Periorbital dark circles

Dark blemishes around the eyes

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Medical condition

Periorbital dark circles

Other names| Dark circles, infraorbital venous stasis, periorbital hyperpigmentation
Minor dark circles and a hint of periorbital puffiness—a combination principally suggestive of minor sleep deprivation.
Specialty| Sleep medicine

Periorbital dark circles (including dark circles of the lower eyelid) are dark blemishes around the eyes. There are many causes of this symptom, including heredity and bruising.[1]

## Causes

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### Anatomical factors

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Bony structure and prominence of the orbicularis oculi muscle can contribute to infraorbital dark circles.[2][3] Skin in the lower eyelid is very thin which accentuates subdermal features.[2]

### Allergies, asthma, and eczema

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Any condition that causes the eyes to itch can contribute to darker circles due to rubbing or scratching the skin around them. Hay fever sufferers in particular will notice under-eye "smudges" during the height of the allergy season. Atopy can lead to frequent rubbing of the eyes, leading to local inflammation and increased pigmentation.[4]

Also, dark circles from allergies are caused by superficial venous congestion[5] in the capillaries under the eyes.

### Medications

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Any medications that cause blood vessels to dilate can cause circles under the eyes to darken. The skin under the eyes is very delicate, any increased blood flow shows through the skin.

### Cortisol deficiency

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When cortisol is deficient the pituitary compensates by producing excess adrenocorticotropic hormone (ACTH) and melanocyte-stimulating hormone (MSH), the latter resulting in dark circles under the eyes.[6]

### Anemia

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The lack of nutrients in the diet, or the lack of a balanced diet, can contribute to the discoloration of the area under the eyes. It is believed that iron deficiency and vitamin B12 deficiency can cause dark circles as well.[7] Iron deficiency is the most common type of anemia and this condition is a sign that not enough oxygen is getting to the body tissues.

The skin can also become more pale during pregnancy and menstruation (due to lack of iron), allowing the underlying veins under the eyes to become more visible.

### Fatigue

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A lack of sleep and mental fatigue can cause paleness of the skin, allowing the blood underneath the skin to become more visible and appear bluer or darker.[8][9]

### Age

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Dark circles are likely to become more noticeable and permanent with age. This is because as people get older, their skin loses collagen, becoming thinner and more translucent. As facial fat descends and fat volume decreases, the somewhat inflexible ligaments can result in orbital rim and facial hollowing.[2] Photoaging has similar effects. [3] Hemoglobin breakdown products such as hemosiderin and biliverdin can leak from the vascular contributing to pigmentation changes.[2]

Circles may also gradually begin to appear darker in one eye than the other as a result of some habitual facial expressions, such as an uneven smile.[citation needed]

### Sun exposure

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Sunlight causes the skin to produce more melanin, the pigment that darkens skin.[10]

### Periorbital hyperpigmentation

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Main article: Periorbital hyperpigmentation

Periorbital hyperpigmentation occurs when more melanin produced around the eyes than is usual, giving them a darker color.[11]

## Treatment

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At one time, hydroquinone solution was often mixed in an oil-free moisturizer that acted like a skin bleach. However, the use of hydroquinone for skin whitening has been banned in European countries due to health concerns. In 2006, the United States Food and Drug Administration revoked its approval of hydroquinone for over the counter preparations, warning that it may cause cancer or have many other detrimental effects.[12] The use of hydroquinone skin-whitening products may be toxic, harmful, or lethal for humans.[12]

Modern treatments include topical creams that are marketed for the condition. Various ingredients have been researched, developed and included in these creams. Specialist treatments including laser and intense pulsed light skin surgery can also be used.[13] Low-level laser therapy, autologous fat transplantation and hyaluronic acid fillers are also alternative treatment options.[14]

In addition, many skin care ingredients can help in the form of eye creams. Caffeine is a potent vasoconstrictor that has been proven to improve the look of dark circles[15] by constricting, or tightening, the dilated vessels under eyes. Vitamin C can help brighten hyperpigmentation as well as thicken the dermal layer of skin which conceals dark circles.[16]

## See also

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* Periorbital puffiness

## References

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1. ^ "What causes the dark circles that sometimes appear under my eyes?". Mayo Clinic Women's Healthsource. 7 (6): 8. 2003. PMID 12838159.
2. ^ a b c d Vrcek I, Ozgur O, Nakra T (2016). "Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment". Journal of Cutaneous and Aesthetic Surgery. 9 (2): 65–72\. doi:10.4103/0974-2077.184046. PMC 4924417. PMID 27398005.
3. ^ a b Friedmann DP, Goldman MP (2015). "Dark circles: etiology and management options". Clinics in Plastic Surgery. 42 (1): 33–50\. doi:10.1016/j.cps.2014.08.007. PMID 25440739.
4. ^ Mendiratta V, Rana S, Jassi R, Chander R (2019). "Study of Causative Factors and Clinical Patterns of Periorbital Pigmentation". Indian Dermatology Online Journal. 10 (3): 293–295\. doi:10.4103/idoj.IDOJ_158_18. PMC 6536080. PMID 31149574.
5. ^ Murdoch, Marshall (2016-11-02). "Dark circles in the periorbital region: diagnosis and treatment options". Journal of Aesthetic Nursing. 5 (9): 431–435\. doi:10.12968/joan.2016.5.9.431. ISSN 2050-3717.
6. ^ Slominski A, Tobin DJ, Shibahara S, Wortsman J (2004). "Melanin pigmentation in mammalian skin and its hormonal regulation". Physiological Reviews. 84 (4): 1155–1228\. doi:10.1152/physrev.00044.2003. PMID 15383650.
7. ^ "Why Do I Have Dark Circles Under My Eyes". www.superpharmacy.com.au. Retrieved 2021-12-30.
8. ^ "Dark Circles Under the Eyes". Medicine.net. 2012-06-03. Retrieved 2016-04-27.
9. ^ "Dark circles under eyes Causes". Mayo Clinic.
10. ^ "Dark circles under eyes Causes". Mayo Clinic. Retrieved 2019-06-03.
11. ^ Mac-Mary, Sophie; Zornoza Solinis, Itziar; Predine, Océane; Sainthillier, Jean-Marie; Sladen, Christelle; Bell, Mike; O’Mahony, Mark (2019-12-18). "Identification Of Three Key Factors Contributing To The Aetiology Of Dark Circles By Clinical And Instrumental Assessments Of The Infraorbital Region". Clinical, Cosmetic and Investigational Dermatology. 12: 919–929\. doi:10.2147/CCID.S217956. ISSN 1178-7015. PMC 6927230. PMID 31908515.
12. ^ a b Research, Center for Drug Evaluation and (May 10, 2022). "FDA works to protect consumers from potentially harmful OTC skin lightening products". FDA.
13. ^ "Undereye Circles". Retrieved 2016-06-29.
14. ^ Alsaad, SM; Mikhail, M (February 2013). "Periocular hyperpigmentation: a review of etiology and current treatment options". Journal of Drugs in Dermatology. 12 (2): 154–7\. PMID 23377386.
15. ^ Ohshima, Hiroshi; Mizukoshi, Koji; Oyobikawa, Midori; Matsumoto, Katsuo; Takiwaki, Hirotsugu; Kanto, Hiromi; Itoh, Masatoshi (2009). "Effects of vitamin C on dark circles of the lower eyelids: quantitative evaluation using image analysis and echogram". Skin Research and Technology. 15 (2): 214–217\. doi:10.1111/j.1600-0846.2009.00356.x. ISSN 1600-0846. PMID 19626722. S2CID 22914681.
16. ^ Ohshima, Hiroshi; Mizukoshi, Koji; Oyobikawa, Midori; Matsumoto, Katsuo; Takiwaki, Hirotsugu; Kanto, Hiromi; Itoh, Masatoshi (2009). "Effects of vitamin C on dark circles of the lower eyelids: quantitative evaluation using image analysis and echogram". Skin Research and Technology. 15 (2): 214–217\. doi:10.1111/j.1600-0846.2009.00356.x. ISSN 1600-0846. PMID 19626722. S2CID 22914681.