RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATEAND ADDRESS / Dr. DIVYASHREE S
Post-Graduate Student,
Bangalore Medical College
& Research Institute,
Fort, K.R.Road, Bangalore - 560002
2. / NAME OF THE INSTITUTION / BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE
3. / COURSE OF STUDY & SUBJECT / M.D. (DERMATOLOGY, VENEROLOGY AND LEPROLOGY)
4. / DATE OF ADMISSION TO THE COURSE / 28 - 04 -2011
5. / TITLE OF THE TOPIC:
“ PERIORBITAL HYPERPIGMENTATION : A CLINICO-EPIDEMIOLOGICAL STUDY”
6.
6.1 / BRIEF RESUME OF THE INTENDED WORK
NEED FOR THE STUDY:
Periorbital hyperpigmentation (POH) presents with a dark area surrounding the eyelids. It is an ill-defined condition, and the pathogenesis can be multifactorial.[1]
Possible causative factors that have been proposed include excessive constitutional pigmentation, thin and translucent lower eyelid skin, shadowing due to skin laxity, and venous congestion.[2] The skin over the lower eyelid is thinner and looser than other sites because it contains less collagen, elastin, and glycosaminoglycans.[3,4]
Marked periorbital melanosis is seen as genetic trait. Pigmentation of the periorbital skin can also be post-traumatic, post-inflammatory or can accompany any melanocyte-stimulating harmone-induced melanosis of any cause.[5] Periorbital melanosis, i.e. hyperpigmentation of the skin around the eyes, may be physiological, occurring at puberty, or hereditary, determined by an autosomal dominant gene.[6]Infraorbital dark circles is a significant cosmetic concern for female patients. Although it does not cause morbidity, it can influence the quality of life from the medical point of view.
6.2 / REVIEW OF LITERATURE:
Most of the literature on POH has focused on Caucasian populations. Because the problem of POH may be more prevalent or of greater concern in Asian populations, data in these groups are needed.[1]
A study was done by Harneet Ranu et al to determine the primary cause of the POH and classify them into five different types. The commonest form of POH was the vascular type (41.8%), followed by constitutional (38.6%), post-inflammatory hyperpigmentation (12%), shadow effects (11.4%) and other causes. The vascular type was seen predominantly in Chinese, whereas as the constitutional type was most common in Indians and Malays.[1]
Subrata Malakar et al in their study to identify the nature of pigmentation in periorbital melanosis concluded that periorbital melanosis and pigmentary demarcation line of the face are not two different conditions; rather they are two different manifestations of the same disease.[7]
A review article by Neena Khanna et al proposed periorbital melanosis as one of the cause of facial melanosis and suggested treatment based on it. The treatment of facial melanosis includes removal of aggravating factors, vigorous photoprotection, and some form of active pigment reduction either with topical agents or physical modes of treatment.[8]
A study carried out by Gupta et al evaluated the prevalence of dissatisfaction with the appearance of skin of 32 women with the eating disorders anorexia nervosa and bulimia nervosa, compared with 34 healthy controls. They found that 9% of American women below 30 years were dissatisfied with darkness under the eyes against 38% of women with eating disorders. These figures give us an idea about how commonly this complaint is reported by patients in daily dermatological practice.[9] Mi Ryung Roh et al in their study stressed the need to identify the cause of infraorbital dark circles before appropriate treatment can be initiated. If infra-orbital dark circles are mainly due to excessive pigmentation, the dermal melanin pigment should be removed with treatment such as a topical bleaching agent, chemical peels, and lasers..[10]
6.3 / AIMS AND OBJECTIVES OF THE STUDY:
· To study the nature and cause of periorbital hyperpigmentation.
· To study the associated aggravating factors of periorbital hyperpigmentation..
7.
7.1
7.2 / MATERIAL AND METHODS:
SOURCE OF DATA:
This consists of both male and female patients attending the dermatology and STD outpatient department from November 2011 to March 2013 at Victoria Hospital and Bowring & Lady Curzon Hospital attached to Bangalore Medical College & Research Institute, Bangalore.
METHOD OF COLLECTION OF DATA:
Hundred patients with periorbital hyperpigmentation will be included in the study as per the inclusion and exclusion criteria.
Inclusion criteria:
Ø Male and female patients (Age group 15-60 years)
Exclusion criteria:
Ø Age < 15 years and >60years.
Methodology:
100 patients with periorbital hyperpigmentation will be included in the study as per the inclusion and exclusion criteria. Written informed consent will be taken for their participation in the study. Detailed history including name, age, sex, address, contact number, marital status, occupation and history of medication will be noted. Photographs will be taken for documentation .Selected patients will be thoroughly examined and investigated. Statistical analysis is done by descriptive analysis.
7.3 / Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so please describe briefly.
A) It does not require any intervention on animals.
B) Investigations only on patients with their consent.
1. Routine blood investigations like hemoglobin, bleeding time, clotting time
2. Blood sugar levels
3. Renal parameters: Blood urea, Serum creatinine(only if necessary)
4. Thyroid profile, Serum cortisol levels ( only if necessary)
5. Wood’s lamp examination.
7.4 / Has ethical clearance has been obtained from your institution in case of 7.3?
YES
8. / LIST OF REFERENCES:
1. Ranu H, Thng S, Goh BK, Burger A, Goh CL. Periorbital Hyperpigmentation in Asians: An Epidemiologic Study and a proposed classification. Dermatol Surg 2011; 37:1297–1303.
2. Lowe NJ, Wieder JM, Shorr N, Boxrud C, Saucer D, Chalet M. Infraorbital pigmented skin. Preliminary observations of laser therapy. Dermatol Surg 1995;21:767–70.
3. Lee Y, Hwang K. Skin thickness of Korean adults. Surg Radiol Anat 2002; 24:183–9.
4. Oresajo C, Dickens M, Znaiden A. Eye area problems puffiness, bags, dark eye circles and crowsfeet. Cosmet Toiletries 1987;102:29-34.
5. J.N Leonard, J.K.G Dart. The skin and the eyes. In, Burns T(ed). Text book of dermatology, eighth edition. U K, Wiley-blackwell,2010;67.5.
6. Dhar S, Datta P, Malakar R. Pigmentary disorders. In, R.G.Valia, Ameet R Valia(ed). IADVL Text book of dermatology, Third edition. India, Balani publishing house,2008;773.
7. Malakar S, Lahiri K, Banerjee U, Mondal S, Sarangi S. Periorbital melanosis is an extension of pigmentary demarcation line-F on face. Indian J Dermatol Venereol Leprol 2007; 73:323-25.
8. Khanna N, Rasool S. Facial melanoses: Indian perspective. Indian J Dermatol Venereol Leprol 2011;77:552-64
9. Gupta MA, Gupta AK. Dissatisfaction with skin appearance among patients with eating disorders and non-clinical controls. Br J Dermatol 2001; 145:110-13.
10. Roh MR, Chung KY. Infraorbital dark circles: definition, causes and treatment options. Dermatol Surg 2009; 35:1163–71.
9. / SIGNATURE OF THE CANDIDATE / ( Dr. DIVYASHREE S )
10. / REMARKS OF THE GUIDE / POH is a common and significant cosmetic concern. It has many underlying causes. Many patients seek treatment for the same without satisfactory outcome. There is paucity of literature on this topic. Hence it is relevant to take up the study for proper management of these cases.
11.
11.1
11.2 / NAME AND DESIGNATION
OF GUIDE
SIGNATURE /
Dr. ASHA G.S.
Assistant Professor
Department of Dermatology and STD
BMC&RI, Bangalore.
11.3
11.4 /
CO-GUIDE ( IF ANY )
SIGNATURE
11.5
11.6 / HEAD OF THE DEPARTMENT
SIGNATURE / Dr. M.MALLIKARJUNA
Professor and Head
Department of Dermatology and STD
BMC&RI, Bangalore.
12.1
12.2 / REMARKS OF THE CHAIRMAN AND PRINCIPAL
SIGNATURE
6