Chemical peeling with trichloroacetic acid and lactic acid for infraorbital dark circles.

BACKGROUND: Periorbital dark circles are relatively common, affecting individuals regardless of age, sex, and race. Available treatment includes bleaching creams, topical retinoid acid, chemical peels, laser therapy, autologous fat transplantation - injectable fillers, surgery (blepharoplasty), and chemical peeling. OBJECTIVE: To evaluate the efficacy of a combination of trichloroacetic TCA 3.75% and lactic acid 15% on improving the periorbital hyperpigmentation. PATIENTS/METHODS: Thirty patients with periorbital dark circles and skin types II, III, or IV were included in the study. Chemical peeling was performed every week for a series of four treatments. The effect was photo-documented, and a patient's and physician's global assessment was evaluated. RESULTS: Almost all the patients showed significant esthetic improvement. Physicians assessed a fair, good, or excellent improvement in 93.3% of the patients. Patient's global assessment rated a fair, good, or excellent response in 96.7% of the patients. The procedure itself had only mild and temporary adverse effects, such as erythema, edema, frosting, dryness, and telangiectasias. The effects of treatment remained for at least 4-6 months in the majority of patients with appropriate sun protection. CONCLUSION: The combination of trichloroacetic TCA 3.75% and lactic acid 15% showed encouraging results on improving periorbital hyperpigmentation.

Direct immunofluorescence on hair follicles--present and future perspectives.

Direct immunofluorescence (DIF) is an important tool for evaluating bullous autoimmune and connective tissue disorders. We report 21 cases of pemphigus vulgaris, bullous pemphigoid and lupus erythematosus that were investigated by performing DIF on scalp hair follicles. The study was done using a simplified technique of preparing the hairs for DIF testing. The anagen hairs tested positive in pemphigus vulgaris patients while the telogen hairs were negative. In bullous pemphigoid and lupus erythematosus cases hair DIF presented negative results.Hair DIF has the potential of taking the place of skin or mucosal DIF in pemphigus patients if performed on anagen hair follicles. The technique used to perform hair DIF is important in obtaining reliable results and eliminating the possibility of generating false-negative testing. Larger studies are needed in order to validate this method.