adverse effects of erythema, edema, frosting, dryness, and
telangiectasia. The authors reported the treatment results remained
for at least 4-6 months in the majority of patients with
appropriate sun protection.31
Laser and Device
This is becoming increasingly integrated into the treatment
of POH, however, there is still a lot to be learned. While there
are randomized controlled studies for periorbital rejuevenation
with laser, there is a paucity of data for the treatment periorbital
hyperpigmentation. Before embarking upon a laser treatment
it is important to understand the skintype of your patient. This
goes beyond Fitzpatrick skintype because your Caucasion patient
(phenotypic Fitzpatrick I or II ) may have a brown or dark
complexioned parent and or grandparent. The patient’s skin
may respond like the darker skinned relative and result in dyschromia.
Both hypo and hyperpigmentation have been seen
as laser complications in ethnic skin of color. The Roberts Skin
Type Classification System is an efficient way to document and
communicate your patients ancestry, liklihood for dyschromia
post laser procedure, and assist in the selection of safe laser
settings (Table 4).32,33 Laser safety is of utmost importance. Patient
protective eyewear such as eyeshields should be used as
necessary. Innappropriate use of laser in this area may result in
eye problems including blindness, dryness and photophobia.34
Importantly, IPL is not indicated for the treatment of POH. The
pigmented iris absorbs light in the same wavelength range of
IPL. The IPL when applied to the perioccular area is absorbed
by the pigment of the iris and can result in severe eye damage
that may include photophobia, pain, and anterior uveitis.34,35 As
we have histologic data showing that dermal melanosis is one
of the etiological factors in POH, laser treatment used to target
the melanin has been investigated.25 An emerging practice is
combination of device and topical product for the treatment of
POH. One group recommends the use of topical hydroquinone
and tretinoin in addition to Q-switched ruby laser sessions; they
postulate that these topical treatments not only enhance treatment
efficacy, but also lower the risk for PIH secondary to laser
treatments.35 Skin laxity has been sighted as a causative factor
of POH and ablative and nonablative lasers and devices are being
investigated.36 In 1998 ,West and Alster conducted a study to
determine the effectiveness of cutaneous CO2 laser resurfacing
in reducing infraorbital hyperpigmentation.
Twelve female patients (age range, 27–56 years; mean, 44
years) presented for either full-face or periorbital CO2 laser resurfacing.
It is an important laser safety tip to note all patients
had skin types I, II, or III. There were no skintypes IV –VI in this
study. Prior to the laser resurfacing procedure and at 3, 6, and
9 weeks after treatment, the average of three melanin measurements
was obtained from the infraorbital regions using a
handheld reflectance spectrometer (Dermaspectrometer; Cortex
Technology, Haugland, Denmark). Photographs were taken
using identical lighting and camera settings preoperatively and
at each of the three scheduled follow-up visits. Simultaneous
projection of pre- and posttreatment photographs (Mirror Image,
Virtual Eyes, Inc., Kirkland, WA) were scored independently
by two blinded assessors. Clinical improvement was rated on a
1–4 scale with <25% lightening = 1, 25–50%= 2, 51–75%= 3, and
