Dermafrac™: An Innovative New Treatment for Periorbital Melanosis in a Dark-Skinned Male Patient
A 48-year-old Indian male (skin type V) presented with complaints of dark circles under his eyes for past 2 years. It had started with light brown pigmentation under his eyes that gradually worsened to brownish black, velvety looking skin at the time of presentation. He was also bothered with the dryness, uneven texture and fine lines on the skin of his face. His past medical history was significant for hypothyroidism (currently euthyroid on oral levothyroxine 100 μg daily) and hyperlipidemia well controlled on rosuvastatin. There was no history of anaemia, diabetes, hypertension or any other significant medical or surgical illness. There was no personal or family history of atopy. He was not on any topical eye medications. His occupation involved working on the computer for 6-8 h a day.\nGeneral physical examination was normal. In the infraorbital area, there was dark brown-black pigmentation extending along the tear trough onto the lower eyelid with thickened skin with a subtle velvety texture []. On stretching the skin, there were no congested vessels visible and there was no obvious scleral pigmentation. There was some hyperpigmentation of the upper eyelid also, which was more prominent laterally than medially. He did not have any significant pigmentation of the skin on his forehead, neck or cheeks, and there was no evidence of acanthosis nigricans elsewhere and no pigmentary demarcation lines on his perioral area or limbs. His haemoglobin was 14.2 and peripheral smear was normocytic normochromic.\nWe decided to treat him using the new DermaFrac™ treatment that combines microchanneling using precisely calibrated needle penetration with simultaneous vacuum-assisted serum infusion. He underwent 12 DermaFrac™ treatments (at 2 weekly intervals) for his entire face and forehead using the hand-piece with a 0.25-mm tip-cap at a pressure of 10 mmHg. After disinfection of the skin, two passes were given at each sitting. Anti-aging serum (containing meristoyl pentapeptide 17 sympeptide, acetyl octapeptide-3 SNAP 8, palmitoyl pentapeptide-4 matrixyl, acetyl hexapeptide-8 argirilene and tripeptide syn-ake) was infused for 10 sessions and the lightening serum (containing kojic acid) for 2 sessions. He was also advised to apply a tinted SPF 40 sunscreen in the morning all over his face. At each visit, the patient was asked to score the improvement on a visual analogue scale from 0 to 10, with 0 as no improvement and 10 as total clearance (Patient's Global Assessment, PGA).\nThe patient noticed gradually progressive improvement in his skin texture as well as marked improvement in his under eye dark circles [Figures and ]. According to physician global assessment, there was 50–75% improvement in periorbital melanosis after 4 sittings and 75–90% improvement after 12 sittings, as assessed by 2 independent physicians. The patient reported improvement on a scale of 0 to 10, with 0 as no improvement and 10 as total clearance, with ‘5’ after four sittings and ‘7’ after twelve sittings. No side effects were observed, and the patient reported that he was comfortable and relaxed during the treatment sessions.