Clinical efficacy and safety of 20% glycolic acid versus 30% lactic acid peel in constitutional type of periorbital melanosis: a comparative study

Ghazal Ahmed, Dharmendra Kumar Mishra


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. 



Periorbital hyperpigmentation, Infraorbital dark circles, Chemical peeling, Alfa hydroxyl acids, Therapy, Effectiveness, Adverse effects

Full Text:



Souza DM, Ludtke C, Souza ER, Scandura KM, Weber MB. Periorbital hyperchromia. Surg Cosmet Dermatol. 2011;3:233-9.

Freitag FM, Cestari TF. What causes dark circles under the eyes? J Cosmet Dermatol. 2007;6:211-5.

Khunger N. Periocular Peels. In: Khunger N, ed. Step by Step Chemical Peels, 2nd edition. New Delhi: Jaypee Brothers Medical Publisher; 2014: 271-283.

Baumann L, Saghari S. Chemical Peels. In: Baumann L, ed. Cosmetic Dermatology Principles and Practice, 2nd edition. New York: McGraw-Hill Medical; 2009: 148.

Landau M. Chemical peels. Clin Dermatol. 2008;26:200–8.

Dayal S, Sahu P, Jain VK, Khetri S. Clinical efficacy and safety of 20% glycolic peel, 15% lactic peel, and topical 20% vitamin C in constitutional type of periorbital melanosis: a comparative study. J Cosmet Dermatol. 2016;5:367-73.

World Health Organization. Process of translation and adaptation of instruments. Geneva: WHO. Available at: abuse/research_tools/translation/en/. Accessed on 26 February 2017.

Sheth PB, Shah HA, Dave JN. Periorbital hyperpigmentation: a study of its prevalence, common causative factors and its association with personal habits and other disorders. Indian J Dermatol. 2014;59:151-7.

Matsui MS, Schalka S, Vanderover G, Fthenakis CG, Christopher J, Bombarda PC, et al. Physiological and lifestyle factors contributing to risk and severity of peri-orbital dark circles in the Brazilian population. An Bras Dermatol. 2015;90:494–503.

David BG, Menon R, Shankar R. A clinico-epidemiological study of periorbital melanosis. Int J Res Dermatol. 2017;3:245-50.

Malakar S, Lahiri K, Banerjee U, Mondal S, Sarangi S. Periorbital melanosis is an extension of pigmentary demarcation line-F on face. Indian J Dermatol Venereol Leprol. 2007;73:323-5.

Roh MR, Kim TK, Chung KY. Treatment of infraorbital dark circles by autologous fat transplantation: a pilot study. Br J Dermatol. 2009;160:1022-5.

Youn S, Shin JI, Kim JD, Kim JT, Kim YH. Correction of infraorbital dark circles using collagenase-digested fat cell grafts. Dermatol Surg. 2013;39:766-72.

Park KY, Oh IY, Moon NJ, Seo SJ. Treatment of infraorbital dark circles in atopic dermatitis with a 2790-nm erbium: yttrium scandium gallium garnet laser: a pilot study. J Cosmet Laser Ther. 2013;15:102-6.

Xu TH, Li YH, Chen JZ, Gao XH, Chen HD. Treatment of infraorbital dark circles using 694-nm fractional Q-switched ruby laser. Lasers Med Sci. 2016;31:1783-7.

Mehryan P, Zartab H, Rajabi A, Pazhoohi N, Firooz A. Assessment of efficacy of platelet-rich plasma (PRP) on infraorbital dark circles and crow's feet wrinkles. J Cosmet Dermatol. 2014;13:72-8.

Mitsuishi T, Shimoda T, Mitsui Y, Kuriyama Y, Kawana S. The effects of topical application of phytonadione, retinol and vitamins C and E on infraorbital dark circles and wrinkles of the lower eyelids. J Cosmet Dermatol. 2004;3:73-5.

Hassan AM, Hassan GFR, Aldalies HY, El Maghraby GM. Treatment of periorbital dark circles: Comparative study of chemical peeling with a combination of trichloroacetic acid and lactic acid versus carboxytherapy. J Surg Dermatol. 2016;1:108–15.

Major RH. The Papyrus Ebers. Hoeber: New York; 1930.

Bryan CP. Ancient Egyptian Medicine: The Papyrus Ebers [translation]. Chicago: Ares publishers; 1974: 158-161.

Brody HJ, Monheit GD, Resnik SS, Alt TH. A history of chemical peeling. Dermatol Surg. 2000;26:405-9.

Vavouli C, Katsambas A, Gregoriou S, Teodor A, Salavastru C, Alexandru A, et al. Chemical peeling with trichloroacetic acid and lactic acid for infraorbitalc dark circles. J Cosmet Dermatol. 2013;12:204–9.