 months post-peel

To forego the comedy of this experience for a moment, it was at this show that I truly learned what many of our dermatology patients with facial dermatoses go through in public on a daily basis. Despite dressing like a classy mobster on the Sopranos, I received looks, smirks, gasps, and even a few concerned patrons asked me if I was okay. Hyper aware of how I was presenting at this festive evening, I took it all in and gained enough empathy points to last at least until the end of my career.

Two weeks after the peel the flaking was over, but post inflammatory erythema on my Fitzpatrick type 2 skin was setting in. Patient after patient asked me what happened, and to that I happily and proudly showed pictures of my peel journey. Many were impressed, many scared, and many asked me what the heck I was thinking. It was truly firsthand patient education and empathy in action!

Nonetheless, I have no regrets. I am currently constructing a glamorous Dobkin peel journey flip book. I also intend to place selfie peel photos on my exam room walls that I can point to when recommending field treatment for actinic keratoses, oh and to make wrinkles better too.