An article published in Pigment International discussed that periorbital hyperpigmentation (POH) is a common dermatologic condition with an enigmatous pathogenesis that can have a significant psychological impact on the patients’ quality of life. Although easily diagnosed, cure is not easy.

POH is known by various synonyms including periorbital melanosis, periocular hyperpigmentation, infraorbital darkening, dark circles, infraorbital hyperpigmentation or idiopathic cutaneous hyperchromia of the orbital region. Factors promoting its occurrence can be exogenous as well as endogenous. Chiefly, the diagnosis is based on clinical examination. Moreover, finding the relative cause of POH is the most important factor in its management.

Worldwide data regarding the prevalence and incidence of POH is less, because this disease lacks a reasonable etiologic explanation. An Indian study has shown that the prevalence of POH is 30.76% and is most prevalent in the females of age group 16–25 years. Basically, POH has multifactorial etiology. Various proposed etiologic factors include – constitutional pigmentation, thin and translucent eyelid skin leading to vascular prominence, shadowing effect due to lax skin and ageing, periorbital edema, dermal melanocytosis, post-inflammatory hyperpigmentation, extension of pigmentary demarcation lines, ocular hypotensive drugs, periorbital melasma, periorbital lichen planus pigmentation, periorbital acanthosis nigricans and environmental causes such as ultraviolet (UV) radiation, atopy, lack of sleep, stress, alcohol and smoking.

Source: Pigment International. Daroach M, Kumaran MS. Periorbital hyperpigmentation − An overview of the enigmatous condition. 2018;5:1-3