Treatment of Periorbital Hyperpigmentation Possible, But Not Without Adverse Events

In patients with periorbital hyperpigmentation (POH), the efficacy of carboxytherapy and platelet-rich plasma (PRP) treatment is comparable, but carboxytherapy is a simpler, slightly more effective modality that is better tolerated than PRP, according to results published in the Journal of Cosmetic Dermatology.

The investigators sought to compare the efficacy and safety of 2 new modalities for the treatment of POH — carboxytherapy and PRP.

A total of 30 patients with POH were enrolled in the study. Each patient received 7 intradermal injections of PRP on the left periorbital area, with 2-week intervals between treatments, and carboxytherapy on the right periorbital area, with a 1-week interval between sessions.

Evaluations were based on investigators’ assessment using pretreatment and posttreatment photographs and rated on a scale of 1 to 3, with 1=fair improvement, 2=good improvement, and 3=excellent improvement; visual analog scale scores of POH by both physicians and patients, ranging from 0 (none) to 10 (severe); and (3) patients’ satisfaction with their treatment.

All of the patients completed all sessions on the carboxy-treated side. In contrast, 10 participants declined to complete all sessions on the PRP-treated side, citing intolerable side effects. Regarding PRP therapy, 55% of patients achieved a fair response, 15% achieved a good response, and 30% achieved an excellent response.

With respect to carboxytherapy, 46.7% of patients achieved a fair response, 33.3% achieved a good response, and 20% achieved an excellent response. In terms of patient satisfaction, 45% of participants were slightly satisfied, 25% were moderately satisfied, and 30% were well satisfied with PRP therapy, whereas 40% of participants were slightly satisfied, 30% were moderately satisfied, and 30% were well satisfied with carboxytherapy.

Significant improvement in POH was attained on both of the treated sides (P ≤.0001). The improvements were similar, with no statistically significant differences reported between the two treatments. When side effects were compared, those on the carboxy-treated side were mild and well tolerated by all participants, while those on the PRP-treated side were considered relatively severe and continued for days after the sessions.

The researchers concluded that both of the modalities are promising options for the treatment of POH but neither is an ideal solution for the various problems associated with the disorder, which has a multifactorial etiology. Investigations of different treatments that may deal with the causes of POH are highly recommended in larger-scale, comparative studies.

Reference

Nofal E, Elkot R, Nofal A, Eldesoky F, Shehata S, Sami M. Evaluation of carboxytherapy and platelet-rich plasma in treatment of periorbital hyperpigmentation: a comparative clinical trial [published online January 3, 2018]. J Cosmet Dermatol. doi:10.1111/jocd.12478