title: Combination of microneedling and 10% trichloroacetic acid peels in the management of infraorbital dark circles.
abstract: BACKGROUND
  Dark circles (DC), seen in the periorbital area, are defined as bilateral, round, homogeneous pigmented macules whose aetiology is thought to be multifactorial. Available treatments include bleaching creams, topical retinoic acid, chemical peels, lasers, autologous fat transplantation, injectable fillers and surgery (blepharoplasty).
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of a combination of microneedling and 10% trichloroacetic acid (TCA) peels in the treatment of DC.
  
  
  METHODS
  Thirteen female patients with mild to severe infraorbital DC were included in the study. The patients were aged between 21 and 61 years. They were treated with Automatic Microneedle Therapy System-Handhold and topical application of 10% TCA solution to each infraorbital area for five minutes. The effect was photo-documented and a Patient and Physician Global Assessment was evaluated. Safety was assessed by evaluating early and delayed adverse events.
  
  
  RESULTS
  Almost all patients showed significant aesthetic improvement. Both Physician and Patient Global Assessment rated a fair, good or excellent response in 92.3%. The procedure was well tolerated. Mild discomfort, transient erythema and oedema were quite common during or immediately after the procedure. The patients were followed up regularly every month for four months, and no recurrence was recorded.
  
  
  CONCLUSIONS
  Microneedling and 10% TCA constitute an innovative combination treatment for DC with encouraging results and minor side effects.
authors.affiliation: a Department of Dermatology and Venereology , Andreas Sygros Hospital , Athens , Greece.
authors.forename: George
authors.initials: G
authors.lastname: Kontochristopoulos
authors.affiliation: a Department of Dermatology and Venereology , Andreas Sygros Hospital , Athens , Greece.
authors.forename: Anargyros
authors.initials: A
authors.lastname: Kouris
authors.affiliation: a Department of Dermatology and Venereology , Andreas Sygros Hospital , Athens , Greece.
authors.forename: Eftychia
authors.initials: E
authors.lastname: Platsidaki
authors.affiliation: a Department of Dermatology and Venereology , Andreas Sygros Hospital , Athens , Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Markantoni
authors.affiliation: a Department of Dermatology and Venereology , Andreas Sygros Hospital , Athens , Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Gerodimou
authors.affiliation: a Department of Dermatology and Venereology , Andreas Sygros Hospital , Athens , Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Antoniou
mesh_terms: D000328:Adult; D002615:Chemexfoliation / Q000379:methods*; D005148:Facial Dermatoses / Q000628:therapy*; D005260:Female; D006801:Humans; D017495:Hyperpigmentation / Q000628:therapy*; D008875:Middle Aged; D009339:Needles; D009915:Orbit; D010147:Pain Measurement; D016896:Treatment Outcome; D014238:Trichloroacetic Acid / Q000627:therapeutic use*
chemical_list: D014238:Trichloroacetic Acid
keywords: Dark circles; TCA 10%; microneedling