A Prospective Study Comparing Clinical Efficacy of 30% Mandelic Acid Peel Versus 30% Lactic Acid Peel in Periorbital Melanosis.

Background: Periorbital melanosis (POM), or dark circles, is characterized by hyperpigmentation around the eyes, mainly affecting females aged between 16 to 25 years. It results from genetic and environmental factors. Chemical peels with mandelic acid and lactic acid are commonly used for treatment, but their comparative effectiveness and safety are underexplored. This study compares the effectiveness and safety of 30% mandelic acid peel versus 30% lactic acid peel for treating POM.

Patients and methods: A prospective, comparative study was conducted at a tertiary healthcare institute over 18 months (September 2022 to February 2024) with 70 patients. They were randomly assigned to receive either mandelic acid (35 patients) or lactic acid peels (35 patients) across three sessions (weeks 0, 2, and 4), followed by an end of study visit at week 6. Efficacy was measured using the POM grading, visual analog scale (VAS), and patient satisfaction score, while safety was assessed via adverse events.

Results: Both treatment groups showed significant improvement in POM severity, with a shift from higher to lower grades of pigmentation. However, the lactic acid group exhibited a significantly greater reduction in pigmentation (50% of patients with more than 30% improvement in VAS, P = 0.001). Patient satisfaction was higher in the lactic acid group (100% satisfied vs. 83.9% in the mandelic acid group, P = 0.011). Side effects included mild erythema and swelling, with exfoliation more common in the lactic acid group and irritation more frequent in the mandelic acid group.

Limitations: This study is limited by its small sample size and short duration, which may impact the generalizability and long-term evaluation of the treatments.

Conclusion: Both 30% mandelic and lactic acid peels effectively treated POM, with lactic acid showing better outcomes and patient satisfaction. Both treatments were safe, but lactic acid may be better for sensitive skin due to milder side effects. Larger studies with longer follow-up are needed.