If any area of dermatitis is found red and pain is produced during alcohol degreasing, it is advisable to postpone the peeling procedure or, if the main area to be treated is sound and healthy for the peel, this peeling can be done on localized areas, without pass over the irritated areas, to prevent hot spots and PIH.

This peel may be applied with a soft cotton (Fig. 2), a soft brush, or a folded 4 × 4 gauze sponge, in a crescent order of penetration. The soft cotton application delivers a thin layer of solution and has no increased penetration by friction. The soft brush , such as sable-hair brush or goat-hair brush, is delicate but delivers a thicker layer of the solution onto the skin. This subtle difference occurs because hair has limited liquid absorbing properties, while a cotton ball acts as a sponge. The use of gauze sponges is indicated for increased penetration by mild to moderate friction. If heavy friction is performed, it may be advisable to consider switching to a mild deep peel, such as phenol 30–35% with croton oil 0.4%, which will provide better penetration to the dermis.

Pyruvic acid must be neutralized or washed once it produces erythema, which usually occurs after 3–5 min, so the solution must be applied in a fast manner, full face, or applied in each cosmetic unit and neutralized at a time, which usually produces more controllable uniformity of penetration, because perioral, periocular, and cheeks present faster penetration than the forehead. So if a full-face procedure is intended, I usually start on the forehead and nose. Then the peeling solution is applied on the lateral cheeks, medial cheeks, perinasal area, perioral area, and then periocular area/neck.

For safety reasons, this peel is typically neutralized with 10% sodium bicarbonate solution or face washing in a sink with copious amounts of water. This neutralization may prevent superficial damage. The neutralization starts at the most erythematous area, which is usually periocular or perioral, but in some well-prepared patients, the forehead may achieve erythema by the end of the application and must be neutralized first. In exceptional cases, no neutralization is chosen for stronger effects.

Full medical control of the neutralization is advisable; therefore, a 10% bicarbonate solution is prepared in a plastic disposable water cup where dry cotton wipes are soaked before the application on each area of the skin for neutralization (Fig. 3). Bicarbonate spray may be used and rinsed with a soft cotton ball or cotton wipe. If water is used as a neutralization solution with a wipe, it is advisable to have more wipes soaked in the water and to use them in a series of new fresh-water wipes. After complete removal of the solution, it is advisable to ask the patient wash the face in a sink to ensure maximum removal of the acid. (Fig. 4).