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Pathways affecting lipid metabolism and cell junctions, such as mitogen-activated protein kinase (MAPK) signaling, peroxisome proliferator-activated receptor (PPAR) signaling, tight junction, extracellular matrix (ECM)receptor interactions, focal adhesion, and regulation of the actin cytoskeleton, were suggested to potentially contribute to IMF deposition [29]

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The interest in carboxytherapy, combined with the prior application of a 20% lactobionic acid solution, a gentle exfoliant, was studied in a recent clinical trial involving 39 individuals with vascular or pigmented dark circles