Dark Circles Under the Eyes (Periorbital Hyperpigmentation): How Do You Treat Them?

Dark circles around the eyes are a common cosmetic concern, and one that affects a lot of people's confidence. The usual misconception is that there's a single cause behind them. In reality the condition is complex, and several factors typically contribute at once. An accurate diagnosis is the key to choosing a treatment that is both appropriate and effective.

Types and causes of periorbital dark circles

Medically, the main causes fall into three categories:

• Structural factors. These dark circles aren't caused by pigment at all. They're the result of the anatomy around the eye casting a shadow — recession of the orbital bone, for example, or a hollow beneath the eye known as a tear trough deformity. Both tend to become more pronounced with age, and as light falls across the area it reads as darkness.
• Vascular factors. The skin around the eye is delicate, with an unusually thin dermis, so the capillary network underneath shows through far more clearly than it does elsewhere on the face. In people with poor circulation, or in allergic conditions that dilate the blood vessels, the discoloration becomes more visible still.
• Abnormal pigment deposition. This type is caused by excess melanin production and accumulation in the epidermis, the dermis, or both. Triggers include genetics, chronic inflammation (frequent eye rubbing in allergy sufferers, for instance), and — importantly — ultraviolet exposure from the sun.

Evidence-based treatment approaches

Effective treatment has to match the underlying cause.

• Dermal fillers. For dark circles that are structural in origin, hyaluronic acid filler can correct the tear trough, smoothing the contour and reducing the shadow that creates the darkness.
• Topical treatments:
  • Retinoids stimulate collagen production, which thickens the skin and helps fade pigment.
  • Brightening agents such as vitamin C, niacinamide, and azelaic acid inhibit melanin production and lighten discoloration.
  • Caffeine produces temporary vasoconstriction, which can reduce the prominence of vascular dark circles.
• Sun protection. Daily broad-spectrum sunscreen is essential for both preventing and treating dark circles — particularly formulas containing iron oxide, which also blocks visible light, another trigger for pigment production.

Getting the best result from treatment depends on correctly identifying what is actually causing the problem. Consulting a specialist for an individual assessment and treatment plan is therefore the most important step, and the way to be confident the treatment you receive is both targeted and safe.

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