Periorbital Hyperpigmentation: Review of Etiology, Medical Evaluation, and Aesthetic Treatment

April 2014 | Volume 13 | Issue 4 | Original Article | 472 | Copyright © April 2014

Wendy E. Roberts MD

Generational and Cosmetic Dermatology, Rancho Mirage, CA

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Chemical Peeling

There is much anecdote regarding peeling of the periorbital region though there are few published articles. While chemical peeling has been used to treat a variety of facial pigmentary disorders, as of this publication, there are no randomized control studies on the efficacy of chemical peeling for the treatment of POH. The peeling agents removing melanin from the stratum corneum and epidermis, deep peels may remove melanin from the dermis but may lead to dyspigmentation and scarring and in this area of thin skin with minimal folliculosebaceous structures for repitheliazation, is not recommended.30 Prepeel instructions should include discontinuance of retinoids or hydroxy acids that may potentiate the depth of the peel. Careful and gentle application of the wounding agent must be used to not traumatize the skin and inadvertantly increase the depth of the peel. With little published data specifically regarding treatment in POH, superfical, and medium depth peels utilizing salicylic, glycolic, lactic, hydroxy acids, retinoic, TCA, and mandelic acid have all been used on the face in the treatment of pigmentary disorders such as photodamage and melasma. A staged approach with the patient returning every 2-4 weeks for a peel is recommended for patient safety. C. Vavouli and A. Katsambas et al performed a use study of chemical peeling with TCA 3.75% and lactic acid 15% for infraorbital dark circles.31 Thirty patients with periorbital dark circles and skin types II, III, or IV were included in the study. Chemical peeling was per-
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formed every week for a series of four treatments. The effect was photo-documented, and a patient’s and physicians global assessment was evaluated. Almost all the patients showed significant improvement. Physicians assessed a fair, good, or excellent improvement in 93.3% of the patients. Patient’s global assessment rated a fair, good, or excellent response in 96.7% of the patients. The procedure itself had expected temporary