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-
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
