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The effects of topical application of phytonadione, retinol and vitamins C and E on infraorbital dark circles and wrinkles of the lower eyelids
Abstract
Infraorbital dark circles and wrinkles of the lower eyelids are a cosmetic problem, especially with age.
To determine whether a gel containing 2% phytonadione, 0.1% retinol and 0.1% vitamins C and E is effective in reducing dark under-eye circles and wrinkles of the lower eyelids in healthy Japanese adults.
Fifty-seven adult Japanese volunteers with dark under-eye circles and wrinkles were enrolled in an open label study. The gel formulation was applied twice daily to the lower eyelid site for 8 weeks. Haemostasis, pigmentation and wrinkles were evaluated by a physician and by the patients themselves, using a digital camera and a visual analogue scale respectively, after 4 and 8 weeks of treatment.
Topical application of the gel decreased not only haemostasis but also wrinkles after 8 weeks of treatment. Of 57 patients, 27 (47%) had reductions in haemostasis. Wrinkles were also decreased in some patients. However, pigmentation was not clearly removed by this gel.
Topical application of the gel containing 2% phytonadione, 0.1% retinol, 0.1% vitamin C and 0.1% vitamin E was fairly or moderately effective in reducing dark under-eye circles, especially in cases of haemostasis, over a short treatment period in healthy Japanese adults. This treatment also slightly decreased wrinkles.
... Ocasionalmente, algumas drogas podem desencadear esse quadro, como os antipsicóticos, quimioterápicos e alguns colírios. [1][2][3][4][5] Diferentes tratamentos têm sido propostos, ainda que poucos tenham promovido melhora satisfátória e duradoura; estão entre essas opções: criocirurgia; luz intensa pulsada; lasers de CO 2 , argônio, ruby e excimer; retinóides; dermoabrasão; e peelings químicos. A resposta terapêutica depende de várias sessões de qualquer procedimento escolhido, por isso o paciente deve estar ciente de que a melhora é lenta, mantendo, assim, a continuidade do tratamento. ...
... A melhor maneira de evitá-las é identificar os fatores de risco e individualizar a terapêutica. [1][2][3][4][5][6] Neste artigo, apresenta-se o ácido tioglicólico como possível agente na abordagem da hiperpigmentação periorbicular constitucional. Também chamado ácido mercapto acético, o ácido tioglicólico é composto que inclui enxofre, com peso molecular de 92,12 (intermediário entre os ácidos tricloroacético e o glicólico, 163,4 e 76,05, respectivamente). ...
... 7 Insônia e cansaço persistentes atuam, sem dúvida alguma, na piora desse processo, através da estase dos vasos sanguíneos, levando à mudança de cor na região. [1][2][3][4][5][6] O ácido tioglicólico é um dos representantes da classe dos tioglicolatos, cujas substâncias são, há muito tempo, utilizadas na indústria cosmética, como, por exemplo, depilatórios corporais, alisantes e colorantes capilares. 8 As substâncias da classe dos tioglicolatos podem manifestar capacidade de irritação e sensibilização cutâneas. ...
Eyelid dark circles are important in clinical practice because they cause visual sensation of tiredness and aging. They are classified into vascular discoloration, hyperpigmentation, tear trough depression, and skin texture alteration. Vascular discoloration occurs in thin skin by accumulation of hemoglobin and components of its degradation in the skin by microruptures in the vessels. Thioglycolic acid has an antioxidant activity and capability of eliminating iron accumulation. The protocol is three to five sessions of 10% acid with a minimum interval of 15 days. Burning sensation and frost are guides to the endpoint of the session. The possible complications are related to pain, persistent burning sensation, edema, erythema, and post-inflammatory hyperpigmentation. The use of bleach creams and sunglasses and avoiding sun exposure improve the results and help to avoid complications.
... Ocasionalmente, algumas drogas podem desencadear esse quadro, como os antipsicóticos, quimioterápicos e alguns colírios. [1][2][3][4][5] Diferentes tratamentos têm sido propostos, ainda que poucos tenham promovido melhora satisfátória e duradoura; estão entre essas opções: criocirurgia; luz intensa pulsada; lasers de CO 2 , argônio, ruby e excimer; retinóides; dermoabrasão; e peelings químicos. A resposta terapêutica depende de várias sessões de qualquer procedimento escolhido, por isso o paciente deve estar ciente de que a melhora é lenta, mantendo, assim, a continuidade do tratamento. ...
... A melhor maneira de evitá-las é identificar os fatores de risco e individualizar a terapêutica. [1][2][3][4][5][6] Neste artigo, apresenta-se o ácido tioglicólico como possível agente na abordagem da hiperpigmentação periorbicular constitucional. Também chamado ácido mercapto acético, o ácido tioglicólico é composto que inclui enxofre, com peso molecular de 92,12 (intermediário entre os ácidos tricloroacético e o glicólico, 163,4 e 76,05, respectivamente). ...
... 7 Insônia e cansaço persistentes atuam, sem dúvida alguma, na piora desse processo, através da estase dos vasos sanguíneos, levando à mudança de cor na região. [1][2][3][4][5][6] O ácido tioglicólico é um dos representantes da classe dos tioglicolatos, cujas substâncias são, há muito tempo, utilizadas na indústria cosmética, como, por exemplo, depilatórios corporais, alisantes e colorantes capilares. 8 As substâncias da classe dos tioglicolatos podem manifestar capacidade de irritação e sensibilização cutâneas. ...
Introduction: Constitutional infraorbital hyperchromia (commonly called under-eye circles) is a common dermatosis that is difficult to treat. Objective:To evaluate the clinical improvement of constitutional infraorbital pigmentation resulting from the application of a series of five 10% thioglycolic acid gel peeling sessions. Methods: Patients were administered five successive 10% thioglycolic acid gel peel sessions, in 15-day intervals. In the first session, the product was left on for two minutes, with three minutes added in each subsequent session, culminating with 15 minutes of contact in the last session. Fifteen days after the last session, a satisfaction scale ranging from 0 (lack of improvement) to 10 (total improvement) was administered to the patients, to the dermatologist investigating the peelings, and to a blindevaluator medical doctor (a dermatologist that had not had taken part in the treatment sessions). Results: Study subjects (n=10) were females aged 24-50.The average clinical satisfaction presented by the patients, the investigator, and the blind-evaluator were 7.8, 7.6 and 6.8, respectively, with no statistically significant differences among them (p=0.065). Conclusion: The serial application of 10% thioglycolic acid gel peels is a safe, efficient, and costeffective treatment for constitutional infraorbital pigmentation.
... Ocasionalmente, algumas drogas podem desencadear esse quadro, como os antipsicóticos, quimioterápicos e alguns colírios. [1][2][3][4][5] Diferentes tratamentos têm sido propostos, ainda que poucos tenham promovido melhora satisfátória e duradoura; estão entre essas opções: criocirurgia; luz intensa pulsada; lasers de CO 2 , argônio, ruby e excimer; retinóides; dermoabrasão; e peelings químicos. A resposta terapêutica depende de várias sessões de qualquer procedimento escolhido, por isso o paciente deve estar ciente de que a melhora é lenta, mantendo, assim, a continuidade do tratamento. ...
... A melhor maneira de evitá-las é identificar os fatores de risco e individualizar a terapêutica. [1][2][3][4][5][6] Neste artigo, apresenta-se o ácido tioglicólico como possível agente na abordagem da hiperpigmentação periorbicular constitucional. Também chamado ácido mercapto acético, o ácido tioglicólico é composto que inclui enxofre, com peso molecular de 92,12 (intermediário entre os ácidos tricloroacético e o glicólico, 163,4 e 76,05, respectivamente). ...
... 7 Insônia e cansaço persistentes atuam, sem dúvida alguma, na piora desse processo, através da estase dos vasos sanguíneos, levando à mudança de cor na região. [1][2][3][4][5][6] O ácido tioglicólico é um dos representantes da classe dos tioglicolatos, cujas substâncias são, há muito tempo, utilizadas na indústria cosmética, como, por exemplo, depilatórios corporais, alisantes e colorantes capilares. 8 As substâncias da classe dos tioglicolatos podem manifestar capacidade de irritação e sensibilização cutâneas. ...
... Ocasionalmente, algumas drogas podem desencadear esse quadro, como os antipsicóticos, quimioterápicos e alguns colírios. [1][2][3][4][5] Diferentes tratamentos têm sido propostos, ainda que poucos tenham promovido melhora satisfátória e duradoura; estão entre essas opções: criocirurgia; luz intensa pulsada; lasers de CO 2 , argônio, ruby e excimer; retinóides; dermoabrasão; e peelings químicos. A resposta terapêutica depende de várias sessões de qualquer procedimento escolhido, por isso o paciente deve estar ciente de que a melhora é lenta, mantendo, assim, a continuidade do tratamento. ...
... A melhor maneira de evitá-las é identificar os fatores de risco e individualizar a terapêutica. [1][2][3][4][5][6] Neste artigo, apresenta-se o ácido tioglicólico como possível agente na abordagem da hiperpigmentação periorbicular constitucional. Também chamado ácido mercapto acético, o ácido tioglicólico é composto que inclui enxofre, com peso molecular de 92,12 (intermediário entre os ácidos tricloroacético e o glicólico, 163,4 e 76,05, respectivamente). ...
... 7 Insônia e cansaço persistentes atuam, sem dúvida alguma, na piora desse processo, através da estase dos vasos sanguíneos, levando à mudança de cor na região. [1][2][3][4][5][6] O ácido tioglicólico é um dos representantes da classe dos tioglicolatos, cujas substâncias são, há muito tempo, utilizadas na indústria cosmética, como, por exemplo, depilatórios corporais, alisantes e colorantes capilares. 8 As substâncias da classe dos tioglicolatos podem manifestar capacidade de irritação e sensibilização cutâneas. ...
Introdução: A hipercromia infraorbicular constitucional é dermatose comum, de difícil tratamento.Objetivo: Avaliar a melhoria clínica da pigmentação infraorbicular constitucional com cinco peelings seriados de ácido tioglicólico a 10% em gel. Métodos: 10 voluntárias do sexo feminino, entre 24 e 50 anos de idade, realizaram cinco sessões quinzenais de peeling de ácido tioglicólico 10% gel. Na primeira sessão, o produto foi deixado por dois minutos, acrescentando-se três minutos a cada uma das sessões subsequentes, tendo na última sido deixado por 15 minutos; 15 dias após a última sessão, foiaplicada escala de satisfação clínica, de 0 (ausência de melhora) a 10 (melhora total), tanto às pacientes quanto ao médico aplicador e a um médico avaliador-cego. Resultados: A média da satisfação clínica apontada pelas pacientes foi 7,8; a do médico aplicador, 7,6; e a do médico avaliador-cego, 6,8, sem diferenças estatísticas entre eles (p=0,065). Conclusão: Os peelings seriados de ácido tioglicólico 10% em gel são alternativa segura,eficiente e barata para a abordagem da pigmentação infraorbicular constitucional.
... However, many active agents used in these types of serums have various individual properties such as retinol is used to boost up collagen synthesis and reduces the fine lines and wrinkles, hyaluronic acid improves the skin sagging issues, and peptides are used to rectify the deepest fine lines and wrinkles. Because of their advantages (deep absorption and non-greasy appearance) over the eye formulations like creams, these serums are nowadays used most commonly [215][216][217][218][219][220][221]. ...
... A history of eczema, another heritable condition, also correlated with objective measures. This is in agreement with reports of increased vascular congestion as a physiological basis of dark circles 7,8,12,17 . In fact, dark circles are so characteristic of atopy in children that their presence, whether in the form of Dennie-Morgan folds or orbital darkening, is sufficient to elicit a suspicion of atopy 17 . ...
Background:
Periocular dark circles (PDCs) are a common cosmetic complaint. Grading systems based on objective measures have been used but no standard system is in place.
Objective:
To determine factors associated with subjective and objective PDC severity.
Methods:
Enrolled patients (n=100) completed a questionnaire comprised of demographic variables, medical history, and self-perception of PDC. Those perceiving PDC graded dissatisfaction on a 10-point scale. Clinical severity (grades 0~4) and subtype (constitutional, post-inflammatory, vascular, shadow effects, or others) were determined. A Konica Minolta CR-400 chromameter was used to obtain colorimetry measurements (L*a*b* values). The objective average difference in darkness (ΔL*) between the periocular region and the cheek was determined. Comparisons were made using Spearman correlation coefficients (r).
Results:
Patient dissatisfaction correlated with both clinical severity (r=0.46, p<0.001) and the ΔL* by colorimetry (r=0.35, p=0.004). Factors associated with subjective dissatisfaction were female sex (r=0.38, p=0.002), higher Fitzpatrick skin type (r=0.42, p=0.001), fewer hours of sleep (r=-0.28, p=0.03), and use of concealer (r=0.35, p=0.004). Factors associated with objective measures were higher Fitzpatrick skin type (r=0.36, p=0.0007 and r=0.28, p=0.009, respectively), family history of PDC (r=0.34, p<0.001 and r=0.20, p=0.05), and history of eczema (r=0.45, p<0.001 and r=0.20, p=0.0504). Clinical severity grading correlated with colorimetric severity (r=0.36, p=0.0003).
Conclusion:
Overall, subjective dissatisfaction was associated with clinical severity. However, factors associated with subjective severity did not necessarily overlap with factors associated with objective severity. These findings highlight the importance of patient-reported grading. There may be added value in incorporating a component of subjective grading into the traditionally objective PDC grading scales.
... 3 Physiologic causes include general fatigue, lack of sleep,premenstrual phase, extension of pigmentary demarcation line, and presence of medical problems like iron-deficiency anemia etc 4 Various treatment modalities of POM include topical skin lightening agents such as hydroquinone, kojic acid, azelaic acid and topical retinoic acid, and physical treatments, such as chemical textures, surgical corrections, and laser therapy. 3,5,6 Dermoscopy is a non-invasive technique which helps us to find if the source of pigment is melanin or underlying vasculature and thereby plan the treatment as the therapy is entirely dependent on the source of pigmentation. 7 However, its utility in periorbital hypermelanosis has been the least illustrated. ...
Introduction
Periorbital melanosis (POM) is an aesthetic facial concern on increasing trend and has a severe emotional impact on patients. We aimed to study the clinical and dermoscopic patterns of periorbital melanosis to aid in the classification and strategize therapy.
Methods
A cross‐sectional, observational study was conducted on one hundred patients with POM in a tertiary care centre in India from January 2020 – March 2020. Dermoscopic assessment of POM was done using video dermatoscope‐ FotoFinder Medicam 1000s (magnification upto 140x).
Results
The mean age of participants was 32.8±9 years. It was more prevalent among females (78%). The constitutional type (43%) of POM was the most common followed by shadow effect type (32%). The various dermoscopic pigmentary patterns seen were scattered pigmented dots (56%), exaggerated pigment network (31%), globules (30%) and blotches (27%). Dilated veins and telangiectasia were seen in 50% and 32% of subjects respectively. Exaggerated skin markings were seen in 43% of participants. Scattered pigmented dots was most commonly seen in constitutional, vascular and shadow types but was significantly associated with vascular type. Exaggerated pigment network was the most frequent pigmentary pattern in post inflammatory type of POM. Globules were significantly associated with constitutional as well as shadow type of POM and blotches with shadow type of POM.
Conclusions
Periorbital melanosis presents as multifactorial entity with constitutional type being the most common. The dermoscopic patterns of POM may provide a clue to the underlying aetiology, thereby helping to plan appropriate treatment.
... [12][13][14][15][16] Topical application of different agents have also been used in the treatment. Such agents are phytonadione, retinol, and vitamin C, vitamin E etc. 17 Microneedling and carboxytherapy have also been used for the treatment of periorbital dark circles. 18 There is no doubt that cosmetic dermatology is a new and growing branch of medical science, but the cosmetic concern of skin is ancient among the humankind. ...
p class="abstract"> Background: Periorbital melanosis (POM) is a common aesthetic condition with significant impact. Chemical peeling is a frequently used treatment; yet, an ideal peeling agent is however to find. The aim of the study was to compare the clinical efficacy and safety of 20% glycolic acid (GA) and 30% lactic acid (LA) peels in POM.
Methods: With approval and consent, the study was conducted from September 2016-August 2017. Patients aged 18-60 years of both sexes, having a constitutional POM were enrolled. Patients known to be allergic to the peeling agents were excluded. Alternate patients were enrolled into Gr-G (20% GA) and Gr-L (30% LA) and were treated every 3 weeks, for 3 sessions and evaluated till 9 weeks. Clinical improvement using POM grading, patients’ global assessment, satisfaction, and physician's global satisfaction were noted. Data are presented in number, percentages and mean±standard deviation. INSTAT software was used for statistical analysis; p<0.05 was considered significant.
Results: Fifty-six (27 in Gr-G, 29 in Gr-L) were enrolled; 70.37% and 68.97% completed the study. Demographic variables, baseline POM grade, and skin types were similar. Compared to baseline, both Gr-G and Gr-L showed significant improvement (p<0.0001). Patient-reported significantly higher improvement in Gr-L (p=0.008) and higher satisfaction. Both the peeling agents were tolerated well with statistically indifferent adverse effects.
Conclusions: Both GA and LA are useful in the aesthetic treatment of the constitutional type of POM. Three sessions of 30% LA peel appears to be better than 20% GA peeling used at 3 weeks apart.
</p
... É possível que a melanina associada à HCIRO possa responder a agentes despigmentantes, peelings químicos, laserterapia (LIP, lasers para pigmentação, lasers fracionados). 1,2,17,18 Entretanto, de acordo com os achados do presente estudo, um número crescente de evidências demonstraram que a pigmentação ao redor das pálpebras não é restrita à camada epidérmica, mas também afeta profundamente a camada 21 Inesperadamente, apesar de todos os casos de HCIRO relacionados à hiperpigmentação pós-inflamatória terem sido excluídos deste estudo, até 67% (10 das 15 biópsias) dos casos do tipo hiperpigmentação constitucional possuíam inflamação perifolicular grave, além de alto grau de dilatação dos vasos sanguíneos (Tabela 3). O tipo sulco lacrimal é freqüentemente associado à deformidade da estrutural facial, sendo que vários estudos propuseram que a estase sangüínea / congestão venosa pode contribuir para o surgimento do tipo sulco lacrimal / sombreamento. ...
Introdução: A identificação das causas da hipercromia cutânea idiopática da região orbital
(HCIRO) é fundamental para o processo de seleção da melhor conduta terapêutica.
Objetivo: O presente estudo tem como objetivo avaliar as alterações histopatológicas de
diferentes tipos de HCIRO.
Métodos: Quarenta e nove voluntários saudáveis foram classificados em 3 grupos: (i)
hiperpigmentação, (ii) hipervascularização e (iii) sulco lacrimal. As deposições de melanina e hemossiderina,
a dilatação dos vasos sanguíneos, a inflamação perifolicular e as estruturas das
cristas epidérmicas foram analisadas histologicamente; a associação com o tipo de HCIRO
foi analisada pelo teste do qui-quadrado de Pearson.
Resultados: Um total de 53,1% dos indivíduos portadores de HCIRO foram diagnosticados
e classificados em hiperpigmentação, 16,3% como hipervascularização e 30,6%
como sulco lacrimal. O teste qui-quadrado de Pearson mostrou que o grupo hiperpigmentação
foi associado a um alto nível de depósito de melanina (p
... VitE was first described in 1922 by Herbert M Evans and Katherine Bishop in 1936, it was biochemically characterized and named tocopherol such as Greek: -tocos‖ meaning offspring and -phero‖ meaning to bring forth (Evans and Bishop, 1922 On the other hand, topical vitamin E was found to be effective in granuloma annulare as a promising cosmetic appearance of scars (Baumann et al., 1999) as well as anti aging treatment (Jenkins et al., 1986). In addition, topical application of the gel containing 2% phytonadione, 0.1% retinol, 0.1% vitamin C, and 0.1% vitamin E has been seen to be fairly or moderately effective in reducing dark under-eye circles, especially in cases of hemostasis (Mitsuishi et al., 2004). ...
Vitamin E is an antioxidant agent with low aqueous solubility and
bioavailability which has been used to protects the skin from atopic
dermatitis and various deleterious effects due to solar radiation by
acting as a free-radical scavenger. The aim of the present study was to formulate, to characterize and in vitro evaluate the microemulsion
containing vitamin E at 0.1% for topical skin application. In order to
design suitable microemulsion system, appropriate amounts of
isopropyl myristate, tween 80, propylene glycol and water able to
encapsulating high vitamin E amount were earlier defined by our
research group and herein characterized. Physicochemical properties
such as particles size, polydispersity index, zeta potential and
encapsulation efficiency were measured. The particles size,
polydispersity index, zeta potential was obtained by dynamic light
scattering method and the analysis indicated an average of particles size 250 nm, a low PDI index and negative zeta potential. In this work, none of the investigated formulations were able to induce cell cytotoxicity within the tested conditions during 4h cell exposure. In this work, the investigated vitamin E-loaded microemulsion and unloaded microemulsion (control) were unable to induce cell cytotoxicity in the concentration range below 0.75mg/mL
of vitamin E after 24h cell exposure.
... In vascular POH, the main treatment is to target the vessel walls to stabilize them, and the use of vitamin C, Phytonadione (vitamin K1), tretinoin [10] and so on can help, whereas pigmented POH is treated with hydroquinone and other depigmenting agents, along with lasers. [11] In mixed type POH, the approach should be through combination therapy. ...
... 5,7-9 It is estimated that several exogenous and endogenous factors are involved, the main mechanisms being melanin deposition, hemosiderotic pigment deposition caused by vascular ectasia and anatomical changes. 1,4,6,11,12 Popularly, one of the possible associated causes is lack of sleep, but few studies have evaluated whether or not this hypothesis is appropriate. ...
Introduction
Periorbital hyperchromia (POH) is a multifactorial condition, precipitated or aggravated by sleep disorders, which negatively affects quality of life (QoL). The aim of this study was to evaluate the impact of POH on QoL, sleep quality, and dissatisfaction of affected patients.
Methods
In this cross‐sectional study of male and female patients over 18 years, participants were examined, their demographic data were registered, and Dermatology Quality of Life Index (DLQI), Pittsburgh Sleep Quality Index (PSQI‐BR), and Visual Analogue Scale (VAS) were used to assess dissatisfaction.
Results
Patients (n = 100) were mostly women (91%) with a mean age of 36.9 years and POH duration of 18.32 years. Phototypes II (24%) and III (60%) were predominant. A total of 33% reported 4‐6 hours and 66% reported over 6 hours of sleep per night. POH was classified as mild (59%), moderate (37%), or severe (4%). Mean dissatisfaction with POH was 6.9, PSQI was 6.04, and DLQI was 4.92. There was a significant difference in the dissatisfaction scale (P < .005) between men and women. Women reported worse QoL (P < .001) and higher dissatisfaction (P < .0001). A correlation between DLQI and disease duration was found.
Conclusion
Periorbital hyperchromia negatively impacts patients’ QoL. Dissatisfaction is directly related to disease severity.
... A number of studies confirmed that topical application of antioxidants had great beneficial effect as photo-protective and that it is desirable to add these agents to the skin reservoir by applying them directly to skin. Also, direct application has the added advantage of targeting them to the dermal site needing the protection [4][5][6][7]. The use of more than one photo-protective agents topically has been investigated in some previous literature using a combination of agents with similar [8] or different [5] mechanisms of action; an optimal protection by synergistically preventing the baleful effects of sun exposure was reported. ...
Solar irradiation induces skin inflammatory processes causing deleterious effects like premature ageing. In this study, the designed lipoid colloidal carrier (LCC) was loaded with Diosmin in combination with different essential oils, to be used as a topical photo-protective preparation. To investigate the ability of the essential oils to potentiate Diosmin effects, the Diosmin/essential oil-loaded LCCs (LCC2, LCC3 and LCC4) were compared to the Diosmin-loaded LCC (LCC1). The incorporated essential oils were those of Rosmarinus officinalis, Zingiber officinale or Vitis vinifera in LCC2, LCC3 and LCC4, respectively. All the LCCs had particle size (PS) values ranging from 121.1 to 144.3nm with uniform distribution and, zeta potential (Z) values around 30mV. Also, they all had high drug encapsulation efficiencies. LCC1 had the lowest anti-oxidant and in-vitro sun-blocking effect (p<0.05). In-vivo photo-protective studies showed that all the formulated LCCs had a skin protective effect when compared to the positive control (p<0.05); however LCC1 had the lowest anti-erythemal and anti-wrinkling effect. Histological studies proved the efficacy of the designed LCCs as skin anti-photoageing, with LCC1 showing the lowest anti-inflammatory and anti-wrinkling effect, while LCC2 had the highest anti-wrinkling effect. These results indicated that the suggested Diosmin/essential oil combinations improved the anti-oxidant, sun-blocking and anti-photoageing effects of Diosmin. After one year of storage, the LCCs showed satisfactory physical stability. This study presents the designed LCCs as safe and effective nano-structured dermal care products containing 'all-natural' components.
... Mitsuishi et al. 23 desenvolveram um estudo com 57 japoneses voluntários com HPO. O estudo testou um composto contendo 2,0% phytonadiona (vitamina K1), 0,1% retinol, 0,1% vitamina C e 0,1% vitamina E (tocoferol), preparados em emulsão óleo/água. ...
... A number of topical products have been reported to improve lower eyelid pigmentation, laxity, and rhytides. A study by Mitsuishi and colleagues 77 found subjective improvement in under-eye hemostasis and wrinkling with use of a gel containing 0.1% retinol and vitamins C, E, and K for 8 weeks. Other uncontrolled studies of creams with vitamins C, E, and K or vitamin K and retinol have demonstrated improvement in infraorbital pigmentation in 93% to 100% of subjects, albeit with variable results. ...
Dark under-eye circles are a common cosmetic complaint among patients, spanning all age groups and skin types. We review the anatomic and physiologic features of dark circles and highlight the varied treatment options available, including lasers to target pigment and superficial vasculature, fillers to reverse volume loss, and resurfacing to improve skin laxity and wrinkling.
Copyright © 2015 Elsevier Inc. All rights reserved.
... [1] It is commonly observed in dark-skinned patients, especially Asians, but there is only little data in scientific literature. A number of treatment modalities have been tried for this condition with mixed results, including topical agents, [2] chemical peels, [3] lasers like the Q-switched Nd: YAG laser [4] and even fat transplantation. [5] None of the treatments is uniformly effective and there is a need for newer approaches to its management. ...
Periorbital melanosis (under eye dark circles) is an often idiopathic cosmetically disturbing condition that is poorly responsive to currently available treatment modalities. We present the case of a 48-year-old man (skin phototype V) with significant idiopathic periorbital melanosis and who had good to excellent reduction in periorbital melanosis with the new DermaFrac™, which combines microneedling with simultaneous infusion of a serum containing active ingredients. The possible mechanisms of benefit are discussed. DermaFrac™ may be an innovative and effective new treatment option for patients with periorbital melanosis.
... Topical treatment of nobiletin on the skin of the back prevented the UVB-induced increase of transepidermal water loss and hyperplasia of the epidermis in hairless mice (Tanaka et al., 2004). Clinical studies in healthy Japanese adults showed that topical application of the gel containing 2% phytonadione, 0.1% retinol, 0.1% vitamin C and 0.1% vitamin E was fairly or moderately effective in reducing dark under-eye circles and also decreased wrinkles (Mitsuishi et al., 2004). Burke (2004) highlights the need to use specific concentrations and chemical forms of vitamins C, E and selenium so that they can be used topically and can suitably reverse photodamage to the skin. ...
Ageing proceeds by highly complicated biochemical processes, in which the involvement of the reactive oxygen species (ROS) and free radicals has been implicated. Reactive oxygen species are dramatically enhanced by exposure to the ultraviolet radiation. Free radical scavengers and antioxidants can thus provide a long-term protection against these changes. Currently, dermaceutical and cosmetic industry is growing immensely with its main focus on packaging the active into a suitable/novel delivery system. This not only enhances the customer acceptance but offers better targeting to the upper skin layer, with faster onset, at a lower concentration of the active. Later also counter toxic or adverse effects observed with large doses especially when administered orally. Several of the antioxidant molecules are labile to degradation in the presence of oxygen, water and light, hence it becomes all the more appropriate to use a delivery system which will augment their stability and hence enhance the performance. In the present review, we focus on the pioneering research on novel delivery systems which can promote the therapeutic value of antioxidants for combating UV-induced photoageing.
Background:
Periorbital hyperpigmentation (POH) is a common skin condition that presents as infraorbital darkening. POH has a multifactorial etiology. Studies evaluating POH treatment are several with varying satisfaction results.
Objectives:
To compare carboxytherapy and microneedling (MN) combined with topical glutathione for POH treatment.
Materials and methods:
A split-face pilot clinical trial was conducted on 31 female patients with POH. Carboxytherapy injection was done at the right periorbital area, and MN with topical glutathione (Left periorbital area), for 6 biweekly sessions. Visual analogue scale (VAS), dermoscopic evaluation, patient satisfaction, and patient dermatology life quality index questionnaire (DLQI), safety evaluation were done with 3 months follow up. The trial registry number is NCT04389788.
Results:
Carboxytherapy showed a higher significant improvement as regards VAS evaluation compared to MN with glutathione during the active treatment phase (P = 0.001) and during the follow-up phase (P = 0.006). Also, the dermoscopic evaluation showed a statistically significant improvement in the Carboxytherapy group. DLQI showed a statistically significant improvement (P <.001). As regards patient satisfaction, carboxytherapy showed in comparison to MN with glutathione (80.6% vs 25.8% in moderate satisfaction) and (3.2% vs 0% in marked satisfaction respectively) (P = .05). As regards the patients' safety, there was no significant difference between both eyes (P = .23).
Conclusions:
Carboxytherapy showed higher efficacy than MN with glutathione in POH patients. Carboxytherapy improved clinical, dermoscopic, patient satisfaction, and patient DLQI; with a good safety profile.
Introduction: Dark circles and wrinkles under the eyes are common cosmetic problems, caused by various conditions, especially aging and overproduction of melanin in the epidermis or dermis of the skin. Iin addition to the application of topical lightening agents, different types of lasers, especially the Q-Switched ND:YAG laser, have been used for the treatment of cutaneous hyperpigmentation. Because of a high prevalence of idiopathic eye dark circles (EDCs) or periorbital melanosis and a poor response to available therapies, we decided to evaluate the efficacy and safety of the Fractional QS 1064 nm ND:YAG Laser through a before-after trial. Methods: 18-65-year-old patients with skin Fitzpatrick phototype of I-V and without any usage of a topical or systemic therapeutic regimen (2-4 weeks before the trial) were enrolled in the study. Each patient was treated with 6 sessions of the Fractional QS 1064 nm ND:YAG Laser at 2-week intervals and assessed for response and possible side effects or recurrences through 4 outcome measures, including Visoface-based color and erythema, melanin index and lightness (Before the fourth and sixth sessions of the therapy; also 1 week and 3 months after finishing the trial). Results: The changes of Visoface-based color and erythema, the melanin pigment amount by the Mexameter (melanin index) and the degree of lightness by the Colorimeter of patients after 6 months of intervention were statistically significant (P<0.001). Conclusion: The fractional QS 1,064 nm ND:YAG Laser is an effective and safe therapy in EDCs since objective outcomes like the reduction of the melanin index and improving lightness and subjective ones like the reduction of darkness and erythema were confirmed.
In this research, we propose a method using a spectroscopic camera to estimate the concentration of blood in different layers of skin tissue. For the demonstration that shows the possibility of application of our method, we conducted a stimulation experiment on 20 subjects involving hot or carbonated baths to promote blood circulation, and estimated the blood concentration before and after stimulation. The results indicate the possibility of estimating blood concentration by proposed method based on spectroscopic images.
Background
Studies on the anti-wrinkle effects of retinol have been widely reported, but there are few reports on the infraorbital dark circles reducing effects.
Objective
To evaluate the efficiency and tolerance of one novel formulation containing supramolecular retinol plus acmella oleracea extract in Chinese urban eye skin.
Methods
Thirty-three women with dark circles and visible fine wrinkles around the eyes, aged 20–45 years, were enrolled and instructed to use the formula for 6 weeks. Instrumental measures and subject assessment were obtained at baseline and at 3-week intervals.
Results
After 6 weeks, Mexameter MX18 results demonstrated a statistically significant 13.8% decrease in MI (melanin index) value, and Colorimeter CL400 results demonstrated a statistically significant 0.5% increase in L* (lightness) value, which proved the efficacy of reducing dark circles. Primos-Lite data showed that the wrinkles parameters of Ra, the wrinkle area %, and number of the wrinkles under the eyes and crow's feet revealed significant reduction to varying degrees. Cutometer results showed that R2 value increased significantly by 13.0%, indicating the benefits of firmer skin. In addition, subject assessment revealed that at the end of 6 weeks, the eye skin was noticeably improved.
Conclusions
By clinical evaluation and subject assessment, the novel formulation containing supramolecular retinol plus acmella oleracea extract can effectively diminish the collective signs of stressed urban eye skin for Chinese female in terms of dark circles, fine wrinkles, and sagging skin with good tolerance.
Microneedling (MN), also known as percutaneous collagen induction therapy, is a relatively new minimally invasive procedure involving superficial skin puncture by rolling multiple miniature fine needles into the skin. This chapter focuses on microneedling of hyperpigmentation problems through different mechanisms. Melasma is one of the most common acquired symmetrical hypermelanotic disorders, mostly affecting females with darker skin types. It has a considerable negative psychological impact on the patient's quality of life. There is no evidence‐based guideline presently established for the use and efficacy of MN on melasma patients. Periorbital melanosis presents with dark circles under both eyes occurring after puberty or in early childhood. It is commonly found in dark‐skinned patients, especially Asians. Microneedling therapy has shown success in treatment of periorbital melanosis. Platelet‐rich plasma (PRP) is developed by enriching plasma with an autologous high concentration of platelets derived from whole blood. PRP has multiple uses in dermatology.
Background:
Periorbital hyperpigmentation (POH) is an aesthetic concern for patients. Etiologies of the condition include pigmentary, structural, vascular, and mixed causes.
Objective:
To systematically review the current literature for treatment of POH.
Methods:
A systematic literature review was performed on PubMed. Search terms included "infraorbital dark circles," "dark circles," "periorbital hyperpigmentation," "idiopathic hyperchromia AND orbital," "under-eye circles," "ICHOR (idiopathic cutaneous hyperchromia of the orbital region)," "dark circles" AND "treatment," and "filler" AND "dark circles."
Results:
A total of 39 studies were included. Effective treatments for POH include lasers, topical creams and serums, fillers, chemical peels, carboxytherapy, plasma-rich platelet injections, blepharoplasty, and normobaric oxygen.
Conclusion:
Soft tissue fillers and autologous fat grafting are most effective in treating dark circles due to volume loss. Blepharoplasty surgery is best when excessive skin laxity is the underlying cause. Various topical creams and chemical peels are useful in treating pigment-based POH, whereas lasers are mildly to moderately beneficial for both vascular and pigment types. Given the scarcity of high-quality evidence supporting these results, recommendations should be interpreted selectively. Additional randomized clinical trials studying POH will be helpful.
Background:
Tear trough and infraorbital region changes are one of the first signs recognizable aging. This is a common consultation for cosmetic dermatologists and there are many treatment options available.
Objective:
This article provides a review of the anatomy and changes that occur in the infraorbital region as we age. We also suggest the use of the osseous, color, underlying anatomy, laxity, adipose, rhytides (OCULAR) mnemonic to evaluate these changes and review the literature for treatments options.
Materials and methods:
A literature search was performed through PubMed, using search terms "Tear trough," "Infra-orbital," "Dark-circles," "Lower-Eyelid," and "Midface."
Results:
Fillers, lasers, radiofrequency devices, chemical peels, various topicals, and botulinum toxin are available non-surgical treatment options discussed in the literature found to significantly improve and rejuvenate the infraorbital region.
Conclusion:
A complete understanding of the anatomy and changes that occur with aging are of most importance when assessing the infraorbital region. Organizing these changes into the OCULAR mnemonic is one way to assess the infraorbital region and achieve optimal rejuvenation.
Vitamin E is an important fat‑soluble antioxidant and has been in use for more than 50 years in dermatology. It is an important ingredient in many cosmetic products. It protects the skin from various deleterious effects due to solar radiation by acting as a free‑radical scavenger. Experimental studies suggest that vitamin E has antitumorigenic and photoprotective properties. There is a paucity of controlled clinical studies providing a rationale for well‑defined dosages and clinical indications of vitamin E usage in dermatological practice. The aim of this article is to review the cosmetic as well as clinical implications of vitamin E in dermatology.
Key words: Cosmetic, dermatology, vitamin E
Background
Dark circles refer to a symptom that present darkness under the eyes. Because of improvement in the quality of life, the dark circles have been recognized as one of major cosmetic concerns. However, it is not easy to classify the dark circles because they have various causes.Methods
To select suitable instruments and detailed evaluation items, the dark circles were classified according to the causes through visual assessment, Wood's lamp test, and medical history survey for 100 subjects with dark circles. After the classification, were newly recruited for instrument conformity assessment. Through this, suitable instruments for dark circle evaluation were selected. We performed a randomized clinical trial for dark circles, a placebo-controlled double-blind study, using effective parameters of the instruments selected from the preliminary test.ResultsDark circles of vascular type (35%) and mixed type (54%), a combination of pigmented and vascular types, were the most common. Twenty four subjects with the mixed type dark circles applied the test product (Vitamin C 3%, Vitamin A 0.1%, Vitamin E 0.5%) and placebo on randomized split-face for 8 weeks. The effective parameters (L*, a, M.I., E.I., quasi L*, quasi a* and dermal thickness) were measured during the study period. Result showed that the L* value of Chromameter®, Melanin index (M.I.) of Mexameter® and quasi L* value obtained by image analysis improved with statistical significance after applying the test product compared with the placebo product.Conclusion
We classified the dark circles according to the causes of the dark circles and verified the reliability of the parameter obtained by the instrument conformity assessment used in this study through the efficacy evaluation. Also based on this study, we were to suggest newly established methods which can be applied to the evaluation of efficacy of functional cosmetics for dark circles.
Cutaneous hyperpigmentations are frequent complaints, motivating around 8.5% of all dermatological consultations in our country. They can be congenital, with different patterns of inheritance, or acquired in consequence of skin problems, systemic diseases or secondary to environmental factors. The vast majority of them are linked to alterations on the pigment melanin, induced by different mechanisms. This review will focus on the major acquired hyperpigmentations associated with increased melanin, reviewing their mechanisms of action and possible preventive measures. Particularly prominent aspects of diagnosis and therapy will be emphasized, with focus on melasma, post-inflammatory hyperpigmentation, periorbital pigmentation, dermatosis papulosa nigra, phytophotodermatoses, flagellate dermatosis, erythema dyschromicum perstans, cervical poikiloderma (Poikiloderma of Civatte), acanthosis nigricans, cutaneous amyloidosis and reticulated confluent dermatitis.
Background:
Periocular "dark circles" fall among the most difficult chief complaints to address. In most cases, we have little information regarding etiology and no gold-standard treatment option. The extent of the problem is reflected in the sheer number of products on the market advertised to either lighten or cover the pigmentation.
Objective/methods:
To present dermatologists with a complete review of the literature with regard to anatomy, definition, etiology, and treatment of periocular hyperpigmentation.
Conclusions:
Our understanding of the causes and treatment of periocular hyperpigmentation continues to advance. Nevertheless, we are in need of additional controlled clinical trials and novel therapeutic options. Individual patients will likely benefit most from a combination of approaches. Although more randomized clinical studies are necessary, Pfaffia paniculata/Ptychopetalum olacoides B.⁄Lilium candidum L.-associated compound cream seems to be a promising option, with 90% improvement. For patients with increased melanin deposition, quality-switched ruby laser therapy could offer a better treatment option. In the hands of experienced professionals, a surgical option might be suitable, either by autologous fat transplantation or hyaluronic acid filler.
Background
Dark circles under or around the eyes is a cosmetic problem for a large number of people. It is a condition of unknown etiology characterized by the darkening of the eyelids and periorbital skin. The aim of this study was to determine histopathological changes associated with cutaneous idiopathic hyperchromia of the orbital region (CIHOR).
Methods
Twenty-eight adult patients with CIHOR were consecutively selected for the study. Biopsy specimens were taken from the darkened skin of the eyelid and from the normal retroauricular skin as a control.
Results
Hemosiderin was absent in all cases. The increase in melanin content in the papillary dermis was slight in mild clinical cases and moderate in both the moderate and severe clinical cases of CIHOR. Mild dilation of blood vessels was observed in the papillary dermis at the different clinical levels of CIHOR severity, while in the reticular dermis, blood vessels showed moderate dilation and few melanophages were found.
Conclusion
An increase in melanin content was the most marked histological change in specimens of darkened skin. Dilation of dermal blood vessels may contribute to the severity of CIHOR. Hemosiderin was not observed in any case.
Level of Evidence III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www. springer. com/ 00266.
BACKGROUND Periorbital hyperpigmentation (POH) presents with a dark area surrounding the eyelids. It is an ill-defined condition, and the pathogenesis can be multifactorial.OBJECTIVE This epidemiologic study was conducted to assess the prevalence of periorbital hyperpigmentation in Singapore in an attempt to propose a classification.MATERIALS AND METHODS One thousand consecutive patients attending the general dermatology clinic at the National Skin Center were enrolled in the study to assess for POH, of whom 200 with POH were examined and investigated to define the cause of POH. The possible causes were determined according to a detailed history, clinical examination, and assessment by three dermatologists. The extent of the POH was measured using a mexameter.RESULTS The commonest form of POH was the vascular type (41.8%), followed by constitutional (38.6%), postinflammatory hyperpigmentation (12%), and shadow effects (11.4%). The vascular type was seen predominantly in Chinese, whereas as the constitutional type was most common in Indians and Malays.CONCLUSION The vascular form of POH was the predominant type. We propose a comprehensive classification for POH that we hope will influence the choice of treatment modalities used in managing POH in the future.Unilever R&D Trumbul, USA provided funding for this study.
Periorbital hyperpigmentation (POH) presents with a dark area surrounding the eyelids. It is an ill-defined condition, and the pathogenesis can be multifactorial.
This epidemiologic study was conducted to assess the prevalence of periorbital hyperpigmentation in Singapore in an attempt to propose a classification.
One thousand consecutive patients attending the general dermatology clinic at the National Skin Center were enrolled in the study to assess for POH, of whom 200 with POH were examined and investigated to define the cause of POH. The possible causes were determined according to a detailed history, clinical examination, and assessment by three dermatologists. The extent of the POH was measured using a mexameter.
The commonest form of POH was the vascular type (41.8%), followed by constitutional (38.6%), postinflammatory hyperpigmentation (12%), and shadow effects (11.4%). The vascular type was seen predominantly in Chinese, whereas as the constitutional type was most common in Indians and Malays.
The vascular form of POH was the predominant type. We propose a comprehensive classification for POH that we hope will influence the choice of treatment modalities used in managing POH in the future.
With the rise of the cosmeceutical industry, numerous formulations have surfaced with claims of reducing the clinical manifestations of photoaging. Many of these products capitalize on the positive connection the public makes with vitamins, especially with respect to their antioxidant capabilities. An impressive amount of basic science and clinical research has been conducted in both an attempt to discover novel strategies for preventing detrimental sun damage and to validate the addition of vitamins to skin care products. As dermatologists, it will be essential to provide our patients with substantiated counseling regarding the efficacy of commercial assertions. In this review, we will systematically examine the evidence supporting the use of vitamins in oral and topical formulations and provide a brief summary of the pathogenesis of photoaging. Limitations of this study include that there may be unpublished data or additional studies that may have been overlooked in our comprehensive review of this topic.
Evidence suggests that periorbital hyperchromia (dark circles) occurs mainly as a consequence of postinflammatory hemodynamic congestion producing a typical bruising aspect on the lower eyelids.
To evaluate the clinical effects of Pfaffia paniculata/Ptychopetalum olacoides B./Lilium candidum L.-associated compound (PPLAC) on periorbital hyperchromia and to study in vitro its underlying anti-inflammatory and antioxidant mechanisms.
Twenty-one volunteers presenting with periorbital hyperchromia received a serum sample containing 5.0% PPLAC, which was applied topically in the periorbital area twice a day for 28 days. Skin color was measured using variations in the individual typological angle (DeltaITA(0)) and skin luminance (DeltaL*) calculated in the area around the eyes and in the adjacent area. Colorimetric readings were taken at the onset and end of the 28-day treatment. Volunteers were also asked to fill out a questionnaire concerning the improvement in "dark circles." The anti-inflammatory and antioxidant effects of PPLAC were measured by quantification of prostaglandin E(2), leukotriene B(4), histamine, and superoxide dismutase levels using an in vitro model of human skin culture.
Topical application of PPLAC led to a significant improvement in skin luminance and tone in the periorbital area, which was demonstrated by increased values of ITA(0) and L* in about 90% of volunteers. In addition, subjects reported reduced intensity and improved appearance of "dark circles." A dose-dependent decreased production of inflammatory mediators, concomitant to increased antioxidant enzyme levels, was observed in our in vitro studies, under basal and lipopolysaccharide-stimulated conditions.
Although the precise mechanisms related to PPLAC remain to be clarified, our results indicate that the reduction in the inflammatory process as well as the antioxidant protection against deleterious elements may be considered as an integral approach to preserve the integrity of vascular endothelium, preventing the hemodynamic congestion that culminates in the formation of "dark circles" around the eyes.
Vitamin K is a fat-soluble vitamin crucial to the production of many proteins involved with the coagulation process. It is integral in the synthesis of coagulants (factors II, VII, IX and X) and anticoagulants (proteins C and S). It is generally recognised that routine administration of vitamin K (phytomenadione) shortly after birth will prevent major neonatal morbidity and mortality related to haemorrhage. Vitamin K supplementation during pregnancy is also recommended if mothers are on anticonvulsant therapy or prolonged treatment with certain antibiotics. These medications, if ingested by pregnant women, predispose the neonate to a bleeding tendency caused by vitamin K deficiency. Vitamin K treatment of pregnant mothers before premature delivery has also been suggested to reduce the incidence of severe intracranial haemorrhage (ICH) in premature neonates. Although further studies are pending, the data to date do not support using antenatal vitamin K for preventing ICH.
An inhibitory effect of ascorbic acid (AsA) on melanogenesis has been described. However, AsA is quickly oxidized and decomposed in aqueous solution and thus is not generally useful as a depigmenting agent.
Our purpose was to examine the effect on pigmentation of magnesium-L-ascorbyl-2-phosphate (VC-PMG), a stable derivative of AsA.
Percutaneous absorption of VC-PMG was examined in dermatomed human skin, and its effect on melanin production by mammalian tyrosinase and human melanoma cells in culture was also measured. A 10% VC-PMG cream was applied to the patients.
VC-PMG suppressed melanin formation by tyrosinase and melanoma cells. In situ experiments demonstrated that VC-PMG cream was absorbed into the epidermis and that 1.6% remained 48 hours after application. The lightening effect was significant in 19 of 34 patients with chloasma or senile freckles and in 3 of 25 patients with normal skin.
VC-PMG is effective in reducing skin hyperpigmentation in some patients.
Pulsed dye laser treatments usually result in purpura. Any topical application that eliminates or shortens the duration of purpura would be extremely useful.
The purpose of this prospective study was to determine the safety and efficacy of topical vitamin K cream in shortening the duration of laser-induced purpura.
Twenty adult subjects were enrolled. Each subject had five 1.5 cm sites treated with a pulsed dye laser at 585 nm, 450 nsec, 7 mm spot size at each subject's respective threshold fluence. Each subject had a control site where no topical application was used and four other sites where a different formulation was applied to each for 2 weeks before and for 2 weeks after laser irradiation. Five vitamin K formulations with or without retinol were studied: 3% vitamin K in acrylates copolymer cream, 5% vitamin K in acrylates copolymer cream, 1% vitamin K and 0.3% retinol in acrylates copolymer cream, 1% vitamin K and 0.15% retinol in acrylates copolymer cream, 1% free vitamin K cream. Purpuric discoloration at each site was rated on days 0, 1, 3, 7, 10, and 14 after laser treatment on a quartile scale. Each site was assigned 100% discoloration on day 0 after laser irradiation.
Laser-induced purpuric discoloration resolved faster with 1% vitamin K and 0.3% retinol in acrylates copolymer cream than with no topical application. The difference is statistically significant from day 3 onward.
A combination of 1% vitamin K and 0.3% retinol in acrylates copolymer cream hastened the resolution of laser-induced purpura.
Cosmetics are commercially available products that are used to improve the appearance of the skin. Since the late 1980s, consumer demand for more effective products that more substantively beautify the appearance has resulted in increased basic science research and product development in the cosmetics industry. The result has been more ingredients that may actually improve not just the appearance of the skin, but the health of the skin as well. We now have products that renew, restore, and rejuvenate—not just cleanse, protect, and moisturize. There is probably no greater focus of interest currently than the incorporation of vitamins and antioxidants in skin care products. There are considerable data to suggest the benefits of such ingredients in cosmetics. This article reviews the published data that support the usefulness of vitamins and antioxidants in cosmetics. Our job as dermatologists is to digest and assess the data so we can give knowledgeable recommendations to our patients. The ingestion and absorption of vitamins and antioxidants, most importantly through diet, and secondarily through intake of manufactured supplements, is critical to the health of human beings. The skin is the largest organ; as our primary external barrier, it is on the forefront of the battle with external causes of damaging free radicals. Ultraviolet light and environmental pollutants are known initiators of free radicals. Free radicals are highly reactive molecules with an unpaired electron that result in damage to surrounding molecules and tissues. The most significant damage by free radicals is to biomembranes and to DNA. It is thought that additional, topical use of vitamins and antioxidants in cosmetics can better protect and possibly correct the damage by neutralizing these free radicals. In addition, some vitamins may be beneficial to the skin because of other actions such as effects of suppression of pigmentation and bruising, stimulation of collagen production, refinement of keratinization, or anti-inflammatory effects. Vitamin A
Pulsed dye laser treatment and other cosmetic procedures result in significant bruising. Claims have been made regarding the efficacy of topical vitamin K in both preventing and speeding the clearing of bruising; however, well-controlled studies are lacking.
The purpose of this study is to evaluate the effects of topical vitamin K versus placebo in the prevention and clearing of laser-induced purpura.
A total of 22 patients were enrolled in this double-blind randomized placebo-controlled study. The patients were divided into pretreatment and posttreatment groups; the 11 patients in the former group applied vitamin K cream to half of their face and vehicle alone to the other half of their face twice daily for 2 weeks before laser treatment. The latter group followed the same procedure for 2 weeks after laser treatment. On day 0, all subjects underwent laser treatment for facial telangiectases using a 585-nm pulsed dye laser. Bruising was rated by the both the patient and physician by means of a visual analogue scale on days 0, 3, 7, 10, 14, and 17.
The side of the face treated with topical vitamin K before laser therapy showed no significant difference in bruising as compared to placebo. However, the side of the face treated with vitamin K cream after laser treatment had significantly lower scores of bruising severity when compared with the side treated with placebo.
Although pretreatment with vitamin K did not prevent bruising after laser treatment, use of vitamin K cream after laser treatment did reduce the severity of bruising, particularly in the initial days of application.
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