Constitutional periorbital dark circles (PDC) are frequently reported in skin of color and represent a therapeutic challenge.

The present study summarized the experience of the International Peeling Society on the safety and effectiveness of deep chemical peeling in treating constitutional PDC. It explored multi-institutional, retrospective case series (1990-2020) of constitutional PDC treated by deep chemical peeling. 

The study observed:

• Performance of 55 phenol-croton oil peels in 52 patients: 3 patients received a second peel for periorbital rhytids 72 to 84 months after the first peel. 
• Ninety-two percent of patients were women, with a median age of 46 years (range, 23-68 years). 
• Eighty-nine percent of patients were Fitzpatrick III-IV. 
• The most common formula was phenol 60% to 65% and croton oil 0.6% to 0.7%. 
• Eighty-nine percent of peels demonstrated >50% clinical improvement.
• The median duration of improvement was 24 months (range, 1.5-168 months), and 69% of patients demonstrated ongoing improvement at the last follow-up.
• Four percent of peels exhibited complications of persistent erythema that resolved without scarring.

This study shows that deep chemical peels are a treatment of choice for constitutional PDC as they are safe and effective. 

Source: Soon SL, Wambier CG, Rullan PR, et al. Phenol-croton oil chemical peeling induces durable improvement of constitutional periorbital dark circles. Dermatol Surg. 2023 Feb 1.