Reduced Appearance of Under-eye Bags With Twice-daily Application of Epidermal Growth Factor (EGF) Serum: A Pilot Study

April 2015 | Volume 14 | Issue 4 | Original Article | 405 | Copyright © 2015

Rachel Seidel BAa and Ronald L. Moy MD FAADa,b

aMoy-Fincher-Chipps Dermatology, Beverly Hills,CA
bKeck School of Medicine of the University of Southern California, Los Angeles, CA

Abstract

BACKGROUND: Under-eye bags are a common manifestation of age and a frequent complaint among patients who no longer feel youthful. Non-invasive topical agents are largely ineffective at reducing their appearance.
OBJECTIVE: We studied the ability of a topical serum containing epidermal growth factor (EGF) to minimize the appearance of under-eye bags.
METHODS: A single-center clinical trial was performed on eighteen volunteer male and female patients with under-eye bags. Subjects applied EGF serum to the infraorbital area twice daily for 12 weeks. At each visit, subjects were evaluated using clinical photography and written self-assessment. A grade on the Merz Infraorbital Hollowness Scale was also given and two independent, blind investigators assigned an Investigator’s Global Assessment (IGA) score. At the trial’s end, patients shared their final evaluation and perception of results with a questionnaire.
RESULTS: Sixteen subjects completed the trial. The final average Merz grade was 1.63 (SEM = .273), statistically significantly lower than the mean baseline average of 2.06 (SEM = .232) (P = .0019). A reduction in average IGA score was also significant (P < .0001). Average initial IGA was 2.75 (SEM = .270) and average final IGA was 2.00 (SEM = .310). All but two subjects reported improvement at the final visit. Improvement was quantified as 76-100% by two subjects, 50-75% by three subjects, and 25-49% by nine subjects. Eleven subjects classified their under-eye bags as milder at the end of the trial compared to the first visit. Seven subjects reported greater satisfaction with their overall facial appearance. Of the subjects who had used other topical treatments in the past, two reported the serum to be “significantly better” and four said it was “better” in treating their under-eye bags.
CONCLUSION: Our results offer evidence that topical EGF can reduce the appearance of under-eye bags.

J Drugs Dermatol. 2015;14(4):405-410.

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introduction

With age, lower eyelid skin laxity leads to sagging of the infra-orbital area, a feature referred to commonly as “under-eye bags.” Research has shown that the presence of this condition can detrimentally influence first impressions and general public perception. Understandably, the conflict between what is inferred and the patient’s true character can be a significant source of distress and feelings of one’s appearance can decline to the point of impairing self-esteem.

Though sometimes seen in younger patients owing to genetic influences, the overwhelming majority of under-eye bags result from age-related processes that accelerate over time. Changes in the extracellular matrix and loss of key structural proteins collagen and elastin cause the skin to lose structural support and elasticity.1 Incapable of countering gravitational forces, skin overhangs beyond the lid margins, forming palpebral bags.

Laser resurfacing is a popular modality for the treatment of under- eye bags because it triggers an inflammatory process that ultimately leads to the synthesis of collagen and elastin.2 However, the process of tissue ablation is not without peri-operative discomfort, a variable recovery period and an array of potential side effects. Knowing this, we investigated a less invasive treatment capable of producing similar changes in the extracellular matrix while circumventing the need to inflict damage to tissue.

Known for its ability to promote neocollagenesis and dermal thickening, epidermal growth factor (EGF) is released during the process of inflammation and wound healing and has cytoprotective, antiapoptotic and mitogenic activity during the course of normal cellular development.3 Topical EGF in various applications has been well tolerated, though its efficacy in treating under-eye bags has not been thoroughly studied. As a result, we performed a clinical trial using a synthetic, barley-derived EGF to investigate its effect on the appearance of under-eye bags in volunteer patients.

METHODS

A single-center clinical trial was performed on eighteen self-selected subjects (13 women, 5 men, mean age 52) with evidence of under-eye bags on clinical exam. Sixteen subjects self-report-

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