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Periorbital hyperpigmentation (POH) is a common worldwide problem. It is challenging to treat, complex in pathogenesis, and lacking straightforward and repeatable therapeutic options. It may occur in the young and old, however the development of dark circles under the eyes in any age is of great aesthetic concern because it may depict the individual as sad, tired, stressed, and old. While “dark circles” are seen in all skin types, POH is often more commonly seen in skin of color patients worldwide. Periorbital hypermelanosis is a complex entity with a multifactoraletiology and an expanding knowledge base. The etiology of POH may be multifactorial with no one etiologic agent
A 36-year-old presented with complaints of dark circles under his eyes for past 2 years. It had started with light brown pigmentation under his eyes that gradually worsened to brownish black, velvety looking skin at the time of presentation. He was also bothered with the dryness, uneven texture and fine lines on the skin of his face.
General physical examination was normal. In the infraorbital area, there was dark brown-black pigmentation extending along the tear trough onto the lower eyelid with thickened skin with a subtle velvety texture.
We decided to treat him using options available for POH. Among the available treatment options for POH include topical depigmenting agents, such as hydroquinone, topical retinoic acid, and physical therapies, including chemical peels, most of which are tried scientifically for melasma, another common condition of hyperpigmentation.Chemical peels.
Chemical peels may be used alone or in combination with treatments such as topical bleaching agents. Glycolic acid is the most widely used alpha hydroxy acid for chemical peeling. Glycolic acid 20% can also be used for periocular hyperpigmentation. Lactic acid 15% has been used in periorbital hyperpigmentation.
The patient noticed gradually progressive improvement in his skin texture as well as marked improvement in his under eye dark circles. No side effects were observed, and the patient reported that he was comfortable and relaxed during the treatment sessions.
Periorbital hyperpigmentation is a commonly encountered condition. It is less responsive to standard therapies due to its multifactorial etiology and deposition of melanin in both dermis and epidermis. However, even a mild-to-moderate improvement in appearance can cause an improvement in the quality of life of the patient, hence topical therapies and simple physical therapies such as chemical peels can be used to treat the patients who want to improve the cosmetic appearance of their face.