Illuminating the shadows: an insight into periorbital hyperpigmentation

Abstract

Periorbital hyperpigmentation (POH), also referred to as periorbital melanosis or dark eye circles, is a common dermatological concern characterized by darkening of the skin around the eyes. This review article aims to comprehensively analyze the current understanding of POH, encompassing its epidemiology, etiopathogenesis, clinical manifestations, diagnosis and available treatment modalities, and focusing on patients’ skin color. The review also consolidates a grading system for POH and emphasizes the importance of accurate diagnosis using clinical examination, assessment scores, Wood’s lamp, ultrasonography, and dermoscopy. Treatment modalities range from non-pharmacological measures to topical agents, including kojic acid, alpha-arbutin, vitamin C, vitamin E, niacinamide, retinoids, and hydrating agents. The manuscript explores the efficacy of various skin-lightening agents, such as hydroquinone, and introduces emerging treatments like caffeine, carotenoids, lactic acid, curcumin, and vitamin K. Additionally, it delves into procedural treatments like chemical peels, lasers, blepharopigmentation, mesotherapy, platelet-rich plasma therapy, fillers, autologous fat transplantation, and surgical interventions. The comprehensive approach to understanding and managing POH presented in this review aims to provide clinicians with valuable insights into the diverse therapeutic options available for this challenging cosmetic concern.