Hi all, I need some advice please.

I'm experienced in administering chemical peels - Jessner, TCA, AHAs, etc. -- I've done hundreds so this was bound to happen eventually, I suppose. :/

Whenever I do 4-6 layers of Jessner or a 15% or 18% TCA I make it a point to kind of "put the fear in" (lovingly, of course) my clients regarding post peel care. I always send them home with product, a list of steps for the next 7 days and I always say DON'T PICK. I tell them this verbally as well as in text and email.

Well, one of my regulars didn't listen to me. She is the first in over 200+ peels in the last year and I'm not sure what to do now.

She picked her forehead and as a result has the hyperpigmentation I warned her would likely happen if she picked.

I've asked her to come see me tomorrow (the earliest she can) so I can assess her skin in person.

I run a private studio and it's just me so I'm seeking advice from those of you that have had a picker with the same experience.

I suggested she use a cortisone / steroid cream in the mean time. Any advice offered is appreciated.

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Do you have a microderm machine? When I worked at a medi spa, I had many clients who would come to me to fix the hyper pigmentation they got from a laser treatment, or from strong peels elsewhere, many of these clients also did not listen to their Esthetician and caused it themselves. I would use microdermabrasion to fix it, but I would obviously start low. I would recommend lots of protection and I would also use brightening products on them as well as recommending products with lightening agents in them. Natural Hydroquinone, is an ingredient that blocks the enzyme "tyrosine" which is responsible for causing hyperpigmentation. I know you can find this in the skincare line Eminene, their "bright skin" collection, they even have the "bright skin moisturizer" with tyrosine blockers and SPF all in one product. You may be able to find these things in other product lines as well, or you can look for other tyrosine blocking ingredients; you may even have a few in your products. This all worked, but it did take awhile, as anything would in a situation like this.Do they just have hyperpigmentation; or do they have scabs or open wounds too though? Because that makes a difference.
Thank you for your response, Nina!

I don't have a microderm machine. It's on my wish list but I'm a one person studio and went out on my own a little earlier than I'd planned due to the instability of the spa I previously worked at for over a year.

The skin care line I carry does offer products with lightening agents that are alternatives to hydroquinone with SPF.

The peel itself was 15% TCA, hardly what I'd consider to be strong... Medium, definitely but ugh... I've done this particular peel numerous times and am so disappointed she picked. Prior to the TCA this client received monthly glycolic facials. In the picture I've attached (I haven't seen her in person yet since the peel; I'll see her tomorrow) - it looks as though the picking has caused some breakout activity, also. She picked on her 2nd full day of desquamation. The skin had JUST started to peel naturally the day before. :(

Aside from lightening agents & microderm (which I don't have) any other suggestions?

Thank you so much.
Attachments:

Nutrient Skin Care's NutriFoliant is a great after peel method of releasing dry, peeling skin without inflammation.  I am happy to send you a sample. 

Susan Nathan, Formulator

Nutrient Skin Care

I kind of have the same situation as you, with previously dealing with instability of the medi spa I worked at, and then going on my own, solo Esthetician, I can't yet afford a good professional microderm machine either although that's the first thing in my wishlist, so for now, I purchased what's called "PMD pro microderm" from universalcompanies.com, its a hand held microderm device, for $100, it is for professionals and although its not as effective as the machine, it definitely does work in the meantime, so that's an option.

I took a good look at the picture, and to me it does look like she broke out a bit, did she have any acne or anything before this? Can definately tell she picked, and that she may have even picked at the break outs a little bit, she looks very irritated. Without a microderm machine or device, which in this case based on the raw areas, I wouldn't even do microderm yet I'd wait till next time, here is what I would do...

I would use a very gentle cleanser, and go very easy on the steam, I would definately stay away from any chemical peels right now, instead, I would do a very very gentle enzyme peel. And then next time depending on the improvement of her skin, I would use a very light gentle lactic acid peel. I'd try to avoid a scrub only because the beads in the scrubs may spread any kind bacteria she has from the newly formed blemishes and raw skin, and may be too abrasive. I would definately avoid any products with alcohol or fragrances if possible since those are known to be very irritating. Then I would do a gentle facial massage, with soothing extracts if you have, extracts like chamomile, aloe, Rose Mary, calendula, green tea, and arnica, with a light lotion containing peptides, and maybe some gentle lightening agents, nothing too thick since she's broken out, don't want to clog her pores, that's if she normally gets clogged easily. Then I would use 2 masks, first I would put a mask that might help with the break outs a little bit, I'm not sure exactly which line and products you use, I'd possibly be able to help a little bit better if I did, but some sort of a gentle detoxifying mask, that has ingredients in it like kaolin clay, and probiotics, not pure clay though, that's too drying, even Manuka honey would be awesome for this, then I would take it off, and put a very soothing mask on her, leave that on for awhile. After I take that off, I would tone her with a soothing toner, to balance pH, and then for skincare, I would use a serum and then a moisturizer with SPF, both that have gentle lightening agents in them, and/or peptides, and antioxidats, bioflavonoids, and even alpha Lipoic acid which encourages cell renewal, (I might even apply a treatment serum with some of these ingredients under the soothing mask).....you want to think "restorative and soothing" when it comes to a situation like this. To spot treat the worse areas, that may be very raw, and may have some open wounding, I would finish with hydrocortisone as you already mentioned, or calendula cream if you can get that, I got mine at a natural health food store; I have battled with sensitive skin of my own many times before, and I found it to work great. If it gets any worse, you may want to refer her to a dermatologist, but I do think that this is fixable. I would encourage her to eat healthy, take vitamins, to speed up the healing process as well, and hopefully she learned how important it is not to pick!

So key things to look for in your products for this situation: green tea, aloe, chamomile, rosemary, arnica, calendula, peptides, Zinc Oxide, hydroquinone (or alternatives to hydro.), antioxidants including low doses of vitamin C, bioflavonoids, kaolin clay as long as it's not the clay alone (it is the most gentle detoxifying clay out of all though), lactic acid in small doses, Manuka Honey, and Alpha Lipoic Acid, and if you want to tell me a little bit about what you have, I just might be able to help you better and suggest what I think would work best for her.
Nina, first I can't thank you enough for taking the time to reply and at length, too. I'm grateful beyond words.

My core line is Control Corrective (the results and feedback I've received since replacing my back bar with this line, especially from my acne prone clients, has been overwhelmingly positive. Their sensitive line is great, especially the Growth Factor moisturizer & Calming Balm, both of which I recommend post peel. I also use Herbal Recovery Oil by Eminence as a massage medium & serum in the skin post peel & for sensitive skin. Works amazingly well.

You're the second person to mention Manuka Honey to me in the last couple days so I'm going to stop at the health food store around the corner from me tomorrow and see what I can find.

I thought, too, once she's healed of doing a series of lactic acid to lighten up remaining hyperpirntation. She did have some breakouts prior to the peel but they were on the mend (healing); no inflamed acne or lesions. What I've found with this particular TCA peel is that it will purge the skin pretty quick right after. It's definitely a reparative TCA not a maintenance TCA. I also think she's broken out a little more though from using Aquafor on her forehead, which I was reluctant to recommend but had to after she couldn't afford the product I recommended in place of.

I've been overwhelmed since this happened. I know it's not the end of the world and she'll recover and I know I did everything I could have done - short of staying at her place and slapping her hand away every time she reached to pick. This is just an all new experience for me and freaked me out.

I absolutely love what I do, pride myself on education and safety (as I can tell you do, too) so I'm sure you get it.

Thank you so much for your response, your wisdom, and your time!
No problem, glad I could help a little bit. When you're looking for Manuka honey, just make sure when you are looking for it that is has a minimum rating of 10 UMF, it needs to have at least 10umf in order for it to be potent enough for theraputic purposes. Manuka honey at or above that level is marketed as "UMF Manuka Honey" or "Active Manuka Honey." Before applying it, it helps to heat it up a little bit first since it can be sticky.

I actually have 2 control corrective products in my product collection, love them. I have checked out the line a little bit before deciding what line to chose for my clients, and I'm sure they work great. I wish you the best and I'm sure you will be able to handle the situation just fine, may seem a little scary at first but these things do happen to the best, and a lot of the time they are out of our hands, but I think you are on the right track, I can tell you have the knowledge. & If you have any more questions, feel free to ask:)
Great advice Nina!

I've been told by another solo Esthetician, (but haven't tried) that using the diamond tip and wand on the vaccum setting of a 8-in-1 machine for microderm works well.  She did this until she could afford a microderm machine with good results.

LED LIGHT GREEN TO CALM THEN red light to rejuvenate collagen & elastin fibers. And QUT PICKING !!! You can also suggest an enzyme mask to help the peeling along and discourage picking Good Luck. We want to help but we can't be there every second. They have to do there part.
Hi- I like u have done dozens of peels.. The key here is to always make sure client is well pretreated, for Fitzpatrick 4-6 pretreat at least 2 weeks prior to treatment with lightners/ bleach creams in order to avoid any post inflammatory reactions from peel. Hope this helps.

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