Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Dermatology and Venerology

Background:Periorbital hyperpigmentation (POH) is a commonly encountered condition that affects both genders with female predominance. It presents as bilateral circular or semicircular homogenous light or dark brown pigmentation in the periorbital region. Various exogenous and endogenous factors are implicated in its pathogenesis and treatment is considered to be challenging. Vitamin C, an essential dietary nutrient, plays a role in the maintenance of proper skin functions through its action on wound healing, photoprotection, skin hydration, antiaging, as well as depigmentation. Tranexamic acid (TXA) has lately gained popularity as an adjuvant therapy in some pigmentary disorders especially melasma.Aim of work: The present study aims at evaluating and comparing the therapeutic effect of topical tranexamic acid solution in POH compared to topical vitamin C solution, both combined with microneedling. Patients and methods:Fifty eight patients, twenty nineeach group,were subjected to detailed medical history, clinical examination of the skin, digital photography and dermoscopic evaluation at weeks 0, 10. One eye was treated with 20% topical vitamin C solution in group A and with topical TXA 5mg/ ml solution in group B. The other eye was treated with 0.9% NaCl as a placebo in both groups both combined with microneedling.A session was done every two weeks over a period of six weeks with a total of four treatments. Patients came one month after the last session for evaluation. Dermatology life quality index (DLQI) and visual analogue score (VAS) were performed by the patients giving a score from 0 to 30 for DLQI and0 to 10 for VAS, at weeks 0 and 10. At week 10,percentage of dermoscopic improvement was evaluated using a score from 0 to 4, also two blinded physicians evaluated percentage of clinical improvement using a score from 0 to 4 and their results were averaged.Results:In both groups, group A (treated with Vit.C) and group B (treated with TXA) clinical grading at week 10showed significant improvement compared to week 0, there wasstatistically significant improvement of POH by dermoscopy in the eye treated with Vit. C or TXA compared to eye treated with saline (placebo)

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