Under-eye Circles: Causes and Care


Click through to the July 2019 digital edition to read the complete article.

Dark circles under or around the eyes represent a cosmetic problem for a large number of people. Also referred to as peri- or infra-orbital hyperpigmentation, hyperchromia, melanosis or idiopathic cutaneous hyperchromia at the orbital region (ICHOR), this clinically complex, multifactorial condition of unknown etiology is characterized by the darkening of the eyelids and peri-orbital skin.

The contributing factors are difficult to distinguish clinically, which is due in part to their transitory nature. Data on the prevalence of the condition also is difficult to obtain but anecdotally, it occurs more frequently in darker skin types; i.e., phototypes II and III, which are predominantly Latin and Asian ethnic groups.

Research out of Singapore indicates periorbital hyperpigmentation is most frequently of the vascular type, characterized by the presence of erythema mainly in the inner aspect of the lower eyelids, with prominent capillaries or telangiectasia or bluish discoloration of the lower eyelid. In addition, the prevalence of the constitutional condition—characterized by the presence of a curved band of brownish to black hyperpigmentation of the lower eyelid skin along the shape of the orbital rim and upper eyelids—is also high, followed by post-inflammatory hyperpigmentation. Sun exposure, medication, hormonal causes and lack of sleep are known to contribute; however, there is a less significant correlation with family history than originally assumed.

Pigmentation Location

Skin biopsies comparing the areas from under-eye skin with normal skin in the same individual have found that under-eye pigmentation is localized in the dermis, and that this increase in melanin content reflects the severity of the condition. For instance, in one study, Graziosi1 examined individuals afflicted by ICHOR and noted mild dilation of blood vessels in the papillary dermis, and moderate dilation and a few melanophages in the reticular dermis. Melanin content also increased with increasing severity.

Verschoore, et al.,2 instead used an objective noninvasive method to measure the color changes of subjects in vivo. Spectrophotometric intracutaneous analysis (SIA), or sciascopy, was used in an Indian population to measure the concentration and distribution of total melanin, dermal melanin and oxyhaemoglobin in affected and nonaffected areas. This work confirmed that both melanin deposits and blood stasis played a role in the condition.

The authors also noted sun exposure is a risk factor, aggravating the condition. As such, patients tended to reduce sun exposure after the onset of dark circles.2

Quality of Life and Lifestyle

A tired and sagging appearance, along with a disproportionally pigmented eye area, may even influence an individual’s quality of life; particularly women. Socially, under-eye circles are viewed negatively and challenge one’s acceptance in the community. This is exacerbated by not only the severity, but also the length of time living with the condition.

Click through to the July 2019 digital edition to read the complete article.


  1. Graziosi, A.C., Quaresma, M.R., Michalany N.S, and Ferreira, L.M. (2013, epub Jan. 24). Cutaneous idiopathic hyperchromia of the orbital region (CIHOR): A histopathological study. Aesthetic Plast Surg 37(2) 434-8. doi: 10.1007/s00266-012-0048-2.
  2. Verschoore, M., Gupta, S., Sharma, V.K., and Ortonne, J.P. (2012, Jul.). Determination of melanin and haemoglobin in the skin of idiopathic cutaneous hyperchromia of the orbital region (ICHOR): A study of Indian patients. J Cutan Aesthet Surg 5(3) 176-82. doi: 10.4103/0974-2077.101371.
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