Periorbital hyperpigmentation is a problem with complex multifactorial etiology, with early knowledge expanding. Another study found evidence suggesting green tea extracts can inhibit the activity of tyrosinase, thereby slowing melanin production.Green tea can be safely applied at home by following these steps: This treatment can be applied both morning and evening for all skin types. For example, those with a high nasal radix and deep-set eyes often appear to have dark circles. What causes periorbital hyperpigmentation and how can you treat it? Search terms included infraorbital dark circles, dark circles, periorbital hyperpigmentation, idiopathic hyperchromia AND orbital, under-eye circles, ICHOR (idiopathic cutaneous hyperchromia of the orbital region), dark circles AND treatment, and filler AND dark circles.. A systematic literature review was performed on PubMed. 36 In a review by Agrawal et al, it was shown that Q-switched Nd:YAG could be a good modality to treat periorbital hyperpigmentation. We could find only 6 reports of LPPig or EDP with periorbital localization in English literature. Vavouli C, Katsambas A, Gregoriou S, et al. Sleeping with extra pillows to elevate the head is helpful in preventing edema in the eye area. . Search terms included "infraorbital dark circles," "dark circles," "periorbital hyperpigmentation," "idiopathic hyperchromia AND orbital," "under-eye circles," "ICHOR (idiopathic cutaneous hyperchromia of the orbital region)," "dark circles" AND "treatment," and "filler" AND "dark circles." RESULTS A total of 39 studies . Patients opting for laser therapy must be advised that bruising can last up to 2 weeks. 37 However, in a recent systematic review by Michelle et al, it was concluded that laser treatments are only mildly to moderately . There are very little scientific data available on the clinical profile and pathogenesis of POH. Conclusion: Doshi M, Edward DP, Osmanovic S. Clinical course of bimatoprost -induced periocular skin changes in Caucasians. An official website of the United States government. Tretinoin is a retinoid, a class of drugs that work by dispersing keratinocyte pigment granules, interfering with pigment transfer and accelerating epidermal turnover. The investigators sought to compare the efficacy and safety of 2 new modalities . Evaluation of Efficacy and Safety of Low-Fluence Q-Switched 1064-nm Laser in Infra-orbital Hyperpigmentation Based on Biometric Parameters. We do not provide medical diagnosis, advice, or treatments. Careers, Unable to load your collection due to an error. People can reduce dark eye circles by protecting their skin from the sun. At-home hyperpigmentation treatments function either by inhibiting the formation of melanin or by brightening skin that has already become darkened. Periorbital hyperpigmentation is most prevalent within the 16-25 . It acts by inhibiting tyrosinase, and is used in a concentration ranging from 1 to 4%.28,29, In a study conducted by Lim et al,28 it was found that the addition of kojic acid to a gel containing 10% glycolic acid and 2% hydroquinone further improves pigmentation in melasma. Management of melasma with 2% analogue of green tea extract in a hydrophilic cream: A placebo-controlled, double-blind study. Physical sunscreens like zinc oxide and titanium dioxide provide excellent protection from UVA/UVB. Long-term use can lead to exogenous ochronosis, leukomelanoderma en confetti, nail discoloration, and colloid millium.23,24, Hydroquinone was reported to cause cancer in rodents, yet human carcinogenicity has not been established. Kojic acid is a naturally occurring fungal derivative produced by Aspergillus species and Penicillium species. Citrus fruits, such as oranges, lemons and limes are rich natural sources of vitamin C, and their juice can easily be incorporated into DIY cleansers and toners. Soft tissue fillers and autologous fat grafting are most effective in treating dark circles due to volume loss. It also causes redness and irritation, and there are no scientific studies supporting its safety for use in the delicate eye area. Director, Clinical Research Computing Unit (CRCU) (Standing Faculty Sr. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Also ask about any contact, airborne or food allergy, asthma, or eczema that may cause itching, excessive touching or scratching, and subsequent postinflammatory hyperpigmentation. Researchers studied 45 female patients with periorbital hyperpigmentation at an outpatient dermatology clinic in Cairo, Egypt. Chan R, Park KC, Lee MH, et al. Vitamin C promotes collagen production and conceals color of blood stasis, which could improve appearance of dark circles under the lower eye lid.34. Comparison of carboxy therapy and fractional Q-switched ND - Springer Structural type (S) appears as structural shadows formed by facial anatomic surface contours. Although medical treatment is not always indicated, there are some newer approaches and combined therapies that offer hope for the treatment of dark circles. Diagnosis and management of these patients are often challenging. You should see a dermatologist or doctor if you notice dark spots that: Hyperpigmentation, caused by clusters of excess melanin, appears as scattered areas of dark skin. Simmer the mixture until it forms a paste and then leave to cool. Bosniak S, Sadick NS, Cantisano-Zilkha M, et al. Management of infraorbital dark circles. sharing sensitive information, make sure youre on a federal Bosniak et al38 treated 12 patients with POH, tear trough deformity, or prominent nasojugal groove with the hyaluronic acid push technique. 2023 Apr;47(2):654-665. doi: 10.1007/s00266-022-03116-x. Periorbital hyperpigmentation has many Periorbital Hyperpigmentation (Dark Circles) : Causes & Treatment This plumping effect can make thin skin around the eyes appear smoother and more even; however, these effects are temporary. Lasers. Most at-home hyperpigmentation remedies work by naturally dispersing clustered melanin, disrupting the formation of melanin or by reducing inflammation. Objective: Acquired hyperpigmentation disorders - UpToDate Periorbital hyperpigmentation has been successfully treated with various noninvasive lasers that target pigment and vascularity. Dr. Sonthalia is from Skinnocence Clinic, Gurgaon, Haryana, India. Periorbital hyperpigmentation (POH) is an aesthetic concern for patients. Histological characteristics of periorbital hyperpigmentation suggest that it can be both epidermal and dermal in nature. Additional randomized clinical trials studying POH will be helpful. 1999;65(21):PL241-6. Many trial studies support the use of soy extract for treating hyperpigmentation. FOIA official website and that any information you provide is encrypted Given the scarcity of high-quality evidence supporting these results, recommendations should be interpreted selectively. A significant cosmetic concern. Int J Cosmet Sci. Treatment of Patients With Periorbital Hyperpigmentation Various lasers that have been used for treating dark circles are: Q switched ruby laser (694 nm), Q switched alexanderite laser, and Nd:Yag laser (1064nm).1,2, In a study conducted by Watanabe et al,12 patients with homogenous bilateral pigmented macules in the periorbital region were selected for study of dark circles. Before Curcumin has also demonstrated potential as a treatment for acne, which can sometimes lead to postinflammatory hyperpigmentation. A systematic literature review was performed on PubMed. 2014. The effectiveness of two common methods for periorbital dark circle treatment was compared in 28 patients with PDC. In addition to diligent sun protection, patients should be aware of other environmental triggers such as lack of sleep, excess salt intake, sleeping position, allergens, and cosmetic irritants that might exacerbate the appearance of their dark circles. Treatment of Periorbital Vascularity, Erythema, and Hyperpigmentation. Please try again soon. It is particularly important to factor in the impact of facial structure when contemplating rhinoplasty, blepharoplasty, facial implants, or other procedures that may alter facial contour. While home remedies may sometimes be effective in treating hyperpigmentation, over-the- counter (OTC) products and treatments are better studied, and have been proven to be both safe and effective. Periorbital hyperpigmentation: review of etiology, medical evaluation, and aesthetic treatment. Lifestyle changes may make a difference for some patients. PDF Periorbital hyperpigmentation etiology, pathophysiology, and clinical Topical vitamin C. Vitamin C, an antioxidant, has also been used for the treatment of hyperpigmentation. To make a turmeric paste, mix one part dry turmeric to two parts water in a saucepan. Aloe vera can be applied by following these steps: This process can be repeated each night until the hyperpigmentation fades. Hyperpigmentation is the darkening or increase in the natural color of the skin, usually due to an increased . Periocular dermatitis (Periorbital dermatitis): Symptoms with Images Clinically, POH is characterized by light- to dark-colored, brownish-black pigmentation surrounding the eyelids. Many surgeons recommend chemical peels or laser resurfacing performed in conjunction with surgery. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Their results showed that in 92 percent of study patients, periorbital melanosis was an extension of the pigmentary demarcation line over the face.10, Periorbital hyperpigmentation with pigmentary demarcation line (G type). January 2013 | Volume 12 | Issue 1 | Original Article | 45. Ocular hypotensive drugs. Ohshima H, Mizukoshi K, Oyobikawa M, et al. Outcomes, although highly dependent on operator skill, can be quite good. A distinct lack of ocular or mucosal involvement differentiates the nevus of Hori from other forms of dermal melanocytosis. Dermatol Ther. Higher concentrations can be compounded (if indicated) but may be irritating, so any increase above 4% should be gradual. Paolo et al41 used subcutaneous injections of C02once a week for seven weeks in the periorbital area and found significant improvement in fine lines and POH. Data is temporarily unavailable. Side effects also include allergic contact dermatitis and postinflammatory hyperpigmentation. Pseudoherniated fat located underneath the orbital rim causes a ballooning of the lower eyelid, resulting in dark shadows. The combination of glycolic acid and hydroquinone or kojic acid for the treatment of melasma and related conditions. Efforts to enhance and accentuate the eyes range from simple application of moisturizing creams and colored pigments to medical procedures such as injections and surgery. Etiologies of the condition include pigmentary, structural, vascular, and mixed causes. Your resource for everything skin-related. Ertam I, Mutlu B, Unal I, et al. Topical turmeric extract in a moisturizing cream formula reduces the appearance of facial spots and fine lines and wrinkles on human facial skin. This powder is typically intended for oral consumption, and the effects of its topical application have not been thoroughly studied. Periorbital Acquired Dermal Macular Hyperpigmentation: A Distinctive Resurfacing lasers like the carbon dioxide (CO2) or Erbium:YAG may be an option for some patients. This powder can be blended into a paste and applied to the skin by following these steps: You can start with a once-a-day treatment to determine how skin reacts. The etiology is multifactorial with a genetic background. Ohshima et al34 showed that vitamin C and its derivatives, such as magnesium ascorbyl phosphate and ascorbic acid glucoside, inhibit melanogenesis in human melanocytes. Periorbital hyperpigmentation usually appears as a curved band of brownish or bluish skin approximating the shape of the underlying inferior orbital rim. For example, if fluid retention is a concern, salt intake must be monitored. Recently, platelet-rich plasma has been used in treating dark circles due to tear trough deformity and wrinkles. PMID 24719068. For Fitzpatrick types I and II, a concentration of up to 35% TCA can be safely used. Periorbital hyperpigmentation is a generally benign, extremely common condition that is notoriously resistant to treatment. Start by applying the juice a few times per week and manage your usage based on your skins response. These clusters result in the appearance of scattered, dark spots. The addition of topical steroids to tretinoin helps increase epidermal skin thickness and enhance the depigmenting effects. Paraskevas LR, Halpern AC, Marghoob AA. In considering this option, patients must fully understand the significant risks for negative side effects including permanent pigment changes, both hypo- and hyperpigmentation, resulting in obvious demarcation, ectropion, pain, infection, and a long recovery period (up to 6 months). Periorbital HyperpigmentationDark Circles under the Eyes; Treatment Hyperpigmentation on Black Skin - Healthline Br J Dermatol. Disclosure:The authors report no relevant conflicts of interest in the preparation or content of this manuscript. What to do about periorbital hyperpigmentation. Hollinger, J. C., Angra, K., & Halder, R. M. (2018). Certain treatments also work to reduce some of the visible signs of UV damage, reducing the appearance of sun spots. Papaya is another rich source, and a popular ingredient in DIY face mask recipes. Ultrasonographic evaluation can help to differentiate the vascular cause from the periorbital puffiness. Even those amenable to treatment are often subject to relapse, particularly when the primary cause is hyperpigmentation. Journal of Drugs and Dermatology. doi: 10.1111/dth.13717. A systematic review of the data banks of scientific and research articles including PubMed, Web of Knowledge, Google Scholar, SCOPUS, and Iranian databases including SID . Thus, it was concluded that in treating POH, the Q switched ruby laser should be considered as first-line treatment and it was found effective in both dermal and epidermal pigmentation.26 The Nd:Yag laser (1064nm) is also effective in reducing the pigmentation and vascular component of infraorbital dark circles. Noninvasive lasers that have been shown to be effective include the intense pulsed light (IPL) and Q-switched ruby. PDF Treatment Suggestions and Combining Procedures World J Clin Cases. In most patients the affected area encompasses the entire lower lid, concentrated along the lower aspect of the eyelid beneath the orbital fat. Woods lamp examination may distinguish between dermal and epidermal melanin deposition. Volume 60, Issue 3, Supplement 1, 2009, Page AB160, ISSN 0190-9622. Periorbital hyperpigmentation: a study of its prevalence, common causative factors and its association with personal habits and other disorders. Arbutin. Treatment options include topical agents and sunscreens, chemical peels, Botox, soft-tissue fillers, laser therapy, surgery, alternative cures, and over-the-counter cosmetics (Table 3). HHS Vulnerability Disclosure, Help Treatment has to consider underlying pathologies and patients' needs. These include the pulsed dye laser, diode laser, 1064nm Nd:YAG laser, 1320nm Nd:YAG laser, 1540nm erbium glass laser, and intensed pulsed light laser sources. If patients complain of a sudden onset of symptoms or unexplained progression, a complete medical work up may be indicated. Chronic treatment of asthma. Pigmented type (P) appears as infraorbital brown hue. Kojic acid. It is sometimes recommended as a replacement for a professional chemical peel, but can be dangerous to use and poses the risk of a chemical burn. When adding vitamin-derived agents to any treatment regimen, it is important to understand how ingredients interact or counteract. An increase in violaceous discoloration on manual stretching of the lower eyelids is due to thin eyelid skin or hypervascularity of lower eyelid.7. Alpha hydroxy acids such as lactic and citric acid are derived from milk products and citrus fruits, respectively. Periorbital hyperpigmentation presents with one or more of the following characteristics: (1) diffuse and concentrated melanin deposits (hyperpigmentation), (2) excessive or superficial subcutaneous vasculature, and (3) shadows caused by pseudoherniated orbital fat. Blepharoplasty helps in eliminating dark circles caused by shadows that are cast by fat deposits or excess skin.40 Transconjunctival blepharoplasty is a better approach than transcutaneous blepharoplasty so that no external visible scar is created. Agents that prevent as well as repair sun damage such as ultrasomes, the liposomal encapsulated enzyme UV-endonuclease, may also play an important role in treating and preventing periorbital hyperpigmentation in the future. For more information, please refer to our Privacy Policy. Phytother Res. Topical antioxidants in addition to Vitamin A are of increasing interest. Combination therapy using 2% to 5% hydroquinone, 1% tretinoin, and 0.1% dexamethasone (the Kligman formula) is the current gold standard for topical bleaching. Facial self-tanners may also help obscure the contrast between dark and light skin, as well as providing a refreshed and rested look. Hyperpigmentation is caused by an increase in the production of melanin, the pigment responsible for the color of hair and skin. Females are often more disappointed by POH than males. Periorbital hyperpigmentation (POH) is a common worldwide problem. Clinical observation is usually sufficient to determine the primary cause of periorbital hyperpigmentation; confirmation by histological examination is rarely necessary. Careful selection of patients for chemical peeling should involve not only identification of Fitzpatrick skin type, but also determination of ethnic background. Home remedies also offer a more cost- and time-effective alternative to conventional treatments. Treatment of Periorbital Vascularity, Erythema, and Hyperpigmentation Periorbital Hyperpigmentation: Review of Etiology - Home - JDDonline Treatment response of periorbital ADMH was less than satisfactory. liver, thyroid, kidney) and sinus infections are some of the reasons for Peri-Orbital Edema or puffiness, resulting in post-inflammatory hyperpigmentation. Paolo F, Nefer F, Paola P. Nicol S. Periorbital area rejuvenation using carbon dioxide therapy. Periorbital hyperpigmentation is a common clinical entity, especially among young adults in pigmented races. Among the available alternatives to treat dark circles are topical depigmenting agents, such as hydroquinone, kojic acid, azelaic acid, and topical retinoic acid, and physical therapies, such as chemical peels, surgical corrections, and laser therapy, most of which are tried scientifically for melasma, another common condition of hyperpigmentation that occurs on the face. It can be used safely for prolonged periods of time. Facial Plast Surg Clin North Am. Periorbital hyperpigmentation, also known as hereditary dark circles, is characterized by darker skin around the eyes caused by the presence of additional melanin. A combination of the hollowness and the overlying pseudoherniation of the infraorbital fat accentuate the shadowing in the tear trough causing dark circles, depending on the lighting condition (Figure 2).1-3, Tear trough deformity presenting as dark circles, Periorbital edema. Preliminary studies suggest it may be effective in reducing the appearance of melasma. Various topical creams and chemical peels are useful in treating pigment-based POH, whereas lasers are mildly to moderately beneficial for both vascular and pigment types. Roh MR, Chung KY. Infraorbital dark circles: definition, causes, and treatment options. Ellen C. Gendler, MD, New York, NY,is a board-certified dermatologist. Barone CR, Boza JC, Machado PG, Cestari TF. Chemical peels to address lower eyelid hyperpigmentation may be used alone or in combination with other treatments, such as topical bleaching agents. Dr. Garg S is from the Department of Dermatology, Army College of Medical Sciences, Base Hopsital, Delhi Cantt-10, India. If applying turmeric extract or paste does stain your skin, you can apply a sugar scrub, or warm coconut or vegetable oil into the stained area and then wash the area with soap. Traditional therapies such as hydroquinone-based bleaching creams are frustratingly slow and yield minimal, barely perceptible results. Many of them recognized the pigmentation early in childhood and stated that pigmentation increased with age. 8600 Rockville Pike Periorbital HyperpigmentationDark Circles under the Eyes; Treatment A new formula for depigmenting human skin. Combined therapy using Q-switched ruby laser and bleaching treatment with tretinoin and hydroquinone for periorbital skin hyperpigmentation in Asians. Tretinoin, a derivative of Vitamin A acid, is an effective albeit slow bleaching agent that can be safely used in the eye area in a 1% concentration in an emollient cream base (Figure 1). Periorbital hyperpigmentation (POH) is a common dermatological problem and constitutes a significant percentage of patients visiting the clinics of dermatologists. Some natural ingredients have proven to be safe and effective treatment options for hyperpigmentation. Because ascorbic acid is unstable in many topical preparations, esterified derivatives, such as L-ascorbic acid 6-palmitate and magnesium ascorbyl phosphate are used in compounds. Prostaglandin analogues, such as latanoprost and bimatoprost, which are used as ocular hypotensive eye drops in patients with glaucoma, can also cause periorbital hyperpigmentation.18,19 Patients develop periocular hyperpigmentation most frequently between 3 to 6 months of initiating bimatoprost therapy. Carboxytherapy. An extract of the bearberry plant, arbutin, is widely used in Asia as a depigmenting agent. All three types of hyperpigmentation can be addressed to some degree using at-home options. The use of topical . Watanabe S, Nakai K, Ohnishi T. Condition known as Dark Rings under the Eyes in the Japanese population is a kind of dermal melanocytosis which can be successfully treated by Q-switched ruby laser. Momosawa A, Kurita M, Ozaki M, et al. Dermatologic Surgery47(1):70-74, January 2021. Guevara IL, Pandya A. Licorice extract is usually accompanied by application instructions that should be followed closely for optimal results. An understanding of different contributing factors and ability to classify hyperpigmentation can aid in the management of POH. Management of periorbital hyperpigmentation: An overview of nature Facial structure can also impact the appearance of dark circles. Although there are several medical techniques that successfully address fine wrinkling and contour deficiencies, dark under-eye circles have been notoriously resistant to treatment. It is available in a concentration of 3%.33. (a)-19-year-old patient. doi: 10.34172/jlms.2022.16. 13(4) 472-82. The use of a moisturizing eye cream can help to improve the overall appearance of periorbital skin by aiding in moisture retention. Despite our best efforts, a significant reduction in the extent and intensity of dark circles may not be a realistic goal for all patients. Periorbital hyperpigmentation. Chemical peels are contraindicated in patients in whom dark circles are primarily caused by hypervascularity because of the risk of worsening their appearance. Periorbital hyperpigmentation (POH), also known as periocular hyperpigmentation, periorbital melanosis, dark circles, infraorbital darkening, infraorbital discoloration, or idiopathic cutaneous hyperchromia of the orbital region, is a common condition encountered in dermatology practice. You can read the full text of this article if you: You may be trying to access this site from a secured browser on the server. Soy extract is available form specialized organic vendors in powder form. Many treatment options are avaiblabe with variable efficacy and safety in . Optimal improvement usually requires several treatments over 3 to 4 months. Bethesda, MD 20894, Web Policies 2022 Apr 12;13:e16. The safety of hydroquinone. Sarkar, Ranjan, Garg V, and Bansal are from the Department of Dermatology, Maulana Azad Medical College and LokNayak Hospital, New Delhi, India. Preliminary research suggests that a number of natural ingredients show promise as treatment options for hyperpigmentation. 2023 Copyright Derm Collective. . Hypervascularity causes dark circles having a purple or blue tinge, rather than brown. It is notable that the skin in the periorbital area is the thinnest and softest of any bodily area, with an average thickness of 0.5 mm compared with 2-mm thickness in other areas. There are a number of treatment options available for POH. 2013 Sep;12(3):204-9. doi: 10.1111/jocd.12044. 2011 Oct;25(10):1140-5. A multimodal approach may be r A multimodal approach may be required, encompassing topical bleaching agents, chemical peels, laser therapy, and/or surgery. Periorbital hyperpigmentation and erythema dyschromicum perstans. In some cases, darker pigmented areas of skin may actually be early signs of skin cancer. Patients who tolerate treatment well are required to continue with a maintenance regimen of 2% hydroquinone, available without prescription. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Malakar S, Lahiri K, Banerjee U, et al. Periorbital hyperpigmentation is defined as bilateral, homogeneous hyperchromic macules and patches primarily involving the lower eyelids but also sometimes extending towards the upper eyelids, eyebrows, malar regions, temporal regions and lateral nasal root. It appears as speckled or mottled brown-grey to blue-black patches that may involve the skin, conjunctiva, sclera, tympanic membrane, or oral and nasal mucosa of the affected dermatomes. Drs. Some lifestyle factors that may contribute to dark under-eye circles include lack of sleep, overuse of alcohol, use of contact lenses, smoking, or excessive intake of soda or caffeinated beverages. Monitor use for excessive irritation that may exacerbate existing hyperpigmentation. Minimizing sun exposure. Among the available treatment options for POH include topical depigmenting agents, such as hydroquinone, kojic acid, azelaic acid, topical retinoic acid, and physical therapies, including chemical peels, surgical corrections, and laser therapy, most of which are tried scientifically for melasma, another common condition of hyperpigmentation, which also occurs on the face.1-3 The aim of treatment should be to identify and treat the primary cause of hyperpigmentation as well as its contributing factors. Effective treatments for POH include lasers, topical creams and serums, fillers, chemical peels, carboxytherapy, plasma-rich platelet injections, blepharoplasty, and normobaric oxygen. These lasers cause a thermal injury that can stimulate collagen, lighten pigment, and tighten skin simultaneously. Dermal melanocytosis causing periocular hyperperpigmentation can be due to congenital or acquired causes.9,12,13 Dermal melanocytosis can be placed into the pigmentary class of Huang et als classification. review was performed on PubMed. Would you like email updates of new search results? the contents by NLM or the National Institutes of Health. Azelaic acid (1,7- heptanedicarboxylic acid) was initially developed as a topical antiacne agent, but because of its effect on tyrosinase, it has also been used in the treatment of hyperpigmentary disorders such as melasma. Note the area of involvement as well as the pattern of progression. POH interferes with perceived age. Different ethnic groups may respond unpredictably to chemical peeling regardless of skin phenotype. B, Posttreatment view 5 weeks after continuous treatment for periorbital hyperpigmentation with a bleaching cream containing retinol (Young Pharmaceuticals, Inc.). Etiologies of the condition include pigmentary, structural, vascular, and mixed causes. However, despite the overly optimistic promises of cosmetic manufacturers, I advise explaining to patients why the chances for real or lasting success with over-the-counter cosmetic products are slim.
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