Periorbital Hyperpigmentation—Dark Circles under the Eyes; Treatment Suggestions and Combining Procedures

Evaluation of the effectiveness of picosecond KTP and fractional thulium lasers on pigmented-type periorbital dark circles

OBJECTIVE

To determine the effectiveness of picosecond KTP in reducing peri-ocular dark circles caused mainly by excessive pigmentation and to compare Picosecond KTP with Thulium laser ability in reducing the intensity and extent of peri-ocular dark circles.

MATERIALS AND METHODS

This split-face prospective study included twelve women with periorbital dark circles (pigmented or mixed-pigmented type). The left lower eyelid was treated using the PicoHi machine (HIRONIC Ltd), a full beam Q-switched Nd-YAG provided by KTP crystal (523 nm) at settings of 0.3 J/cm2, 5 mm, 5 Hz, and 300 Ps. Whereas the right lower eyelid was treated using the Lavieen machine (WON TECH Co., Ltd), a fractional Thulium laser (1927 nm) at setting 1320 mJ/cm2, 30 × 15 mm, 1500 microseconds. Patients received a series of 3 treatment sessions, given at 4-week intervals.

RESULTS

The 532-nm full beam Q-switched KTP and fractional Thulium lasers were more likely to induce post-inflammatory hyperpigmentation rather than decrease the pigmentation. The risk is higher with a Q-switched KTP laser, which may be attributed to the skin tone of the participants. Nonetheless, some improvement in the pigmented type of PDCs, although not detected clinically, was documented by the VISIA software.

CONCLUSION

No solid conclusion can be drawn from the results of the study. Picosecond KTP and Thulium lasers may have a role in reducing PDCs yet more studies should be performed in order to determine the exact impact these lasers have.

Effectiveness, safety, and patient satisfaction of carboxytherapy as an adjunctive treatment for periorbital hyperpigmentation

INTRODUCTION

Dark under-eye circles or periorbital hyperpigmentation constitute a prevalent and challenging cosmetic problem with diverse etiologies and types. While modifying exacerbating habits can provide partial relief for the pigmentary and vascular factors associated with this condition, and despite the abundance of available treatment options, there is currently a lack of gold-standard evidence-based treatments proposed for curing this disorder.

OBJECTIVES

This study aimed to assess the safety and effectiveness of carboxytherapy in treating periorbital hyperpigmentation.

MATERIAL AND METHODS

In this 4-week single-arm clinical trial, 20 eligible Iranian patients with symmetric periorbital hyperpigmentation received weekly intradermal carboxytherapy. The treatment involved administering 10-20 mL of CO2 at a rate of 20 mL/min and a temperature of 15°C for a duration ranging from a few seconds to 1 min. Follow-up assessments were conducted 1 month after the final session. The primary outcome was defined as the changes in ΔE or the variations in pigmentation observed between the orbital and extra-orbital skin before and after the trial.

RESULTS

The patients reported satisfaction with the statistically significant reduction in hyperpigmentation achieved through carboxytherapy in the lateral (p = 0.002), middle (p = 0.001), and medial (p = 0.001) regions of the periorbital area. The total response rate of the patients was estimated at 20%. Patient satisfaction exceeded ΔE changes, with no significant linear relationship (p = 0.084).

CONCLUSION

Carboxytherapy can be proposed as an effective and safe treatment for periorbital hyperpigmentation.

Clinical Assessment, Diagnosis, and Management of Infraorbital Wrinkles and Pigmentation

Lower eyelid skin is unique and different from that of other areas. In addition to being an area of high exposure to the sun and elements, there are anatomic considerations and specific histologic characteristics that can cause the skin in this area to be more sensitive. These attributes can readily cause under-eye wrinkling and pigmentation. This review aims to present an updated overview of the current knowledge regarding the clinical characteristics, diagnosis, and management of wrinkles and pigmentation in this area. These disorders are usually caused by different factors, such as genetics, aging, sun exposure, lack of sleep, and stress.

A Cluster Validity Index-Based Objective Criteria for Aesthetic Evaluation of Periorbital Treatment

Purpose

Dark circles and pigmentation around the eyes are common reasons people see dermatologists. An effective assessment of the severity of infraorbital color and texture differences is critical for determining appropriate treatment. Evaluation of the visual severity of cases is mostly based on visual inspection. Treatment efficiency is often measured using patient questionnaires in many cases. The subjectivity of assessments may lead to a prolonged healing process, misdiagnosis, and excessive use of drugs or chemicals.

Patients and Methods

In this study, a computer-aided objective evaluation approach was proposed for grading periorbital facial rejuvenation. This approach is based on the analysis of numerical features extracted from different facial regions in digital images. Healing was objectively graded by evaluating data clusters formed using the extracted features. Accordingly, an increase in the visual similarity between paired facial regions is accepted as an indicator of healing, which directly affects the form of data clusters. An intracluster validity index was measured to evaluate the clusters as dense and well separated. A total of 144 facial regions were extracted and examined, and the automatically calculated grades were compared with expert evaluations.

Results

The cosmetic effects of the experimental drug were evaluated during the experiments, and expert grades were accepted as the ground truth. The results show that the proposed automated grading approach can evaluate rejuvenation with an accuracy of up to 0.91 accuracy in the upper orbital region.

Conclusion

This study concluded that the proposed data-clustering-based approach is promising and can be functional without any special instruments.

An overview of the role of carboxytherapy in dermatology

BACKGROUND

Carboxytherapy is defined as intradermal and/or subcutaneous microinjections of sterile purified carbon dioxide into different parts of the body for therapeutic aims. The vasodilatation effect and intradermal collagen reorganization associated with carboxytherapy have advantages for aesthetic dermatology and cosmetology.

OBJECTIVE

In the current article, we have reviewed some of the most important indications of this modality in dermatology and aesthetic dermatology.

METHOD

Our review is a narrative one which has gathered some of the most important indications of carboxytherapy in dermatology and cosmetology.

RESULTS

Carboxytherapy has successfully been applied for some dermatologic and cosmetic conditions among which skin aging, cellulite, localized fat deposits, striae distensae, infraorbital hyperpigmentation, scar, lymphedema, androgenetic alopecia, alopecia areata, psoriasis, morphea, and vitiligo are the most important.

CONCLUSION

Carboxytherapy can be considered as a safe, minimally-invasive modality used for rejuvenation, restoration, and recondition of the skin.

Synergistic Inhibiting Effect of Phytochemicals in Rheum palmatum on Tyrosinase Based on Metabolomics and Isobologram Analyses

Tyrosinase (TYR) plays a key role in the enzymatic reaction that is responsible for a range of unwanted discoloration effects, such as food browning and skin hyperpigmentation. TYR inhibitors could, therefore, be candidates for skin care products that aim to repair pigmentation problems. In this study, we used a metabolomics approach combined with the isobologram analysis to identify anti-TYR compounds within natural resources, and evaluate their possible synergism with each other. Rheum palmatum was determined to be a model plant for observing the effect, of which seven extracts with diverse phytochemicals were prepared by way of pressurized solvent extraction. Each Rheum palmatum extract (RPE) was profiled using nuclear magnetic resonance spectroscopy and its activity of tyrosinase inhibition was evaluated. According to the orthogonal partial least square analysis used to correlate phytochemicals in RPE with the corresponding activity, the goodness of fit of the model (R₂ = 0.838) and its predictive ability (Q₂ = 0.711) were high. Gallic acid and catechin were identified as the active compounds most relevant to the anti-TYR effect of RPE. Subsequently, the activity of gallic acid and catechin were evaluated individually, and when combined in various ratios by using isobologram analysis. The results showed that gallic acid and catechin in the molar ratios of 9:5 and 9:1 exhibited a synergistic inhibition on TYR, with a combination index lower than 0.77, suggesting that certain combinations of these compounds may prove effective for use in cosmetic, pharmaceutical, and food industries.

Nanosecond Q-Switched 1064/532 nm Laser to Treat Hyperpigmentations: A Double Center Retrospective Study

(1) Benign hyperpigmentations are a common problem in cosmetic dermatology. Melasma, solar lentigo, and other acquired hyperpigmentations represent an aesthetic issue for an increasing number of patients. The gold standard in managing this condition is currently 1064/532 nanometers (nm) Q-Switched lasers. This study reports our experience on the use of a Q-switched laser with a nanosecond pulse to treat these conditions. (2) Methods: A total of 96 patients asking for benign hyperpigmentation removal were consecutively enrolled at the Magna Graecia University of Catanzaro and Tor Vergata University of Rome. Treating parameters were the following: 1064 nm with a pulse duration of 6 nanoseconds (ns) for dermic lesions and 532 nm with 6 ns for epidermal ones. Up to five treatments with a minimum interval between laser treatments of thirty days were performed. A follow-up visit three months after the last session assessed patient satisfaction with a Visual Analogue Scale (VAS). Two blinded dermatologists assessed the cosmetic result using a five-point scale comparing pictures before treatment and at follow-up. (3) Results: 96 patients were included; 47 participants were women (49.0%) and 49 men (51.0%). The mean reported age was 50.0 ± 17.3 years. All patients reached a good to complete hyperpigmentation removal at the dermatological evaluation with a mean VAS score of 8.91 ± 1.07. (4) Conclusions: Q Switched 1064/532 nm laser may be considered the gold standard treatment for benign hyperpigmentations. Our results confirm the literature findings on the effectiveness of these devices.

Q-Switched 1064/532 nm Laser with Picosecond Pulse to Treat Benign Hyperpigmentations: A Single-Center Retrospective Study

(1) Benign melanoses are a frequent issue in aesthetic dermatology. Solar lentigo, ephelides, café au lait spots, and other melanoses represent a cosmetic issue for a growing number of subjects. The Q-switched 1064/532-nanometer (nm) laser may be considered the gold standard for management of these aesthetic issues. A new generation of Q-switched lasers, capable of concentrating the energy pulse in the spectrum of hundreds of picoseconds, is emerging, promising better results than previous ones. In this paper, we report the use of a Q-switched laser with a picosecond pulse to manage hypermelanoses. (2) Methods: 36 patients seeking melanosis removal were retrospectively enrolled at Magna Graecia University of Catanzaro. Treatment parameters, although variable, were the following: 1064 nm with a pulse duration of 450 picoseconds (ps) for dermic lesions and 532 nm with 370 ps for epidermal lesions. Up to four treatments, with a minimum interval between laser treatments of 30 days, were performed. After the last session, patients’ satisfaction was assessed at a three-month follow up with a Visual Analogue Scale (VAS). Two blinded dermatologists measured the aesthetic outcome using a five-point scale comparing pictures before laser sessions and during follow-up. (3) Results: 36 patients were enrolled; 23 were females (63.9%) and 13 males (36.1%). The mean reported age was 49.2 ± 18.9 years. All participants were assessed with a complete/almost complete melanosis removal at the dermatological evaluation, with a mean VAS score of 9.39 ± 0.90. (4) Conclusions: The Q-switched 1064/532 nm laser may be considered the main weapon in treating benign hypermelanosis. The picosecond pulse seems to guarantee better results than other devices. However, a clinical trial comparing Q-switched nanosecond pulse with picosecond pulse is necessary to confirm this study’s findings.

Q-Switched 1064/532 nm Laser with Nanosecond Pulse in Tattoo Treatment: A Double-Center Retrospective Study

Tattoo removal is a well-established procedure in dermatology. Lasers represent the gold standard in the management of this condition nowadays. In this study, we report our experience on the use of a Q-switched nanosecond source. A total of 52 patients were consecutively enrolled in performing tattoo removal at Magna Graecia University of Catanzaro and Tor Vergata University of Rome. Black and blue tattoos were treated with a 1064 nm laser, with a pulse duration of 6 ns and a fluence up to 10 J/cm², while colored tattoos were treated with sessions of 532 nm laser, with a pulse duration of 6 ns and a fluence up to 5 J/cm². Up to nine treatments with a minimum interval of 8 weeks between each session were performed. A six-month follow-up visit assessed patient satisfaction (Visual Analogue Scale). Overall clinical result was assessed with a clinical evaluation by two blinded dermatologists using a 5-point scale, comparing pictures before treatment and at follow up. A total of 52 patients were included and analyzed: 30 females (57.7%) and 22 males (42.3%). Mean age was 43.7 ± 12.7 years. According to Fitzpatrick’s skin classification, 16 individuals (30.8%) were type II, 15 (28.8%) were type III, and 21 (40.4%) were type IV. Most of the treated tattoos were carried out by professionals. The mean number of sessions required to obtain a result was 4.6 ± 2.5, and the final tattoo removal rate was 60% or higher, with 51.9% of the patients reporting highest satisfaction scores Q-Switched 1064/532 nm laser may be considered today as the gold-standard treatment for tattoo removal. Our results confirm literature findings of the safety and effectiveness of these devices.