Periorbital hyperpigmentation - Wikipedia Management of infraorbital dark circles. For dermal pigmentation, this contrast is less pronounced. Phenol, another agent sometimes used for chemical peels, acts by reducing the ability of melanocytes to produce melanin and is traditionally limited to patients who are Fitzpatrick types I to III. Published by Wolters Kluwer Health, Inc. All rights reserved. The United States Food and Drug Administration (FDA) has approved a modified combination of the Kligmans formula, containing 4% hydroquinone, 0.05% tretinoin, and 0.01% fluocinolone acetonide for use in melasma and various other pigmentary disorders,27 but its long-term use in the periorbital area is a concern since it contains a topical steroid. These instructions typically include the following steps: This process can be performed nightly until hyperpigmentation begins to fade typically around the eight-week mark. This octyl-beta-D-glucopyranoside derivative of hydroquinone acts by inhibiting tyrosinase and is available in 3% concentrations. Facial Plast Surg Clin North Am. External Z-plasty Technique for Correction of Alar Retraction in Asian Patients. For most patients, the risk of trying new cosmetic products is very low. For example, those with a high nasal radix and deep-set eyes often appear to have dark circles. Periocular dermatitis is a localised form of periorificial dermatitis. Chemical peels. Momosawa A, Kurita M, Ozaki M, Miyamoto S, et al. According to the author, the key to successful treatment is determining the primary cause and complying with maintenance and preventive regimens. The effectiveness of two common methods for periorbital dark circle treatment was compared in 28 patients with PDC. I also advise the use of large, all-weather UV coated sunglasses that block 99% to 100% of UVA/UVB. Ocular hypotensive drugs. Introduction Periorbital hyperpigmentation (POH) or dark circles under the eyes is a very frequent concern among both young and adult patients of any skin type. Miotti G, Zeppieri M, Pederzani G, Salati C, Parodi PC. Periorbital hyperpigmentation is a generally benign, extremely common condition that is notoriously resistant to treatment. Goodman RM, Belcher RW. Copyright 2020 by the American Society for Dermatologic Surgery, Inc. Periorbital Hyperpigmentation: A Comprehensive Review The Journal of Clinical and Aesthetic Dermatology. A significant cosmetic concern. In most patients the affected area encompasses the entire lower lid, concentrated along the lower aspect of the eyelid beneath the orbital fat. 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. Also different modalities are used according to cause of POH. There is scarcity of data regarding the incidence and prevalence of POH due to its transitory nature and lack of reasonable etiological explanation. doi: 10.1111/dth.13717. POH interferes with perceived age. Home remedy chemical peels including apple cider vinegar, should be avoided. A systematic literature review was performed on PubMed. Because of risks of scarring, hypopigmentation, and systemic toxicity, I do not recommend phenol peels. J Eur Acad Dermatol Venereol. Periorbital hyperpigmentation is a commonly encountered condition. Soft tissue fillers and autologous fat grafting are most effective in treating dark circles due to volume loss. 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. Please try again soon. When patients plan to add a new product to an existing regimen, be sure to help them determine how the new product can be most safely incorporated. Sci Rep. 2022 Nov 3;12(1):18553. doi: 10.1038/s41598-022-21131-5. Tang, S. C., & Yang, J. H. (2018). Gao H, Wu D, Jie X, Hu Z, Zhang W, Zhu L, Zhu X. A multimodal approach may be required, encompassing topical bleaching agents . *Department of Dermatology, University of California, Irvine, Irvine, California; School of Medicine, University of California, Irvine, Irvine, California; Department of Dermatology, Thomas Jefferson University, Philadelphia, Pennsylvania, Address correspondence and reprint requests to: Natasha Atanaskova Mesinkovska, MD, PhD, Department of Dermatology, Dermatology Clinical Research Center, University of California, Irvine, 843 Health Sciences Road, Hewitt Hall 1001, Irvine, CA 92697, or email: [emailprotected]. The safety of hydroquinone. Periorbital hyperpigmentation in Asians: an epidemiologic study and a proposed classification. I prefer that patients undergo repositioning of fat over the orbital rim via the transconjunctival approach rather than the traditional transcutaneous method, so that no external visible scar is created. Disclaimer. An understanding of different contributing factors and ability to classify hyperpigmentation can aid in the management of POH. Researchers studied 45 female patients with periorbital hyperpigmentation at an outpatient dermatology clinic in Cairo, Egypt. 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. Bosniak et al38 treated 12 patients with POH, tear trough deformity, or prominent nasojugal groove with the hyaluronic acid push technique. 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. 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. There is evidence that vitamin C can lighten skin and treat hyperpigmentation by preventing melanin production. Mulberry is rich in antioxidants, and has been found to inhibit the activity of tyrosinase. Although medical treatment is not always indicated, there are some newer approaches and combined therapies that offer hope for the treatment of dark circles. What causes periorbital hyperpigmentation and how can you treat it? Five patients with infraorbital dark circles received 1 to 5 treatments with the Q switched ruby laser (694nm); four patients showed good response and two patients showed excellent results.8. Combined therapy using Q-switched ruby laser and bleaching treatment with tretinoin and hydroquinone for periorbital skin hyperpigmentation in Asians. Association between clinical characteristics, quality of life, and sleep quality in patients with periorbital hyperchromia. Treatment of infraorbital dark circles by autologous fat transplantation: a pilot study. Chemical peeling with trichloroacetic acid and lactic acid for infraorbital dark circles. Hydroquinone-induced exogenous ochronosis: a report of four cases and usefulness of dermoscopy. One study demonstrated that a moisturizer containing soy improved and lighten skin tone. Many of them recognized the pigmentation early in childhood and stated that pigmentation increased with age. Although no comprehensive epidemiology exists, women may be affected more frequently than men because of hormonal factors. Patients opting for laser therapy must be advised that bruising can last up to 2 weeks. Hyperpigmentation is caused by an increase in the production of melanin, the pigment responsible for the color of hair and skin. Reports have linked sun exposure, hormonal changes in pregnancy, and chronic atopic dermatitis to occurrence of nevi of Hori.12,13. Drs. Woods lamp examination can be done to differentiate between the epidermal and dermal pigmentation.8 The variations in epidermal pigmentation become more apparent under Woods light. J Cosmet Dermatol 2019;18:2305. Higher concentrations, though more effective, may also cause or exacerbate hyperpigmentation. In vitro studies show that AzA interferes with DNA synthesis and mitochondrial enzymes in abnormal melanocytes and fibroblasts,32 thus neither leukoderma nor exogenous ochronosis are associated with its use. A number of natural ingredients can be used to make natural face cleansers, which can be applied once or twice daily to help address hyperpigmentation. Background: Papaya is another rich source, and a popular ingredient in DIY face mask recipes. This paste can be applied directly to the hyperpigmented area and left on overnight, every night. Clinical analysis and classification of dark eye circle. The disparity in the medical community's understanding of POH versus popular demand for treatment is best illustrated when you have only 65 cited articles to . Blepharoplasty. and transmitted securely. Arbutin can also be used in other facial hyperpigmentation including POH. 1-4 It is an ill-defined entity that presents as bilateral round or semicircular homogenous . Mixed type (M) combines two or three of the above appearances. Additional randomized clinical trials studying POH will be helpful. HHS Vulnerability Disclosure, Help sharing sensitive information, make sure youre on a federal Arch Facial Plast Surg 1999;1:3037. These lasers cause a thermal injury that can stimulate collagen, lighten pigment, and tighten skin simultaneously. Extensive hyperpigmentation during pregnancy: a case report. Structural type (S) appears as structural shadows formed by facial anatomic surface contours. For optimal outcome, I recommend pretreatment with tretinoin and use of a hydroquinone bleaching agent for 2 months before undergoing a chemical peel. Sanchez J L, Vazquez M. A hydroquinone solution in the treatment of melasma. 2016 Aug;30(8):1243-64. 2008;121:282-8. Hollinger, J. C., Angra, K., & Halder, R. M. (2018). Goodman and Belcher11 reported many families with pigmentation around the periorbital area in several members of the family. The investigators sought to compare the efficacy and safety of 2 new modalities . As a library, NLM provides access to scientific literature. Vascular (V) type appears as infraorbital blue, pink, or purple hue with or without periorbital puffiness. Diagnosis and management of these patients are often challenging. Get new journal Tables of Contents sent right to your email inbox, by the American Society for Dermatologic Surgery, Inc. Topical antioxidants in addition to Vitamin A are of increasing interest. Friedmann DP, Goldman MP. Azelaic acid is a naturally occurring nonphenolic agent that acts selectively on abnormal melanocytes by inhibiting DNA synthesis and mitochondrial enzymes. It is available in a concentration of 3%.33. In each, the increase in melanin production has a distinct underlying cause. However, I advise patients to be cautious using chemical sunscreens in the delicate eye area; application should not extend up to the eyelid margin. Aesthetic Plast Surg. Dark circles under the eyes | DermNet Vavouli C, Katsambas A, Gregoriou S, Teodor A, Salavastru C, Alexandru A, Kontochristopoulos G. J Cosmet Dermatol. Wolters Kluwer Health World J Clin Cases. Clinical observation is usually sufficient to determine the primary cause of periorbital hyperpigmentation; confirmation by histological examination is rarely necessary. Unable to load your collection due to an error, Unable to load your delegates due to an error. government site. 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. Epstein JS. Treatment response of periorbital ADMH was less than satisfactory. While these peels can remove excess melanin, they must be used carefully as they can also cause or worsen postinflammatory hyperpigmentation in some individuals. Treatment has to consider underlying pathologies and patients' needs. Triggers, Risk Factors & Long Term Outlook, Acne and Cushings Syndrome: Understanding the Connection, Shoulder Acne: Causes, Treatments, Similar Conditions, and More, Wash the hyperpigmented treatment area with warm water to remove surface debris, Gently massage the lemon juice into the skin for several seconds, Wait 10 minutes; wash off with warm water, Apply a thin layer of pure aloe vera gel to the skin, In the morning, rinse off any residual gel with warm water, Blend two parts soy extract powder with one part moisturizing oil, such as jojoba or almond oil, to form a smooth paste, Apply the licorice extract directly to the area with a cotton swab, Wait several hours, rinse with lukewarm water, Steep one green tea bag in boiling water for 35 minutes, Remove the tea bag and cool in the fridge, Allow the treatment area to dry; wash after 1 hour, Apply a small amount of turmeric extract to the area with a cotton swab, Allow the extract to dry; leave overnight, Wash the treatment area with warm water to remove surface debris, Apply a small amount of mulberry extract to the treatment area using a cotton swab. However, the powder can be used to make a DIY face mask formula. Ellen C. Gendler, MD, Treatment of Periorbital Hyperpigmentation, Aesthetic Surgery Journal, Volume 25, Issue 6, November 2005, Pages 618624, https://doi.org/10.1016/j.asj.2005.09.018. Br J Dermatol. Although ablative laser resurfacing is a well-accepted treatment modality for improving the appearance of photo-induced rhytides coexisting with periocular hyperpigmentation, but due to untoward side effects such as prolonged erythema, pigmentation, and infection, and in some cases scarring, great interest has been shown toward less invasive methods to treat photo-induced rhytides effectively. Feldstein, S., Afshar, M., & Krakowski, A. C. (2015). Minimizing sun exposure. Periorbital hyperpigmentation and erythema dyschromicum perstans. Efficacy of a soy moisturizer in photoaging: a double-blind, vehicle-controlled, 12-week study. Sodhi PK, Verma L, Ratan SK. Clin Plast Surg. There are a number of treatment options available for POH. Frozen gel-filled eye masks feel great and can temporarily help to improve puffiness but usually do not have a noticeable impact on dark circles. To systematically review the current literature for treatment of POH. Vitamin E may help treat existing hyperpigmentation, whereas Vitamin C (L-ascorbic acid) may play a role in prevention. 1999;65(21):PL241-6. However, it is worth noting that turmeric can leave yellow stains on both material and skin. Methods: Periorbital hyperpigmentation is considered to have a genetic basis. The https:// ensures that you are connecting to the FOIA (b)-Result after two sessions of 1064 nm Q-Switched Nd-YAG laser and one session of long pulsed . Combined therapy using Q-switched ruby laser and bleaching treatment with tretinoin and hydroquinone for periorbital skin hyperpigmentation in Asians. 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. POH can be difficult to manage as the etiology is often multifactorial or difficult to elucidate. Patients should expect a 1-month recovery period and must be particularly strict about sun protection, using broad-spectrum sunscreens for at least 6 months postpeel. We dene POH as the occurrence of bilateral hyperchromatic macules and [ 1 ] There are a number of home remedies with the potential to treat it, and although most have only preliminary evidence supporting their use, some options such as Vitamin C and soy extract topicals have many studies supporting their effectiveness. Periorbital hyperpigmentation (POH) is an aesthetic concern for patients. It gives a tired look to the patient. Patients who tolerate treatment well are required to continue with a maintenance regimen of 2% hydroquinone, available without prescription. Many treatment options are avaiblabe with variable efficacy and safety in . Soft tissue fillers and autologous fat grafting are most effective in treating dark circles due to volume loss. Improvement of the eyes and periorbital area is of particular concern to an aging person with fine lines, loose skin, excess fat, and hyperpigmentation (dark circles). Epub 2020 Jul 2. May 2011 | Volume 10 | Issue 5 | Original Article | 483. 4. Effective treatments for POH include lasers, topical creams and serums, fillers, chemical peels, carboxytherapy, plasma-rich platelet injections . A multimodal approach may be required, encompassing topical bleaching agents, chemical peels, laser therapy, and/or surgery. Retinoids are among the most effective treatments available for addressing melasma and postinflammatory hyperpigmentation. Epidermal melanin appears brown; dermal melanin appears blue or blue gray. We could find only 6 reports of LPPig or EDP with periorbital localization in English literature. Periorbital hyperpigmentation due to postinflammatory hyperpigmentation, Superficial location of vasculature. Treatments of Periorbital Hyperpigmentation: A Systematic Review When applying turmeric extract at home, follow any included instructions. Accessibility For medium to darker skins (Fitzpatrick III and IV), it is best to extend the peel to the entire face to avoid postpeel demarcation. It is less responsive to standard therapies due to its multifactorial etiology and deposition of melanin in both dermis and epidermis. Treatment of Patients With Periorbital Hyperpigmentation A randomized controlled trial of the efficacy and safety of a fixed triple combination (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%) compared with hydroquinone 4% cream in Asian patients with moderate to severe melasma. Inclusion in an NLM database does not imply endorsement of, or agreement with, Periorbital Hyperpigmentation (Dark Circles) : Causes & Treatment 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. 2023 Mar 16;11(8):1719-1729. doi: 10.12998/wjcc.v11.i8.1719. Periorbital hyperpigmentation has been successfully treated with various noninvasive lasers that target pigment and vascularity. The hyaluronic acid push technique for the nasojugal groove. Recently, platelet-rich plasma has been used in treating dark circles due to tear trough deformity and wrinkles. The eyelid region has a spongy property, which can lead to fluid accumulation due to systemic and local causes. Periorbital Hyperpigmentation: A Comprehensive Review - PMC 37 However, in a recent systematic review by Michelle et al, it was concluded that laser treatments are only mildly to moderately . Introduction. Also known as 1,4 dihydrobenzene, hydroquinone is the most prescribed bleaching agent worldwide. Hyperpigmentation is a condition characterized by the appearance of scattered areas of darker skin compared to ones natural skin tone. 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). Melanin index, erythema index, thickness, and echogenecity of the dermis of the bilateral eyelid was measured and it was found that there was lightening of pigmentation owing to an increase in dermal thickness due to concealment of dark discoloration from congested blood. Bethesda, MD 20894, Web Policies Al-Samari A, Al Mohizea S, Bin-Saif G, A1-Balbeesi Pigmentary demarcation lines on the face in Saudi women. Your resource for everything skin-related. Side effects may include erythema and peeling. Chemical peels to address lower eyelid hyperpigmentation may be used alone or in combination with other treatments, such as topical bleaching agents. Ohshima H, Mizukoshi K, Oyobikawa M, 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. sharing sensitive information, make sure youre on a federal For those patients who have achieved a good result, it is critical to stress the importance of compliance with maintenance and preventive regimens. 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). A multimodal approach may be required, encompassing topical bleaching agents . Periorbital hyperpigmentation (POH) is a frequent concern among both young and adult patients. 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 . Patient satisfaction is high, but some patients with dark circles noted darker pigmentation after hyaluronic acid gel. If both DIY and OTC treatments fail to provide satisfactory results after six months of regular use, a dermatologist may be able to offer you a prescription strength option to address your hyperpigmentation. Clipboard, Search History, and several other advanced features are temporarily unavailable. Effective treatments for POH include lasers, topical creams and serums, fillers, chemical peels, carboxytherapy, plasma-rich platelet injections, blepharoplasty, and normobaric oxygen. However, most individualsincluding those with dry and sensitive skinshould be able to apply this soy extract blend twice per day due to its safe, gentle properties. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Given the scarcity of high-quality evidence supporting these results, recommendations should be interpreted selectively. Effect was compared three months after treatment with baseline. It is considered to be equal to or better than 2% hydroquinone, but may cause pruritis in some patients. It can be associated with infraorbital palpebral bags, blepharoptosis, and loss of fat with bony prominence. Its effects are dose-dependent, but high concentrations of arbutin can cause hyperpigmentation. PMID 24719068. For patients with very sensitive skin, a concealing makeup with a titanium base may be best. Wang Z, Li X, Yang Z, He X, Tu J, Zhang T. Effects of aloesin on melanogenesis in pigmented skin equivalents. However, they did not find any significant difference in melanin index. They address hyperpigmentation by acting as superficial chemical peels. Epstein JS. 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. Lemon juice can be safely applied to the face by following these steps: Most skin types should be able to tolerate a nightly application of lemon juice. Since it was found to be effective for facial postinflammatory hyperpigmentation, it is a potentially promising agent for periocular hyperpigmentation due to postinflammatory hyperpigmentation. The mechanism of action of most bleaching agents is inhibition of tyrosinase enzyme, which inhibits the conversion of dopa to melanin, hence leading to a reduction of the melanin content of the epidermis. Triple combinations. Etiologies of the condition include pigmentary, structural, vascular, and mixed causes. Periorbital pigmentation due to dermal melanocytosis. This classification can help in introducing the therapeutic modalities on the basis of POH type, as different types of POH respond to different types of treatment. Freitag FM, Cestari TF. and radiofrequency have been evaluated and reported to be beneficial in the treatment of POH. Clinically, these lesions are recognizable by their distinctive grey or blue-grey appearance. Vitamin K has long been touted as a potential treatment for dark circles because of its presumed effect on the clotting mechanism. . Popular literature is replete with homeopathic regimens or devices to cure puffy eyes and dark circles. Similarly, facial bone structure can influence the way light is dispersed across the face. (a)-19-year-old patient. Perioral dermatitis describes an eruption around the mouth and nose. When the lower eyelid is manually stretched, the area of darkness spreads out without blanching or significant lightening and results in deepening of violaceous color, which could be used as a diagnostic test to confirm the vascularity.2, Tear trough depression. Start by applying the juice a few times per week and manage your usage based on your skins response. Some ingredients are better suited to address some types of hyperpigmentation. Blepharoplasty may also be helpful in eliminating dark circles caused by shadows that are cast by fat deposits and/or excess skin. Topical agents. Barone CR, Boza JC, Machado PG, Cestari TF. Careful selection of patients for chemical peeling should involve not only identification of Fitzpatrick skin type, but also determination of ethnic background. The .gov means its official. The improvement in infraorbital color homogeneity was statistically significant.39, Surgery. For example, if fluid retention is a concern, salt intake must be monitored. Its mechanism of action includes the inhibition of DNA synthesis and mitochondrial enzymes, thereby inducing direct cytotoxic effects on the melanocyte.30,31. Pseudoherniated fat located underneath the orbital rim causes a ballooning of the lower eyelid, resulting in dark shadows. Clinically, POH is characterized by light- to dark-colored, brownish-black pigmentation surrounding the eyelids.
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