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Seirafianpour F, Atefi N, Amin NG, Namazi MR, Behrangi E, Shafiei A, Ghassemi M, Mozafarpoor S, Goodarzi A. Effectiveness, safety, and patient satisfaction of carboxytherapy as an adjunctive treatment for periorbital hyperpigmentation. Skin Res Technol 2024; 30:e13651. [PMID: 38483051 PMCID: PMC10938787 DOI: 10.1111/srt.13651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024]
Abstract
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.
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Affiliation(s)
| | - Najmolsadat Atefi
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of Medicine, Iran University of Medical Sciences (IUMS)TehranIran
| | - Nazila Ghoreishi Amin
- Department of RadiologyUniversity of Southern California (USC)Los AngelesCaliforniaUSA
| | - Mohammad Reza Namazi
- Department of DermatologySchool of MedicineShiraz University of Medical Sciences (SUMS)Shahid Faghihi HospitalShirazIran
| | - Elham Behrangi
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of Medicine, Iran University of Medical Sciences (IUMS)TehranIran
| | - Aboozar Shafiei
- Department of DermatologySchool of MedicineShiraz University of Medical Sciences (SUMS)Shahid Faghihi HospitalShirazIran
| | - Mohammadreza Ghassemi
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of Medicine, Iran University of Medical Sciences (IUMS)TehranIran
| | - Samaneh Mozafarpoor
- Skin Diseases and Leishmaniasis Research CenterDepartment of DermatologyIsfahan University of medical SciencesIsfahanIran
| | - Azadeh Goodarzi
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of Medicine, Iran University of Medical Sciences (IUMS)TehranIran
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Rajabi-Estarabadi A, Hartman CL, Iglesia S, Kononov T, Zahr AS. Effectiveness and tolerance of multicorrective topical treatment for infraorbital dark circles and puffiness. J Cosmet Dermatol 2024; 23:486-495. [PMID: 38112168 DOI: 10.1111/jocd.16122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Treatment of infraorbital dark circles and under-eye puffiness is challenging due to its multifactorial nature and lack of broadly applicable, effective treatments. A daily skincare treatment option that is multimodal, effective, and tolerable across a broad patient population is an unmet need. AIM A multicorrective topical eye cream (MTEC) formulated with Tetrahexyldecyl (THD) ascorbate (vitamin C), prebiotic Inula Helenium, bioavailable peptides, botanical extracts, chrysin, and caffeine is hypothesized to improve the appearance of infraorbital dark circles and under-eye puffiness by targeting microvasculature congestion and permeability, melanin accumulation and hemoglobin degradation-related pigmentation, and skin health. METHODS An IRB approved, open-label, 12-week clinical study set out to evaluate the efficacy and tolerability of the MTEC across a broad patient population including varying ethnicities and Fitzpatrick Skin Types (FST). Female subjects (n = 40) ages 35-60 years old, with moderate-to-severe under-eye dark circles, moderate under-eye puffiness, and mild-to-moderate fine lines were enrolled into the study. Objective (Chromameter, VISIA® imaging, and Laser Doppler) and subjective assessments (clinical grading and self-assessment questionnaire) were conducted at baseline and post-baseline timepoints. RESULTS Thirty-seven subjects completed the study, and the MTEC efficaciously demonstrated short-term and long-term improvements in objective and subjective assessments across a broad patient population. Specifically, the MTEC demonstrated significant improvement of infraorbital dark circles, mainly by the reduction in microvasculature congestion and permeability, melanin, and hemoglobin degradation-related pigmentation. CONCLUSION Topical application of the MTEC may offer an effective and tolerable treatment option for infraorbital dark circles and puffiness.
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Platsidaki E, Stravodimou A, Kouris A, Markantoni V, Kontochristopoulos G. Efficacy and Safety of Phenol and Trichloroacetic Acid Combination Peel for the Management of Dark Circles. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:988-990. [DOI: 10.1016/j.ad.2021.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/06/2021] [Accepted: 05/13/2021] [Indexed: 10/18/2022] Open
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Periorbital Hyperpigmentation—Dark Circles under the Eyes; Treatment Suggestions and Combining Procedures. COSMETICS 2021. [DOI: 10.3390/cosmetics8020026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Periorbital hyperpigmentation (POH) is a frequent concern among both young and adult patients. The etiology is multifactorial with a genetic background. Prevalence is higher in darker skin types. It has been estimated as high as 30% in a recent Indian study. Females are often more disappointed by POH than males. Treatment has to consider underlying pathologies and patients’ needs. We present our treatment algorithm for POH. In this study, 74 patients with POH, 64 females (86.5%) and 10 males (13.3%), were treated. Of these, 39 patients (53%) had a family history of POH. The age range of patients was 18−57 years (average: 36.1 years). In case of tear trough deformity, soft tissue augmentation was used by injection of hyaluronic acid gel, calcium hydroxylapatite, or autologous fat. Blepharoplasty with partial fat pad resection or repositioning via arcus marginalis release was used to correct severe orbital fat herniation and excess of the lower lid skin. Melanin hyperpigmentation of the skin was improved by sessions of Q-switched 1064 and 532 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. Small vessels (capillaries and veins) were targeted by a 1064 nm long-pulsed Nd-YAG laser. Sessions of intense pulsed light (IPL) or CO2 fractional laser were employed to improve skin texture and fine lines. Topical hyaluronic acid-based formulations may be used as adjuvant self-treatment by patients. For pigmented and mixed-type POH, ultraviolet light protection is recommended as a maintenance treatment. By the use of various technologies, treatment can be individually tailored.
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Michelle L, Pouldar Foulad D, Ekelem C, Saedi N, Mesinkovska NA. Treatments of Periorbital Hyperpigmentation: A Systematic Review. Dermatol Surg 2021; 47:70-74. [PMID: 32740208 DOI: 10.1097/dss.0000000000002484] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Periorbital hyperpigmentation (POH) is an aesthetic concern for patients. Etiologies of the condition include pigmentary, structural, vascular, and mixed causes. OBJECTIVE To systematically review the current literature for treatment of POH. METHODS A systematic literature review was performed on PubMed. Search terms included "infraorbital dark circles," "dark circles," "periorbital hyperpigmentation," "idiopathic hyperchromia AND orbital," "under-eye circles," "ICHOR (idiopathic cutaneous hyperchromia of the orbital region)," "dark circles" AND "treatment," and "filler" AND "dark circles." RESULTS A total of 39 studies were included. Effective treatments for POH include lasers, topical creams and serums, fillers, chemical peels, carboxytherapy, plasma-rich platelet injections, blepharoplasty, and normobaric oxygen. CONCLUSION Soft tissue fillers and autologous fat grafting are most effective in treating dark circles due to volume loss. Blepharoplasty surgery is best when excessive skin laxity is the underlying cause. Various topical creams and chemical peels are useful in treating pigment-based POH, whereas lasers are mildly to moderately beneficial for both vascular and pigment types. Given the scarcity of high-quality evidence supporting these results, recommendations should be interpreted selectively. Additional randomized clinical trials studying POH will be helpful.
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Affiliation(s)
- Lauren Michelle
- Department of Dermatology, University of California, Irvine, Irvine, California
- School of Medicine, University of California, Irvine, Irvine, California
| | | | - Chloe Ekelem
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Nazanin Saedi
- Department of Dermatology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Pissaridou MK, Ghanem A, Lowe N. Periorbital Discolouration Diagnosis and Treatment: Evidence-Based Review. J COSMET LASER THER 2020; 22:217-225. [PMID: 34078228 DOI: 10.1080/14764172.2021.1899238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Infraorbital dark circles are a significant esthetic concern with few publications however offering evidence-based recommendations for their classification and consequent management. A literature review has been undertaken to classify dark circles based on etiology: shadowing, vascular, idiopathic hyperpigmentation, post-inflammatory hyperpigmentation, constitutional and offer an analysis of current treatment modalities and their effectiveness in managing specific types of infraorbital circles. This review aims to provide a detailed account of dark circle etiology, assessment and management.
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Kassir M, Kroumpouzos G, Puja P, Katsambas A, Galadari H, Lotti T, Abdelmaksoud A, Grabbe S, Juchems E, Goldust M. Update in minimally invasive periorbital rejuvenation with a focus on platelet-rich plasma: A narrative review. J Cosmet Dermatol 2020; 19:1057-1062. [PMID: 32181588 DOI: 10.1111/jocd.13376] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/04/2020] [Accepted: 03/02/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND The periorbital region is among the first areas to be affected by the process of aging, which is influenced by genetic and constitutional factors. As the region plays an important role in overall facial appearance, rejuvenation of the area has immense cosmetic benefit and various treatment modalities have been used to achieve the same. AIMS This article reviews commonly used non-surgical and minimally invasive modalities for periorbital rejuvenation. METHODS The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. Only articles available in English were considered for this review. RESULTS Autologous platelet rich plasma (PRP) is increasingly used in dermatology for skin and hair conditions. The use of PRP is rapidly growing in popularity as a modality to achieve skin rejuvenation. The mechanism by which PRP leads to skin rejuvenation is by increasing the dermal fibroblast proliferation, expression of matrix metalloproteinase and collagen synthesis. CONCLUSION The evidence discussed in this article indicates the increasing importance of minimally invasive modalities in periorbital rejuvenation and a promising role for PRP as solo therapy or in multimodality regimens.
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Affiliation(s)
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.,GK Dermatology, PC, South Weymouth, MA, USA
| | - Priya Puja
- Dermacare skin and laser centre, New Delhi, India
| | | | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Torello Lotti
- University of Studies Guglielmo Marconi, Rome, Italy
| | - Ayman Abdelmaksoud
- Mansoura Dermatology, Venereology and Leprology Hospital, Mansoura, Egypt
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Eva Juchems
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany.,Department of Dermatology, University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
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Dayal S, Sangal B, Sahu P. Ferulic acid 12% peel: An innovative peel for constitutional type of periorbital melanosis-Comparing clinical efficacy and safety with 20% glycolic peel and 15% lactic peel. J Cosmet Dermatol 2020; 19:2342-2348. [PMID: 31944519 DOI: 10.1111/jocd.13292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Periorbital hyperpigmentation (POH) is a very common, yet unexplored aesthetic condition. Topical therapy is mainstay of treatment which includes chemical peels and other depigmenting agents. AIMS To compare clinical efficacy, safety, and tolerability of 20% glycolic acid peels, 15% lactic acid peels, and 12% ferulic acid peels in the treatment of constitutional type of periorbital hyperpigmentation in Indian patients. METHODS Ninety patients of constitutional POH were enrolled for 12 weeks. They were divided into three groups of 30 each. In 1st group 20% glycolic acid peeling, in 2nd group 15% lactic acid peeling and in 3rd group 12% ferulic acid peeling sessions were performed at 3 weekly intervals. Clinical improvement was assessed objectively using POH grading, physician's and patient's global assessment, and patient's global tolerance. RESULTS Significant improvement in periorbital hyperpigmentation was noted in all the three groups. Physician and patient's global assessment was excellent with glycolic acid peel followed by ferulic acid peel and lactic acid peel. The incidence of side effects in the form of erythema and itching was maximum with glycolic acid followed by lactic acid and least with ferulic acid, which did not necessitate cessation of therapy. CONCLUSION Glycolic acid produced the best results among the three peels; however, ferulic acid peel emerged as a safe and effective modality for the treatment of POH.
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Affiliation(s)
- Surabhi Dayal
- Department of Dermatology, Venereology and Leprology, Pt B. D. Sharma, University of Health Sciences, Rohtak, Haryana, India
| | - Bhavya Sangal
- Department of Dermatology, Venereology and Leprology, Pt B. D. Sharma, University of Health Sciences, Rohtak, Haryana, India
| | - Priyadarshini Sahu
- Department of Dermatology, Venereology and Leprology, Pt B. D. Sharma, University of Health Sciences, Rohtak, Haryana, India
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Abstract
Skin color is one of the major attributes that defines both individual distinctiveness and differences between groups. There is a preference for lighter skin world-wide, among both light- and dark-skinned individuals, further leading to skin-color bias based upon skin-color hierarchy within certain ethnoracial groups. The psychiatric and psychosocial ramifications of skin color are important in several situations, including (1) disorders of skin discoloration (eg, vitiligo), which can significantly affect the psychosocial development of the patient especially when it has its first onset during adolescence; (2) widespread use of skin-lightening products, which are used despite knowledge about serious toxicity from inorganic mercury and potent corticosteroids that are some of their main constituents; (3) indoor tanning, which is a recognized carcinogen and practiced by over 50% of university-age adults and 20% of adolescents. Educating about photocarcinogenicity does not change tanning behaviors, which is strongly driven by peer pressure; and (4) when a psychiatric disorder, such as body dysmorphic disorder or major depressive disorder, is the primary basis for skin color dissatisfaction. Despite the role of complex sociocultural and psychiatric factors in clinical manifestations involving skin color, a supportive relation with the dermatologist can significantly aid the patient in managing their disease burden.
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Affiliation(s)
- Madhulika A Gupta
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Psychmed Research, London, Ontario, Canada.
| | - Aditya K Gupta
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Mediprobe Research, London, Ontario, Canada
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Ellabban NF, Eyada M, Nada H, Kamel N. Efficacy and tolerability of using platelet‐rich plasma versus chemical peeling in periorbital hyperpigmentation. J Cosmet Dermatol 2019; 18:1680-1685. [DOI: 10.1111/jocd.12964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/17/2019] [Accepted: 03/21/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Noura F. Ellabban
- Dermatology & Andrology Department Ministry of Health Mansoura Egypt
| | - Moustafa Eyada
- Dermatology, Andrology & STDs Department, Faculty of Medicine Suez Canal University Ismailia Egypt
| | - Hesham Nada
- Dermatology, Andrology & STDs Department, Faculty of Medicine Suez Canal University Ismailia Egypt
| | - Noha Kamel
- Clinical Pathology Department, Faculty of Medicine Suez Canal University Ismailia Egypt
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India E-mail:
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
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