Abstract
Periorbital hyperpigmentation (POH) is a frequent concern among both young and adult patients. The etiology is multifactorial with a genetic background. Prevalence is higher in darker skin types. It has been estimated as high as 30% in a recent Indian study. Females are often more disappointed by POH than males. Treatment has to consider underlying pathologies and patients’ needs. We present our treatment algorithm for POH. In this study, 74 patients with POH, 64 females (86.5%) and 10 males (13.3%), were treated. Of these, 39 patients (53%) had a family history of POH. The age range of patients was 18−57 years (average: 36.1 years). In case of tear trough deformity, soft tissue augmentation was used by injection of hyaluronic acid gel, calcium hydroxylapatite, or autologous fat. Blepharoplasty with partial fat pad resection or repositioning via arcus marginalis release was used to correct severe orbital fat herniation and excess of the lower lid skin. Melanin hyperpigmentation of the skin was improved by sessions of Q-switched 1064 and 532 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. Small vessels (capillaries and veins) were targeted by a 1064 nm long-pulsed Nd-YAG laser. Sessions of intense pulsed light (IPL) or CO2 fractional laser were employed to improve skin texture and fine lines. Topical hyaluronic acid-based formulations may be used as adjuvant self-treatment by patients. For pigmented and mixed-type POH, ultraviolet light protection is recommended as a maintenance treatment. By the use of various technologies, treatment can be individually tailored.
Highlights
Periorbital hyperpigmentation (POH) or dark circles under the eyes is a very frequent concern among both young and adult patients of any skin type
We considered comorbidities that could interfere with treatment selection, such as atopic dermatitis
The major outcome of treatment was an improvement of POH
Summary
Periorbital hyperpigmentation (POH) or dark circles under the eyes is a very frequent concern among both young and adult patients of any skin type. We define POH as the occurrence of bilateral hyperchromatic macules and patches usually affecting the lower eyelids. This hyperpigmentation can be present on the upper eyelids, malar region, eyebrows, and neighboring regions. The combination of Dennie–Morgan fold and POH is highly suspicious for atopic dermatitis [2]. Atopic dermatitis is probably the most common dermatosis associated with POH [3]. A cross-sectional study among Malaysian Chinese identified single nucleotid polymorphism in p53 and vascular endothelial growth factor A (VEGFA) genes. They found an association of TA (tyrosine –adenosine) genotype in rs1437756379 of p53 to mixed vascular-
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