Periorbital hyperpigmentation (POH) is characterized by darkening of the skin under the eyes and has a complex underlying cause. While numerous studies have examined treatments for POH, their outcomes vary. This pilot clinical trial aimed to compare the effectiveness of carboxytherapy versus microneedling combined with topical glutathione in treating POH. It enrolled 31 females with POH, who received carboxytherapy injections at the right periorbital area, and microneedling with topical glutathione (left periorbital area) for 6 biweekly sessions. The study performed a visual analog scale (VAS), dermoscopic assessment, patient satisfaction, patient dermatology life quality index (DLQI) questionnaire, and safety evaluation with 3-month follow-up. 

The study observed:

• A greater improvement regarding VAS evaluation with carboxytherapy compared to microneedling with glutathione during the active treatment and follow-up phases.
• A statistically significant improvement in the carboxytherapy group in the dermoscopic evaluation.
• DLQI showed a statistically significant improvement. 
• Regarding patient satisfaction, carboxytherapy versus microneedling with glutathione showed 80.6% versus 25.8% moderate satisfaction and 3.2% versus 0% marked satisfaction, respectively. 
• Regarding patients safety, no significant difference existed between both eyes. 

The study found that carboxytherapy was more effective than microneedling with glutathione in treating POH patients. Carboxytherapy improved clinical and dermoscopic evaluations, patient satisfaction and patient DLQI. Additionally, carboxytherapy had a good safety profile.

Source: Assaf HA, Ahmed D, Abdelhamed A. Efficacy and safety of carboxytherapy versus combined microneedling with topical glutathione in the treatment of patients with periorbital hyperpigmentation: an evaluator-blind, split-face, controlled pilot clinical trial. Indian J Dermatol. 2022;67(5):504-11.