A recent article published in Cosmetics discussed that the etiology of periorbital hyperpigmentation (POH) multifactorial with a genetic background. POH is more common in darker skin types and has been estimated to be as high as 30% in Indians. 

The authors stated that POH poses greater esthetic concerns for female patients. Moreover, underlying pathologies and patients’ needs have to be considered before planning a treatment. 

This article presented a treatment algorithm for POH which was tested in 74 patients with POH – 64 females and 10 males, of age-range 18-57 years. Among the participants, 53% had a family history of POH. In cases with tear-trough deformity, soft tissue augmentation was used by injection of hyaluronic acid gel, calcium hydroxylapatite or autologous fat. Severe orbital fat herniation and excess of the lower lid skin were corrected by blepharoplasty with partial fat pad resection or repositioning via arcus marginalis release. Melanin hyperpigmentation was treated with sessions of Q-switched 1064 and 532 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. Esthetic appearance of small vessels was improved by a 1064 nm long-pulsed Nd-YAG laser. While sessions of intense pulsed light (IPL) or CO₂ fractional laser were employed to improve skin texture and fine lines. 

It was inferred that treatment of POH can be individually tailored, based on newer technologies and patients’ characteristics. Topical hyaluronic acid-based formulations may be used as adjuvant self-treatment by patients with POH. For pigmented and mixed-type POH, ultraviolet light protection is recommended. 

Topical depigmenting agents are most widely used in the clinical management of POH. Diverse naturally obtained actives or phytonutrients have shown benefits in POH – like arabinoxylans, α-arbutin, asiaticoside, azelaic acid, beta-carotene, boswellic acid, caffeine, chrysin, curcumin, cyanidin-3-glucoside, d-glucoronic acid, dihydrochalcone, dipalmitoyl-hydroxyprolene, fucoxanthin, genistein, glabridin, b-glucogallin, hyaluronic acid, lactic acid, lycopene, niacinamide, pycnogenol, retinol, salidroside and xymenynic acid. The use of topical agents containing α-arbutin, caffeine, cyanidin-3-glucoside and dihydrochalcone demonstrate significant advantages. These phytonutrients act by modulation of melanin and tyrosinase biosynthesis pathway. Furthermore, combination products containing a blend of actives are more efficacious than single-active containing products.  

Sources: Cosmetics. 2021, 8(2), 26. doi: 10.3390/cosmetics8020026

Dermatologic Therapy. 2020 Jul;33(4):e13717. doi: 10.1111/dth.13717.