Sensitivity Scale

Everyone’s response to a peel is slightly different. Patch testing prior to peel application helps determine each patient’s sensitivity level and will help guide the peel selection. We recommend using Smoothing Toner to prepare the skin and patch test for sensitivity.

To test sensitivity:

• Cleanse with Facial Wash Oily/Problem. The gentle surfactants in this cleanser will degrease and begin the preparation of the skin.
• Prep the skin with Smoothing Toner. This product will sting/tingle on some individuals. Ask the patient, “On a scale of one to ten, ten being extremely active, how do you rate this sensation (or feeling)?”

Patients with resilient skin will answer in the range of 0 to 1.

Patients with moderately resilient skin will answer in the range of 1 to 3.

Patients with sensitive skin will answer in the range of 4 to 5.

Patients with highly sensitive skin will answer in the range of 6 to 10.

Note: Using a gentle AHA toner is a good step to begin the loosening of the desmosomes to improve peel outcomes. Acetone is often used by physicians to increase peel penetration. Although effective in this setting, this aggressive degreasing is typically not necessary when performing more frequent, superficial peels.

• Liquid solutions should be applied in layers according to the needs, goals, and individual sensitivity of the patient. Use this scale of 1 to 10 to gauge sensitivity. Fan the skin to keep the patient cool between layers. If the patient responds six or higher on any layer, do not proceed with another layer. If the patient’s response is between one and five, you may proceed with another layer. If a retinoid peel is being used, apply in a thin, even layer, avoiding the under-eye area. One layer is maximum.
• Wait until the patient’s sensitivity begins to subside before applying the next layer. This indicates that the peel solution is beginning to neutralize. The patient will begin to rate lower on the scale of 1 to 10 approximately one to five minutes after each layer is applied.
• The lower the response number, the more resilient the skin and a greater number of layers of peel solution typically may be applied. Be aware that it is expected that applying more layers will increase the patient’s 1 to 10 response. Continue to ask for a response on the sensitivity scale as you apply additional layers of the peel solution.
• Know that the higher the response of the patient on the 1 to 10 scale, the more sensitive and the more likely the patient is to blanch and potentially hyperpigment.