Ferulic acid 12% peel: An innovative peel for constitutional type of periorbital melanosis-Comparing clinical efficacy and safety with 20% glycolic peel and 15% lactic peel

Background: Periorbital hyperpigmentation (POH) is a very common, yet unexplored aesthetic condition. Topical therapy is mainstay of treatment which includes chemical peels and other depigmenting agents.

Aims: To compare clinical efficacy, safety, and tolerability of 20% glycolic acid peels, 15% lactic acid peels, and 12% ferulic acid peels in the treatment of constitutional type of periorbital hyperpigmentation in Indian patients.

Methods: Ninety patients of constitutional POH were enrolled for 12 weeks. They were divided into three groups of 30 each. In 1st group 20% glycolic acid peeling, in 2nd group 15% lactic acid peeling and in 3rd group 12% ferulic acid peeling sessions were performed at 3 weekly intervals. Clinical improvement was assessed objectively using POH grading, physician's and patient's global assessment, and patient's global tolerance.

Results: Significant improvement in periorbital hyperpigmentation was noted in all the three groups. Physician and patient's global assessment was excellent with glycolic acid peel followed by ferulic acid peel and lactic acid peel. The incidence of side effects in the form of erythema and itching was maximum with glycolic acid followed by lactic acid and least with ferulic acid, which did not necessitate cessation of therapy.

Conclusion: Glycolic acid produced the best results among the three peels; however, ferulic acid peel emerged as a safe and effective modality for the treatment of POH.