Comparison of 10 percent trichloroacetic acid and 35 percent glycolic acid peel in the treatment of periorbital hyperpigmentation

this study is a randomized interventions split face study , single blinded ,parallel group, single central trail comparing the efficacy and safety of trichloroacetic acid and glycolic acid peel in the treatment of periorbital hyper pigmentation for one year duration that study should be conducted on Dr Baba Saheb Ambedkar medical college and hospital Rohini Delhi India. the primary outcome measure the efficacy of trichloroacetic acid peel vs glycolic acid peel 3 weeks for four session 0,3,6,9 weeks and follow up after 12 weeks and dermoscope picture taken pre and post treatment and the secondary  outcome will be safety and physician global assessment trichloroacetic acid peel vs glycolic acid peel in treatment of periorbital hyper pigmentation.

Inclusion criteria -All patient of age  18-60 years attending the outpatient department clinically  diagnosed as periorbital hyperpigmentation and are willing to participate in the study after giving informed consent.

Exclusion criteria-

• Patients on topical or systemic treatment for POH in the past 1 month

• Patients with photosensitive disorders/on photosensitizing drugs

• Inflammatory dermatoses on the face

• Patients with unilateral POH

• Patients with a history of keloid scarring

Pregnancy and lactation

• Active viral/bacterial/ infection on face

METHODOLOGY

1. Patients clinically diagnosed with POH will be provided with a Patient information sheet and invited to  participate in the study

2. Written informed consent will be taken from all the patients prior to inclusion in he study

inclusion in the study.

3. Detailed demographic data and clinical history, including the onset, duration of POH, aggravating factors, treatment received, any prolonged

drug intake, cosmetic use, history of atopy, family history, and menstrual history of all the patients will be taken and recorded in a preset proforma.

4. Detailed examination of the face under good illumination will be conducted to assess the lesions, clinical type, and grade of POH.

5. Clinical photographs (without revealing identity) using standardized position from forehead to malar area and dermoscopic photographs in both polarized and nonpolarized lights will be taken at 0, 3, 6, 9, and 12 weeks.

Procedure

1. Patients will be made to lie down in a reclining position. A postauricular patch test will be performed on each patient 15 minutes prior to the peeling session. After the test peel, the area to be treated will be degreased with a 50% alcohol solution.

2. 10% of TCA will be applied on the right side with a cotton-tipped applicator in the infraorbital areas until the appearance of frosting.

3. Similarly, on the left side 35% GA will be applied, and neutralized with saline after 2 minutes.

4. After neutralising both peels with saline, patients will be asked to apply sunscreen with sun protection factor 30 on their faces before stepping out

of the hospital.

5. They will be instructed to apply sunscreen regularly.

6. The peeling will be done at an interval of 3 weeks on week 0,3,6,9, for a

total of four sessions and followed up on week 12.

7. Single blinding will be done.

Physician’s global assessment

The improvement will be evaluated by means of photographs by the

dermatologist using the following grading scale at 12 weeks of follow up.

Patient’s global assessment-

Patient assessment will be graded as poor, fair, good, and excellent at 12 weeks follow-up by the patient on a similar scale as the Physician’s Global Assessment.

Periorbital hyperpigmentation grading

The degree of improvement in periorbital pigmentation will be done by Periorbital

hyperpigmentation (POH) grading as

0 – Skin colour comparable to other facial skin areas 1 – Faint pigmentation of infraorbital fold. 2 – Pigmentation more pronounced. 3 – Deep dark colour, all four lids involved. 4 – Grade 3 + pigmentation spreading beyond the infraorbital fold.

Dermoscopic examination

Dermoscopic examination finding Right eye Left eye

0 week 12 weeks  with following pattern

Epidermal-

Homogeneous light brown

Cobble stone

Homogeneous light brown with

speckled

Dermal

Speckled

Globules

Cobblestone

Mixed (epidermal and dermal)