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Treatment of periocular hyperpigmentation due to lead of kohl (surma) by penicillamine: a single group non-randomized clinical trial.

El Safoury OS, El Fatah DS, Ibrahim M - Indian J Dermatol (2009)

Bottom Line: The nine females were continuously using kohl as eyeliner.Highly significant P values (0.000) were obtained as regard to the conjunctival lead levels, serum lead levels, horizontal length, and degree of darkness score before and after D-PCN therapy.A less significant P value (0.040) was recorded as regard to the vertical length.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Research Biostatistics Unit, Management Team, EBM Unit, MEDC, Cairo University, Egypt. omar_safoury@hotmail.com

ABSTRACT

Background: Periocular hyperpigmentation is a condition in which skin of eyelids become darker in color than the normal surrounding skin. Lead and other heavy metals produce increased pigmentation because of deposition of metal particles in the dermis and increased epidermal melanin production.

Aims: This study was conducted to evaluate the dual effect of chelation therapy in treating periocular hyperpigmentation and lead toxicity.

Methods: The study population consisted of nine females complaining from dark coloration of their eyelids. The nine females were continuously using kohl as eyeliner. Lead levels in conjunctiva and serum before and after D-penicillamine (D-PCN) oral administration were estimated in relation to vertical, horizontal length, and degree of hyperpigmentation score.

Results: Highly significant P values (0.000) were obtained as regard to the conjunctival lead levels, serum lead levels, horizontal length, and degree of darkness score before and after D-PCN therapy. A less significant P value (0.040) was recorded as regard to the vertical length.

Conclusion: Regardless other causes, this study spots the light on a new concept for periocular hyperpigmentation from lead toxicity in adult females using kohl and suggests D-PCN in a low divided dose (750 mg/day) for its treatment.

No MeSH data available.


Related in: MedlinePlus

After treatment (Satisfactory)
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Figure 0002: After treatment (Satisfactory)

Mentions: The basis on which this clinical trial was conducted depended on a previous study of three groups of females with periocular hyperpigmentation, using kohl, not using kohl, and control. The mean values of lead obtained among the kohl users, non-kohl users and control were 31.16, 5.40, and 5.81 μg/ml in conjunctiva compared to 32.27, 17.23, and 18.01 μg/ml in serum. According to these results, the conjunctival lead was six times higher among females applying kohl, raising the serum lead of kohl users to double the serum lead levels among non-kohl users and controls. The positive correlation detected between conjunctival and serum lead was highly significant (P value 0.000), the more the lead level in conjunctiva, the more the serum level. Therefore, the results obtained suggest using kohl as a source of mild-to-moderate lead toxicity (highly significant P < 0.005-significant P < 0.05). In non-kohl users group, 9.09% showed grade (1) hyperpigmentation, 54.55% showed grade (2) hyperpigmentation, and 36.36% showed grade (3) hyperpigmentation. These data were comparable to 9.09%, 31.82%, and 59.09% among kohl-users, respectively. Comparing the degree of hyperpigmentation in both groups suggests that kohl is an aggravating factor for hyperpigmentation.[5] A highly significant correlation was obtained between frequencies of kohl application to the length of hyperpigmentation (P value 0.005) and to the degree of hyperpigmentation (P value 0.001). A positive statistical correlation was obtained between the duration of kohl application and width of hyperpigmentation (P value 0.021).[5] As lead toxicity is chronic, so to decrease lead levels, stopping kohl alone is illogic, hence chelation should be used. It was interesting that a significant reduction of the vertical and transverse dimensions of the eyelid hyperpigmentation occurred in concomitance with the decreased lead levels. Clinically, the hyperpigmentation faded in responders from lateral to medial side in width and from below to above in vertical length with a remnant of hyperpigmentation in the inner canthus. The decrease in pigmentation score was satisfactory to the participants in grade (2) hyperpigmentation [Figures 1 and 2], but was not satisfactory in grade (3) hyperpigmentation [Figures 3 and 4]. The follow-up of the participants for 1 year revealed no recurrence of hyperpigmentation.


Treatment of periocular hyperpigmentation due to lead of kohl (surma) by penicillamine: a single group non-randomized clinical trial.

El Safoury OS, El Fatah DS, Ibrahim M - Indian J Dermatol (2009)

After treatment (Satisfactory)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2807714&req=5

Figure 0002: After treatment (Satisfactory)
Mentions: The basis on which this clinical trial was conducted depended on a previous study of three groups of females with periocular hyperpigmentation, using kohl, not using kohl, and control. The mean values of lead obtained among the kohl users, non-kohl users and control were 31.16, 5.40, and 5.81 μg/ml in conjunctiva compared to 32.27, 17.23, and 18.01 μg/ml in serum. According to these results, the conjunctival lead was six times higher among females applying kohl, raising the serum lead of kohl users to double the serum lead levels among non-kohl users and controls. The positive correlation detected between conjunctival and serum lead was highly significant (P value 0.000), the more the lead level in conjunctiva, the more the serum level. Therefore, the results obtained suggest using kohl as a source of mild-to-moderate lead toxicity (highly significant P < 0.005-significant P < 0.05). In non-kohl users group, 9.09% showed grade (1) hyperpigmentation, 54.55% showed grade (2) hyperpigmentation, and 36.36% showed grade (3) hyperpigmentation. These data were comparable to 9.09%, 31.82%, and 59.09% among kohl-users, respectively. Comparing the degree of hyperpigmentation in both groups suggests that kohl is an aggravating factor for hyperpigmentation.[5] A highly significant correlation was obtained between frequencies of kohl application to the length of hyperpigmentation (P value 0.005) and to the degree of hyperpigmentation (P value 0.001). A positive statistical correlation was obtained between the duration of kohl application and width of hyperpigmentation (P value 0.021).[5] As lead toxicity is chronic, so to decrease lead levels, stopping kohl alone is illogic, hence chelation should be used. It was interesting that a significant reduction of the vertical and transverse dimensions of the eyelid hyperpigmentation occurred in concomitance with the decreased lead levels. Clinically, the hyperpigmentation faded in responders from lateral to medial side in width and from below to above in vertical length with a remnant of hyperpigmentation in the inner canthus. The decrease in pigmentation score was satisfactory to the participants in grade (2) hyperpigmentation [Figures 1 and 2], but was not satisfactory in grade (3) hyperpigmentation [Figures 3 and 4]. The follow-up of the participants for 1 year revealed no recurrence of hyperpigmentation.

Bottom Line: The nine females were continuously using kohl as eyeliner.Highly significant P values (0.000) were obtained as regard to the conjunctival lead levels, serum lead levels, horizontal length, and degree of darkness score before and after D-PCN therapy.A less significant P value (0.040) was recorded as regard to the vertical length.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Research Biostatistics Unit, Management Team, EBM Unit, MEDC, Cairo University, Egypt. omar_safoury@hotmail.com

ABSTRACT

Background: Periocular hyperpigmentation is a condition in which skin of eyelids become darker in color than the normal surrounding skin. Lead and other heavy metals produce increased pigmentation because of deposition of metal particles in the dermis and increased epidermal melanin production.

Aims: This study was conducted to evaluate the dual effect of chelation therapy in treating periocular hyperpigmentation and lead toxicity.

Methods: The study population consisted of nine females complaining from dark coloration of their eyelids. The nine females were continuously using kohl as eyeliner. Lead levels in conjunctiva and serum before and after D-penicillamine (D-PCN) oral administration were estimated in relation to vertical, horizontal length, and degree of hyperpigmentation score.

Results: Highly significant P values (0.000) were obtained as regard to the conjunctival lead levels, serum lead levels, horizontal length, and degree of darkness score before and after D-PCN therapy. A less significant P value (0.040) was recorded as regard to the vertical length.

Conclusion: Regardless other causes, this study spots the light on a new concept for periocular hyperpigmentation from lead toxicity in adult females using kohl and suggests D-PCN in a low divided dose (750 mg/day) for its treatment.

No MeSH data available.


Related in: MedlinePlus