Treatment of periorbital dark circles: Comparative study of chemical peeling with a combination of trichloroacetic acid and lactic acid versus carboxytherapy

Abstract - 2658 PDF - 1431
Arwa Mohammad Hassan, Ghada Fawzy Hassan, Hedaya Yousef Aldalies, Gamal Mohammad El Maghraby


Periorbital dark circles (PODC) are a common worldwide cosmetic problem. It is difficult to treat due to complications in its pathogenesis and aetiology. Available lines of treatment for PODC include whitening creams, topical retinoid acid, chemical peeling, laser therapy, carboxytherapy, autologous fat transplantation, injectable fillers and surgery (blepharoplasty).The aim of this study isto evaluate and compare the efficacy of chemical peels using trichloroacetic acid (3.75%) and lactic acid (15%) in a gel formula with that of carboxytherapy, in the treatment of periorbital hyperpigmentation.Two groups of patients with PODC were included in the study, named Group A and B in which each group consisted of 15 patients. Group A was assigned for patients who received treatment with chemical peeling with a combination of trichloroacetic acid (3.75%) and lactic acid (15%) in a gel formula, once a week for four weeks. Group B was assigned for patients who received carboxytherapy that was performed by subcutaneous and intradermal injection of CO2 once a week for four weeks. All patients were assessed by digital photographs, before and after treatment, by observing the improvement in the grade of PODC. Reports of patient satisfaction and global tolerance were evaluated by three medical observers. There was a significant improvement in the grade of PODC in both groups. The degree of improvement of PODC in group A was excellent, with good grade in 93.4% of the treated patients while fair grade in 6.6% of them. There was a statistically significant improvement in the pigmented type. The degree of improvement of PODC in group B was excellent, with good grade in 86.7% of the treated patients while fair grade in 13.3% of them. However, no statistically significant difference between the two groups was observed. Minimal and transient side effects were noticed; however, it did not require further treatment. In conclusion, the two methods of treatment were effective in the treatment of PODC, with the improvement of PODC observed from the first treatment session with both chemical peeling and carboxytherapy.


Chemical peeling; carboxytherapy; periorbital dark circles.

Full Text:



Freitag FM, Cestari TF. What causes dark circles under the eyes? J Cosmet Dermatol 2007; 6(3): 211–215. doi: 10.1111/j.1473-2165.2007.00324.x.

Roh MR, Chung KY. Infraorbital dark circles: Definition, causes, and treatment options. Dermatol Surg 2009; 35(8): 1163–1171. doi: 10.1111/j.1524-4725.2009.01213.x.

Cymbalista NC, de Oliveira ZNP. Treatment of idiopathic cutaneous hyperchromia of orbital region (ICHOR) with intense pulsed light. Dermatol Surg 2006; 32(6): 773–784. doi:10.1111/j.1524-4725.2006.32160.x.

Roh MR, Kim TK, Chung KY. Treatment of infraorbital dark circles by autologous fat transplantation: A pilot study. Br J Dermatol 2009; 160(5): 1022–1025. doi: 10.1111/j.1365-2133.2009.09066.x.

Yeh CC, Williams III EF. Midface restoration in the management of the lower eyelid. Facial Plast Surg Clin North Am 2010; 18(3): 365–374. doi: 10.1016/j.fsc.2010.04.001.

Momosawa A, Kurita M, Ozaki M, Miyamoto S, Kobayashi Y, et al. Combined therapy using Q-switched ruby laser and bleaching treatment with tretinoin and hydro-quinone for periorbital skin hyperpigmentation in Asi¬ans. Plast Reconstr Surg 2008; 121(1): 282–288. doi: 10.1097/

Rigopoulos D, Gregoriou S, Katsambas A. Hyperpigmentation and melasma. J Cosmet Dermatol 2007; 6(3): 195–202. doi:10.1111/j.1473-2165.2007.00321.x.

Khunger N. Standard guidelines of care for chemical peels. Indian J Dermatol Venereol Leprol 2008; 74(7): 5–12.

Brandi C, D’Aniello C, Grimaldi L, Caiazzo E, Stanghellini E. Carbon dioxide therapy: Effects on skin irregularity and its use as a complement to liposuction. Aesthet Plast Surg 2004; 28(4): 222–225. doi: 10.1007/s00266-004-2068-z.

Sheth PB, Shah HA, Dave JN. Periorbital hyperpigmentation: A study of its prevalence, common causative factors and its association with personal habits and other disorders. Indian J Dermatol 2014; 59(2): 151–157. doi: 10.4103/0019-5154.127675.

Vavouli C, Katsambas A, Gregoriou S, Teodor A, Salavastru C, et al. Chemical peeling with trichloroacetic acid and lactic acid for infraorbital dark circles. J Cosmet Dermatol 2013; 12(3): 204–209. doi: 10.1111/jocd.12044.

Paolo F, Nefer F, Paola P, Nicolò S. Periorbital area rejuvenation using carbon dioxide therapy. J Cosmet Dermatol 2012; 11(3): 223–228. doi: 10.1111/j.1473- 2165.2012.00633.x.

Kotz S, Balakrishnan N, Read CB, Vidakovic B, Johnson NL. Encyclopedia of statistical sciences. 2nd ed. Hoboken, NJ: Wiley-Interscience; 2006.

Kirkpatrick LA, Feeney BC. A simple guide to IBM SPSS statistics for version 20.0. Student ed. Belmont, California: Wadsworth, Cengage Learning; 2013.

Mashood AA. Treatment of hyperpigmentation disorders. Journal of Pakistan Association of Dermatologists 2006; 16: 65–68.

Gendler EC. Treatment of periorbital hyperpigmentation. Aesthet Surg J 2005; 25: 618–624. doi: 10.1016/ j.asj.2005.09.018.

Slavin JW. Considerations in alpha hydroxy acid peels. Clin Plast Surg 1998; 25(1): 45–52.

Nach R, Zandifar H, Gupta R, Hamilton JS. Subcutaneous carboxytherapy injection for aesthetic improvement of scars. Ear Nose Throat J 2010; 89(2): 64–66.

Chun EY, Lee JB, Lee KH. Focal trichloroacetic acid peel method for benign pigmented lesions in dark-skinned patients. Dermatol Surg 2004; 30(4): 512–516. doi: 10.1111/j.1524-4725.2004.30166.x.

Usuki A, Ohashi A, Sato H, Ochiai Y, Ichihashi M, et al. The inhibitory effect of glycolic acid and lactic acid on melanin synthesis in melanoma cells. Exp Dermatol 2003; 12(Suppl 2): 43–50. doi: 10.1034/j.1600-0625.12.s2.7.x.

Sachdeva S. Lactic acid peeling in superficial acne scarring in Indian skin. J Cosmet Dermatol 2010; 9(3): 246–248. doi: 10.1111/j.1473-2165.2010.00513.x.

Sharquie KE, Al-Tikreety MM, Al-Mashhadani SA. Lactic acid chemical peels as a new therapeutic modality in melasma in comparison to Jessner’s solution chemical peels. Dermatol Sur 2006; 32(12): 1429–1436.

doi: 10.1111/j.1524-4725.2006.32352.x.

Varlaro V, Manzo G, Mugnaini F, Bisacci C, Fiorucci P, et al. Carboxytherapy: Effects on microcirculation and its use in the treatment of severe lymphedema. Acta Phlebol 2007; 8: 1–13.

Zenker S. Carboxytherapy: Carbon dioxide injections in aesthetic medicine. Prime Europe 2012; 2(1): 42–50.

Ferreira JCT, Haddad A, Tavares SAN. Increase in collagen turnover induced by intradermal injection of carbon dioxide in rats. J Drugs Dermatol 2008; 7(3): 201–206.


  • There are currently no refbacks.