Treatments of Infra-Orbital Dark Circles by Various Etiologies

Dark circles refer to visible darkness of the infra-orbital areas. Dark circles are a cosmetic concern for many individuals, although not a medical concern. Moreover, clear definitions and possible causes of dark circles have not been elucidated. This study reviews the possible causes and treatment options for dark circles based on a review of the medical literature and the authors' clinical experience. Potential factors that contribute to dark circles include excessive pigmentation, shadowing due to tear troughs and infra-orbital fat herniation, shadowing due to infraorbital laxity and wrinkles, and thin, translucent skin overlying the orbicularis oculi muscle. Given the different possible causes for dark circles, therapeutic modalities must be individualized for each patient. Because various factors cause dark circles, it is useful to identify the underlying causes in order to select the appropriate treatment.

A Pilot Study to Evaluate the Efficacy and Safety of Treatment with Botulinum Toxin in Patients with Recalcitrant and Persistent Erythematotelangiectatic Rosacea

BACKGROUND: There are few pharmacologic options to reduce erythema and flushing in patients with recalcitrant erythematotelangiectatic rosacea (ETR). We previously reported two cases of refractory flushing and erythema of rosacea that were successfully treated with intradermal botulinum toxin injection, and additional research is needed to prove the efficacy and safety of this treatment. OBJECTIVE: To report the efficacy and safety of botulinum toxin injection as an aid in persistent erythema of rosacea patients. METHODS: A total of 20 Korean patients with recalcitrant ETR were enrolled to receive treatment by injection of botulinum toxin. Patients received one treatment of intradermal botulinum toxin injection and were assessed 1, 2, 4, and 8 weeks after treatment. The severity of erythema and telangiectasia was investigated by a non-treating physician, and the Erythema Index (EI) was assessed by mexameter at each visit. Patient satisfaction and any adverse events were also assessed at each visit. RESULTS: 17 patients completed all follow-up visits and were included in the analysis. Intradermal injection of botulinum toxin significantly reduced erythema severity and EI in ETR patients. Patients reported a satisfaction score of 2.94±0.56 at 8 weeks after treatment. Except for three patients who discontinued the study early due to inconvenience of facial muscle paralysis, 17 patients participating in the final analysis did not report side effects except injection pain at the time of the procedure. CONCLUSION: Intradermal injection of botulinum toxin can be used as an effective and relatively safe adjuvant agent for recalcitrant and persistent erythema of ETR patients.

Therapeutic efficacy of orally administration itraconazole in onychomycosis / 대한피부과학회지

Botween April 1991 and March 1992, a multicenter open trial was done to evaluate the therapeutic efficacy of itraconazole in the treatment of onychomycosis, 116 patients with onychomycosis diagnosed by clinical and mycological finding were recruited from the 24 university hospitals in Korea. They received 100mg of oral itraconazole once a day until clinical improvement was evident or until 12 months. Response to treatment was evaluated clinically and mycologically. Cure was complete absence of clinical lesions and negative mycological results. Marked improvment was minimal clinical lesions with negative mycology. Moderate improvement was some residual clinical lesions with positive mycology. Unchanged was no clinical response until 4 months after therapy. Obtained results were as follows. 1. Mean duration of treatment was 6.3+/-2.0 months (2-12), and 83 (70.7%) were cured, 27 (23.3%) showed marked improvement, 2 (1.7%) were moderately improved, 3 (2.6%) were unchanged, and 2 (1.7%) were excluded due to the possible side effect of the medication, although they showed moderate improvement. 2. When only fingernails were involved, mean duration of treatment was 5.3+/-2.0 months with cure rate of 81.8%. when toenails were involved, mean duration of treatment was 6.5+/-2.0 months, which was significantly longer than that in fingernail, however cure rate was 66.7%, which was not different from that in fingernail. 3. In cases that Candida spp. were causative organism, 91.7% were cured with marked improvement in another 8.3%. Onychomycosis due to dermatophytes were cured in 72.9%. However, when moulds or T. beigelii were isolated, only one out of six was cured. 4. 9 out of the 116 subjects showed possible side effects during itraconazole treatment. Gastrointestinal troubles were noted in seven, whicn were mostly mild and self-limited, however, in one patient, medications were withdrawn due to continuing gastric upset. In another patient, transient visual disturbance was noted and medications were also withdrawn. However, this patient was already suffereing from glaucoma and causal relationshiop was not established. Shoulder pain was noted in another one, however it was regarded probably unrelated to the drug, and medications were contiued without aggravation of the symptoms. 5. 88 patients were followed with serial biochemical liver function tests for two month interval. None of them showed evidence of hepatic injury during the entire observation period. From the above findings, oral itraconazole was regarded as more effective than the preexisting drugs in the treatment of onychomycosis, and also it was regarded safe in long term therapy.