RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES,
RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE.
Profroma for registration of subjects for dissertation
|1. |Name of the candidate |Dr. Nithya R., |
| |and |#32,Raghavendra Nilaya, 7th main, Near Bata showroom, Sonnappa layout, Ramamurthy |
| |address |nagar, Bangalore-560016 |
|2. |Name of the institution |MVJ Medical College and Research Hospital, |
| | |Hoskote, Bangalore- 562114 |
|3. |Course of study and subject |MD, Dermatology |
|4. |Date of admission to course |31-05-2011 |
|5. |Title of the topic |A CLINICAL STUDY OF PERIORBITAL MELANOSIS AND COMPARISON OF EFFICACY OF GLYCOLIC |
| | |ACID PEELING WITH TOPICAL VITAMIN C IN THE TREATMENT |
|6. |Brief resume of the intended work: |
| |6.1 Need for the study: |
| |Periorbital melanosis or infraorbital dark circles refers to the condition that presents with dark area surrounding the eyelids. It is a |
| |significant cosmetic concern for a large number of individuals. Despite its common prevalence, a clear definition has not been elucidated. |
| |There have been little investigations as to the cause of this common disorder and hence various treatment methods are being used with |
| |variable outcomes. Hence this study is undertaken to elucidate the etiology of periorbital melanosis and for comparison of efficacy of |
| |glycolic acid peeling and topical vitamin c serum in the treatment. |
| | |
| |6.2Review of literature: |
| | |
| |Infraorbital dark circles are one of the main aesthetic facial concerns that affect individuals of any age, both genders and all races. |
| |Possible aetiological factors of the dark circles include excessive pigmentation; thin, translucent lower eyelid skin overlying the |
| |orbicularis oculi muscle; shadowing due to skin laxity and tear trough; and constitutional or familial causes.(1). |
| |Excessive pigmentation around the eyes is seen secondary to atopic or allergic contact dermatitis and in dermal melanocytosis. Infraorbital |
| |dark circles are often seen in patients with atopic or allergic contact dermatitis. It is a form of post-inflammatory hyperpigmentation due |
| |to rubbing or scratching of the periorbital area. Dermal melanocytosis is due to congenital and environmental causes. The most common |
| |congenital cause of dermal melanocytosis is Naevus of Ota. Environmental causes that result in dermal melanocytosis include excessive sun |
| |exposure and drug ingestion. In dermal melanocytosis when the lower eyelid skin is manually stretched, the area of pigmentation spreads out |
| |without any blanching or significant lightening of the pigmentation.(2). |
| |Another common cause of infraorbital dark circles can be thin, translucent lower eyelid skin overlying the orbicularis oculi muscle. The |
| |orbicularis oculi muscle lies right beneath the skin, with little or no subcutaneous fat, and the darkness may be due to the visible |
| |prominence of the subcutaneous vascular plexus or vasculature contained within the muscle. In such case, when the lower eyelid skin is |
| |manually stretched, the area of relative darkness spreads out without blanching but results in deepening of the violaceous color. Another |
| |cause of infraorbital dark circles is shadowing due to skin laxity and tear trough. Skin laxity due to photoageing imparts a shadowy |
| |appearance on the lower eyelids that results in infraorbital dark circles. The tear trough is a depression centered over the medial side of |
| |the inferior orbital rim. It deepens as patients age because infraorbital fat is displaced anteriorly, creating shadow below it.(2). |
| |Other causes of Periorbital melanosis could be physiologic phenomena like general fatigue, lack of sleep, premenstrual phase; as an |
| |extension of pigmentary demarcation line; and presence of medical problems like iron deficiency anemia, gastrointestinal diseases, |
| |hepatobiliary diseases, renal diseases, thyroid diseases etc. |
| |Ranu H and Thng s et al have studied hyperpigmentation in Asians and reported that the commonest form of periorbital hyperpigmentation was |
| |the vascular type, followed by constitutional, postinflammatory hyperpigmentation and shadow effects.(3). |
| |Malakar s and Lahari k et al in their study on nature of pigmentation have reported that periorbital melanosis is an extension of pigmentary|
| |demarcation line over the face.(4). |
| |Wood light and polarized diagnostic light imaging may be useful tools in the evaluation and differentiation of the pigmentary and vascular |
| |causes of infraorbital dark circles.(5). |
| |Various treatment modalities have been used for management of periorbital melanosis. These include topical bleaching agents like |
| |hydroquinone, kojic acid and others; topical ascorbic acid, topical retinoic acid; chemical peels; Q-switched ruby (694-nm) laser therapy; |
| |autologous fat transplantation; and transconjunctival blepharoplasty. Glycolic acid is the most widely used alpha-hydroxy acid among |
| |chemical peels. It acts in hyperpigmentation due to its effect on epidermal remodelling and accelerated desquamation, resulting in quick |
| |pigment dispersion.(2). Ascorbic acid may improve periorbital pigmentation by lightening hyperpigmentation, thickening the eyelid dermis, |
| |and improvement of congestive state dermatosis.(6). |
| |Despite the great number of available medications and therapies to attenuate dark circles, there are no evidence-based studies to support |
| |their use. |
| |6.3 Objectives of the study: |
| |1. To study common aetiological factors and associations of periorbital melanosis |
| |2. To correlate the age, sex and duration of the disease with aetiological factors |
| |3. Comparison of Glycolic acid peeling with topical vitamin c in the treatment of periorbital melanosis through image analysis |
|7. |Materials and methods: |
| |7.1 Source of data: Patients with periorbital melanosis attending Dermatology OPD in MVJ Medical College and Research Hospital from Jan2012 |
| |to June 2013. 7.2 Method of collection of data: The patients presenting with periorbital |
| |melanosis will be counseled regarding the study and consent will be taken before enrolling them. |
| |Detailed history will be taken with emphasis on duration of the condition and precipitating factors, concomitant illness and occupation. The|
| |subjects will be examined and investigated by wood’s lamp examination and routine blood examination. The possible causes will be determined |
| |according to the history, clinical examination and treatment will be initiated. The patients will be allocated into two groups using a |
| |computer generated randomization chart. 50% of the patients will be treated with glycolic acid peeling once in 15 days, starting with 20% |
| |glycolic acid and after 3 sittings the concenteration will be increased to 35% glycolic acid depending on the tolerance. Remaining 50% of |
| |the patients will be treated with topical vitamin c serum applied twice daily. Clinical improvement will be assessed through serial |
| |photographic evaluation using digital camera every 4 weeks after starting the treatment. The results will be analyzed and compared. |
| |Inclusion Criteria: Patients in the age group between 10yrs to 50yrs with clinical features of periorbital melanosis which is defined as |
| |bilateral, homogeneous pigment macules on the periorbital regions |
| |Exclusion Criteria: |
| |1.Patients with chronic debilitating disease |
| |2.Patients with generalized pigmentation of the face |
| |3. Pregnant women |
| |7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe|
| |briefly: Yes, vitamin c serum and glycolic acid peel will be used for the treatment of the same. |
| |7.4 Has ethical clearance been obtained from your institution: Yes |
|8. |List of references: |
| |1. Freitag FM, Cestari TF. What causes dark circles under the eyes? J Cosmet Dermatol. 2007 Sep;6(3):211-5. |
| |2. Roh MR, Chung KY. Infraorbital Dark Circles: Definition, Causes, and treatment options. Dermatol Surg 2009; 35:1163-1171. |
| |3.Ranu H, Thng S, Goh BK, Burger A, Goh CL. Periorbital Hyperpigmentation in Asians: An Epidemiologic Study and a Proposed Classification. |
| |Dermatol Surg. 2011 Jun 17. (Epub ahead of print). |
| |4. Malakar S, Lahiri K, Banerjee U, Mondal S, SarangiS. Periorbital melanosis is an extension of pigmentary demarcation line-F on face. |
| |Indian J Dermatol Venereol Leprol. 2007 Sep-Oct;73(5):323-5. |
| | |
| |5. Paraskevas LR, Halpern AC, Marghoob AA. Utility of the Wood’slight: five cases from a pigmented lesion clinic. Br J Dermatol |
| |2005;152:1039–44. |
| | |
| |6. Ohshima H, Mizukoshi K. Effects of vitamin C on dark circles of the lower eyelids: quantitative evaluation using image analysis and |
| |echogram. Skin Res Technol. 2009 May;15(2):214-7 |
|9. |Signature of the candidate |
|10. |Remarks of the guide |
| |As periorbital melanosis is a very common condition which causes a significant cosmetic concern and there is a paucity of Indian studies on|
| |this subject, it is worthwhile to carry out this study. |
|11. |Name and designation of |
| |11.1 Guide: DR.SUJATHA.C. (PROF & HOD), |
| |DEPT. OF DERMATOLOGY, |
| |MVJ MEDICAL COLLEGE & RESEARCH HOSPITAL. |
| |11.2 Signature: |
| | |
| |11.3 Co-guide(If any): |
| |11.4 Signature: |
| |11.5 Head of the department: DR.SUJATHA.C. (PROF & HOD), |
| |DEPT. OF DERMATOLOGY, |
| |MVJ MEDICAL COLLEGE & RESEARCH HOSPITAL. |
| | |
| |11.6 Signature: |
|12. |12.1 Remarks of the chairman & principal |
| | |
| | |
| |12.2 Signature |
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