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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dark circles &#40;DC&#41;&#44; also known as periorbital hyperpigmentation&#44; present as bilateral&#44; semicircular&#44; homogeneous pigmented macules and patches in the periorbital area&#46; They are multifactorial in etiology&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> DC can affect an individual&#39;s emotional well-being constituting a common reason for visiting a dermatologist&#46; A variety of treatment options exist&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> However&#44; improvement can be slow and often barely perceptible&#44; posing a therapeutic challenge to the treating dermatologists&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We aimed to evaluate the efficacy and safety of 10&#37; phenol and 20&#37; trichloroacetic acid &#40;TCA&#41; combination peel&#44; a commercial product&#44; in the treatment of DC&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patients with DC&#44; who were referred from September 2019 to March 2020 to our Dermatology outpatient department&#44; were included in the study&#46; The study protocol was approved by the Ethics Committee of the hospital&#44; and it was carried out in accordance with the Declaration of Helsinki&#46; Pre-peel treatment with 8&#37; glycolic acid once daily was given since 4 weeks before peeling treatment and had been discontinued 2&#8211;3 days before the procedure&#46; Patients were asked to maintain their eyes closed during the procedure and the inner canthus of the eye was protected with petroleum jelly&#44; as eye protection is mandatory when chemicals are used around to such a sensitive area&#46; Three layers of croton oil-free 10&#37; phenol and 20&#37; TCA combination peel were applied using cotton tip applicator &#40;allowing a more precise application&#41;&#44; to each periorbital area &#40;upper and lower eyelids&#41; for five minutes or less if homogeneous frosting occurred &#40;endpoint of peeling&#41;&#46; At that point&#44; they were advised to wash the treated area with pure water&#46; They were subjected to this topical therapy as a single stand-alone treatment&#46; Photographs were taken before the beginning of treatment&#44; as well as after the peeling session and at follow up visits&#46; A Physician&#39;s and Patient&#39;s global assessment scale was used to evaluate the efficacy of the treatment &#40;0&#8211;25&#37; indicated poor response&#44; 25&#8211;50&#37; fair&#44; 50&#8211;75&#37; good and 75&#8211;100&#37; excellent response&#41;&#46; All patients were followed up one and three months after their peeling session&#44; evaluating early and delayed adverse events&#46; They were advised to avoid both vigorous eye rubbing and exposure to sunlight&#46; However if exposed the use of both sunscreen and sunglasses was recommended&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Thirty one female patients with DC were enrolled in the study&#44; aged 43&#8211;75 years &#40;mean 47&#46;61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;81&#41;&#46; The majority of them &#40;81&#37;&#41; had Fitzpatrick skin type III and IV&#46; At the end of the study&#44; almost all patients showed aesthetic improvement &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; After examining the photographs of each patient before and after treatment&#44; none of them was classified as &#8216;worse&#8217; after the treatment&#46; Physicians assessed a poor&#44; fair&#44; good&#44; or excellent improvement in 4&#37;&#44; 25&#37;&#44; 37&#46;2&#37; and 33&#46;8&#37; of patients respectively and Patient Global Assessment rated a poor&#44; fair&#44; good or excellent response in 6&#46;1&#37;&#44; 24&#37;&#44; 44&#46;9&#37; and 25&#37; respectively&#46; Better response was demonstrated by young patients with fair skin phototypes &#40;90&#37; of patients with excellent and good improvement were in their early 40 s while 70&#37; of them had skin type III&#41;&#46; The procedure was well-tolerated&#46; With regards to the side effects&#44; no ocular complication &#40;chemical injury to the eye&#41; was noted&#46; Mild discomfort&#44; oedema and transient erythema were quite common during or immediately after the procedure&#46; However these were only temporary&#46; Persistent periorbital oedema was seen in only 5 patients and subsided after a few days &#40;3&#8211;5 days post therapy&#41;&#46; The exfoliation was most pronounced 7 days after the peel treatment and this scaling persisted up to 14 days&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">DC influence patient&#39;s quality of life&#44; as they interfere with the face appearance&#46; Chemical peeling has been used alone or in combination with other cosmetic procedures for their treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;5</span></a> Among the wide variety of chemical peels available&#44; the ones previously used in treating DC are alpha hydroxy acids&#44; beta hydroxy acids&#44; TCA and ferulic acid&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> In the present study&#44; thirty one women with DC were treated with 10&#37; phenol and 20&#37; TCA combination peel and most of them showed a moderate to remarkable improvement&#46; Phenol&#44; also known as carbolic acid&#44; is a deep peeling agent and causes protein denaturation leading to the production of new collagen and elastin&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Furthermore&#44; it leads to a decrease of melanin granules despite the presence of melanocytes&#46; The classic Baker&#39;s formula of phenol includes concentration which varies from 45 to 55 percent leading to a greater risk of adverse events&#46; The croton oil free formulation as well as the low consideration of 10&#37; phenol&#44; used in the present study&#44; makes cardiac monitoring not required while causes frosting and a delayed exfoliation &#40;after 1&#8211;2 weeks&#41;&#46; TCA in a concentration of 20&#37; acts as a superficial chemical peel and its clinical effect in DC is due to the resultant increase in dermal volume of collagen and melanin reduction through coagulative necrosis of cells&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> The combined use of these agents results in a medium depth peel providing very good cosmetic results in the reduction of pigmentation in DC&#44; alleviating the adverse effects from the usage of each agent alone&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">This is the first study using the combination of 10&#37; phenol and 20&#37; TCA in the treatment of DC&#46; According to our results&#44; it seems to be a promising&#44; safe&#44; easy&#44; efficacious&#44; and a cost-effective method treatment of DC&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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Case and Research Letter
Efficacy and Safety of Phenol and Trichloroacetic Acid Combination Peel for the Management of Dark Circles
Eficacia y seguridad de la exfoliación con una combinación de fenol y ácido tricloroacético, para el manejo de las ojeras
E. Platsidaki
Corresponding author
platsidakieft@yahoo.com

Corresponding author.
, A. Stravodimou, A. Kouris, V. Markantoni, G. Kontochristopoulos
Department of Dermatology and Venereology, Andreas Sygros Hospital, Athens, Greece
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    "titulo" => "Efficacy and Safety of Phenol and Trichloroacetic Acid Combination Peel for the Management of Dark Circles"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dark circles &#40;DC&#41;&#44; also known as periorbital hyperpigmentation&#44; present as bilateral&#44; semicircular&#44; homogeneous pigmented macules and patches in the periorbital area&#46; They are multifactorial in etiology&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> DC can affect an individual&#39;s emotional well-being constituting a common reason for visiting a dermatologist&#46; A variety of treatment options exist&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> However&#44; improvement can be slow and often barely perceptible&#44; posing a therapeutic challenge to the treating dermatologists&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We aimed to evaluate the efficacy and safety of 10&#37; phenol and 20&#37; trichloroacetic acid &#40;TCA&#41; combination peel&#44; a commercial product&#44; in the treatment of DC&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patients with DC&#44; who were referred from September 2019 to March 2020 to our Dermatology outpatient department&#44; were included in the study&#46; The study protocol was approved by the Ethics Committee of the hospital&#44; and it was carried out in accordance with the Declaration of Helsinki&#46; Pre-peel treatment with 8&#37; glycolic acid once daily was given since 4 weeks before peeling treatment and had been discontinued 2&#8211;3 days before the procedure&#46; Patients were asked to maintain their eyes closed during the procedure and the inner canthus of the eye was protected with petroleum jelly&#44; as eye protection is mandatory when chemicals are used around to such a sensitive area&#46; Three layers of croton oil-free 10&#37; phenol and 20&#37; TCA combination peel were applied using cotton tip applicator &#40;allowing a more precise application&#41;&#44; to each periorbital area &#40;upper and lower eyelids&#41; for five minutes or less if homogeneous frosting occurred &#40;endpoint of peeling&#41;&#46; At that point&#44; they were advised to wash the treated area with pure water&#46; They were subjected to this topical therapy as a single stand-alone treatment&#46; Photographs were taken before the beginning of treatment&#44; as well as after the peeling session and at follow up visits&#46; A Physician&#39;s and Patient&#39;s global assessment scale was used to evaluate the efficacy of the treatment &#40;0&#8211;25&#37; indicated poor response&#44; 25&#8211;50&#37; fair&#44; 50&#8211;75&#37; good and 75&#8211;100&#37; excellent response&#41;&#46; All patients were followed up one and three months after their peeling session&#44; evaluating early and delayed adverse events&#46; They were advised to avoid both vigorous eye rubbing and exposure to sunlight&#46; However if exposed the use of both sunscreen and sunglasses was recommended&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Thirty one female patients with DC were enrolled in the study&#44; aged 43&#8211;75 years &#40;mean 47&#46;61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;81&#41;&#46; The majority of them &#40;81&#37;&#41; had Fitzpatrick skin type III and IV&#46; At the end of the study&#44; almost all patients showed aesthetic improvement &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; After examining the photographs of each patient before and after treatment&#44; none of them was classified as &#8216;worse&#8217; after the treatment&#46; Physicians assessed a poor&#44; fair&#44; good&#44; or excellent improvement in 4&#37;&#44; 25&#37;&#44; 37&#46;2&#37; and 33&#46;8&#37; of patients respectively and Patient Global Assessment rated a poor&#44; fair&#44; good or excellent response in 6&#46;1&#37;&#44; 24&#37;&#44; 44&#46;9&#37; and 25&#37; respectively&#46; Better response was demonstrated by young patients with fair skin phototypes &#40;90&#37; of patients with excellent and good improvement were in their early 40 s while 70&#37; of them had skin type III&#41;&#46; The procedure was well-tolerated&#46; With regards to the side effects&#44; no ocular complication &#40;chemical injury to the eye&#41; was noted&#46; Mild discomfort&#44; oedema and transient erythema were quite common during or immediately after the procedure&#46; However these were only temporary&#46; Persistent periorbital oedema was seen in only 5 patients and subsided after a few days &#40;3&#8211;5 days post therapy&#41;&#46; The exfoliation was most pronounced 7 days after the peel treatment and this scaling persisted up to 14 days&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">DC influence patient&#39;s quality of life&#44; as they interfere with the face appearance&#46; Chemical peeling has been used alone or in combination with other cosmetic procedures for their treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#8211;5</span></a> Among the wide variety of chemical peels available&#44; the ones previously used in treating DC are alpha hydroxy acids&#44; beta hydroxy acids&#44; TCA and ferulic acid&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> In the present study&#44; thirty one women with DC were treated with 10&#37; phenol and 20&#37; TCA combination peel and most of them showed a moderate to remarkable improvement&#46; Phenol&#44; also known as carbolic acid&#44; is a deep peeling agent and causes protein denaturation leading to the production of new collagen and elastin&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Furthermore&#44; it leads to a decrease of melanin granules despite the presence of melanocytes&#46; The classic Baker&#39;s formula of phenol includes concentration which varies from 45 to 55 percent leading to a greater risk of adverse events&#46; The croton oil free formulation as well as the low consideration of 10&#37; phenol&#44; used in the present study&#44; makes cardiac monitoring not required while causes frosting and a delayed exfoliation &#40;after 1&#8211;2 weeks&#41;&#46; TCA in a concentration of 20&#37; acts as a superficial chemical peel and its clinical effect in DC is due to the resultant increase in dermal volume of collagen and melanin reduction through coagulative necrosis of cells&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> The combined use of these agents results in a medium depth peel providing very good cosmetic results in the reduction of pigmentation in DC&#44; alleviating the adverse effects from the usage of each agent alone&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">This is the first study using the combination of 10&#37; phenol and 20&#37; TCA in the treatment of DC&#46; According to our results&#44; it seems to be a promising&#44; safe&#44; easy&#44; efficacious&#44; and a cost-effective method treatment of DC&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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                      "titulo" => "Ferulic acid 12&#37; peel&#58; an innovative peel for constitutional type of periorbital melanosis-comparing clinical efficacy and safety with 20&#37; glycolic peel and 15&#37; lactic peel &#91;published online ahead of print&#44; 2020 Jan 16&#93;"
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Article information
ISSN: 00017310
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
es en

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