Editing Periorbital dark circles

{{Short description|Dark blemishes around the eyes}}
{{More citations needed|date=December 2022}}{{Infobox medical condition (new)
| name            = Periorbital dark circles
| synonyms        = Dark circles, infraorbital venous stasis, periorbital hyperpigmentation
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| image           = Dark circles (cropped).png
| caption         = Minor dark circles and a hint of [[periorbital puffiness]]—a combination principally suggestive of minor [[sleep deprivation]].
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| field           = [[Sleep medicine]]
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'''Periorbital dark circles''' (including '''dark circles of the lower eyelid''') are dark blemishes around the [[human eye|eye]]s.  There are many causes of this symptom, including [[heredity]] and [[bruising]].<ref name="pmid12838159">{{cite journal |title=What causes the dark circles that sometimes appear under my eyes? |journal=Mayo Clinic Women's Healthsource |volume=7 |issue=6 |pages=8 |year=2003 |pmid=12838159}}</ref>

==Causes==
===Anatomical factors===
Bony structure and prominence of the [[orbicularis oculi muscle]] can contribute to infraorbital dark circles.<ref name="pmid27398005">{{cite journal | vauthors=Vrcek I, Ozgur O, Nakra T | title=Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment | journal= [[Journal of Cutaneous and Aesthetic Surgery]] | volume=9 | issue=2 | pages=65–72 | year=2016 | doi= 10.4103/0974-2077.184046 | pmc=4924417 | pmid = 27398005 | doi-access=free }}</ref><ref name="pmid25440739">{{cite journal | vauthors=Friedmann DP, Goldman MP | title=Dark circles: etiology and management options | journal= [[List of Elsevier periodicals#C|Clinics in Plastic Surgery]] | volume=42 | issue=1 | pages=33–50 | year=2015 | doi= 10.1016/j.cps.2014.08.007 | pmid = 25440739}}</ref> Skin in the lower eyelid is very thin which accentuates subdermal features.<ref name="pmid27398005" />

===Allergies, asthma, and eczema===
Any condition that causes the eyes to itch can contribute to darker circles due to rubbing or scratching the skin around them. [[Hay fever]] sufferers in particular will notice under-eye "smudges" during the height of the allergy season. [[Atopy]] can lead to frequent rubbing of the eyes, leading to local inflammation and increased pigmentation.<ref name="pmid31149574">{{cite journal | vauthors=Mendiratta V, Rana S, Jassi R, Chander R | title=Study of Causative Factors and Clinical Patterns of Periorbital Pigmentation | journal= Indian Dermatology Online Journal | volume=10 | issue=3 | pages=293–295 | year=2019 | doi= 10.4103/idoj.IDOJ_158_18 | pmc=6536080 | pmid = 31149574 | doi-access=free }}</ref>

Also, dark circles from allergies are caused by superficial venous congestion<ref>{{Cite journal|last=Murdoch|first=Marshall|date=2016-11-02|title=Dark circles in the periorbital region: diagnosis and treatment options|url=https://www.magonlinelibrary.com/doi/abs/10.12968/joan.2016.5.9.431|journal=Journal of Aesthetic Nursing|volume=5|issue=9|pages=431–435|doi=10.12968/joan.2016.5.9.431|issn=2050-3717|url-access=subscription}}</ref> in the capillaries under the eyes.

===Medications===
Any medications that cause blood vessels to [[vasodilation|dilate]] can cause circles under the eyes to darken. The skin under the eyes is very delicate, any increased blood flow shows through the skin.

===Cortisol deficiency===
When [[cortisol]] is deficient the pituitary compensates by producing excess [[adrenocorticotropic hormone]] (ACTH) and [[melanocyte-stimulating hormone]] (MSH), the latter resulting in dark circles under the eyes.<ref name="pmid15383650">{{cite journal | vauthors=Slominski A, Tobin DJ, Shibahara S, Wortsman J | title=Melanin pigmentation in mammalian skin and its hormonal regulation | journal= [[Physiological Reviews]] | volume=84 | issue=4 | pages=1155–1228 | year=2004 | doi= 10.1152/physrev.00044.2003 | pmid = 15383650}}</ref>

===Anemia===
The lack of nutrients in the diet, or the lack of a balanced diet, can contribute to the discoloration of the area under the eyes. It is believed that [[iron deficiency]] and [[Vitamin B12 deficiency|vitamin B<sub>12</sub> deficiency]] can cause dark circles as well.<ref>{{Cite web|title=Why Do I Have Dark Circles Under My Eyes|url=https://www.superpharmacy.com.au/blog/why-do-i-have-dark-circles-under-my-eyes|access-date=2021-12-30|website=www.superpharmacy.com.au}}</ref> Iron deficiency is the most common type of [[anemia]] and this condition is a sign that not enough oxygen is getting to the body tissues.

The skin can also become more pale during [[pregnancy]] and [[menstruation]] (due to lack of iron), allowing the underlying veins under the eyes to become more visible.

===Fatigue===
A [[Sleep deprivation|lack of sleep]] and [[Fatigue (medical)|mental fatigue]] can cause paleness of the skin, allowing the blood underneath the skin to become more visible and appear bluer or darker.<ref>{{Cite web|url=http://www.medicinenet.com/dark_circles_under_the_eyes/symptoms.htm|title=Dark Circles Under the Eyes|last=|first=|date=2012-06-03|website=Medicine.net|access-date=2016-04-27}}</ref><ref>{{cite web | url=https://www.mayoclinic.org/symptoms/dark-circles-under-eyes/basics/causes/sym-20050624 | title=Dark circles under eyes Causes | website=[[Mayo Clinic]] }}</ref>

===Age===
Dark circles are likely to become more noticeable and permanent with age. This is because as people get older, their skin loses [[collagen]], becoming thinner and more translucent. As facial fat descends and fat volume decreases, the somewhat inflexible ligaments can result in orbital rim and facial hollowing.<ref name="pmid27398005" /> [[Photoaging]] has similar effects. <ref name="pmid25440739" /> Hemoglobin breakdown products such as [[hemosiderin]] and [[biliverdin]] can leak from the vascular contributing to pigmentation changes.<ref name="pmid27398005" />

Circles may also gradually begin to appear darker in one eye than the other as a result of some habitual facial expressions, such as an uneven smile.{{citation needed|date=February 2010}}

===Sun exposure===
Sunlight causes the skin to produce more [[melanin]], the pigment that darkens skin.<ref>{{Cite web|url=https://www.mayoclinic.org/symptoms/dark-circles-under-eyes/basics/definition/sym-20050624|title=Dark circles under eyes Causes|website=Mayo Clinic|language=en|access-date=2019-06-03}}</ref>

===Periorbital hyperpigmentation===
{{Main article|Periorbital hyperpigmentation}}
''Periorbital hyperpigmentation'' occurs when more [[melanin]] produced around the eyes than is usual, giving them a darker color.<ref>{{Cite journal|last1=Mac-Mary|first1=Sophie|last2=Zornoza Solinis|first2=Itziar|last3=Predine|first3=Océane|last4=Sainthillier|first4=Jean-Marie|last5=Sladen|first5=Christelle|last6=Bell|first6=Mike|last7=O’Mahony|first7=Mark|date=2019-12-18|title=Identification Of Three Key Factors Contributing To The Aetiology Of Dark Circles By Clinical And Instrumental Assessments Of The Infraorbital Region|journal=Clinical, Cosmetic and Investigational Dermatology|volume=12|pages=919–929|doi=10.2147/CCID.S217956|issn=1178-7015|pmc=6927230|pmid=31908515 |doi-access=free }}</ref>

==Treatment==
At one time, [[hydroquinone]] solution was often mixed in an oil-free [[moisturizer]] that acted like a skin bleach. However, the use of hydroquinone for skin whitening has been banned in European countries due to health concerns. In 2006, the United States [[Food and Drug Administration]] revoked its approval of hydroquinone for [[over-the-counter drug|over the counter preparations]], warning that it may cause cancer or have many other detrimental effects.<ref name=":0">{{Cite journal |last=Research |first=Center for Drug Evaluation and |date=May 10, 2022 |title=FDA works to protect consumers from potentially harmful OTC skin lightening products |url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-works-protect-consumers-potentially-harmful-otc-skin-lightening-products |journal=FDA |language=en}}</ref> The use of hydroquinone skin-whitening products may be toxic, harmful, or lethal for humans.<ref name=":0" />

Modern treatments include topical creams that are marketed for the condition. Various ingredients have been researched, developed and included in these creams. Specialist treatments including [[laser surgery|laser]] and [[intense pulsed light]] skin surgery can also be used.<ref>{{cite web|url=http://www.docshop.com/education/dermatology/skin-flaws/undereye-circles|title=Undereye Circles|access-date=2016-06-29}}</ref> [[Low-level laser therapy]], [[autologous]] fat transplantation and [[hyaluronic acid]] fillers are also alternative treatment options.<ref>{{cite journal |last1=Alsaad |first1=SM |last2=Mikhail |first2=M |title=Periocular hyperpigmentation: a review of etiology and current treatment options. |journal=Journal of Drugs in Dermatology |date=February 2013 |volume=12 |issue=2 |pages=154–7 |pmid=23377386}}</ref>

In addition, many skin care ingredients can help in the form of eye creams. Caffeine is a potent vasoconstrictor that has been proven to improve the look of dark circles<ref>{{Cite journal|last1=Ohshima|first1=Hiroshi|last2=Mizukoshi|first2=Koji|last3=Oyobikawa|first3=Midori|last4=Matsumoto|first4=Katsuo|last5=Takiwaki|first5=Hirotsugu|last6=Kanto|first6=Hiromi|last7=Itoh|first7=Masatoshi|date=2009|title=Effects of vitamin C on dark circles of the lower eyelids: quantitative evaluation using image analysis and echogram|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0846.2009.00356.x|journal=Skin Research and Technology|language=en|volume=15|issue=2|pages=214–217|doi=10.1111/j.1600-0846.2009.00356.x|pmid=19626722|s2cid=22914681|issn=1600-0846|url-access=subscription}}</ref> by constricting, or tightening, the dilated vessels under eyes. Vitamin C can help brighten hyperpigmentation as well as thicken the dermal layer of skin which conceals dark circles.<ref>{{Cite journal|last1=Ohshima|first1=Hiroshi|last2=Mizukoshi|first2=Koji|last3=Oyobikawa|first3=Midori|last4=Matsumoto|first4=Katsuo|last5=Takiwaki|first5=Hirotsugu|last6=Kanto|first6=Hiromi|last7=Itoh|first7=Masatoshi|date=2009|title=Effects of vitamin C on dark circles of the lower eyelids: quantitative evaluation using image analysis and echogram|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0846.2009.00356.x|journal=Skin Research and Technology|language=en|volume=15|issue=2|pages=214–217|doi=10.1111/j.1600-0846.2009.00356.x|pmid=19626722|s2cid=22914681|issn=1600-0846|url-access=subscription}}</ref>

==See also==
* [[Periorbital puffiness]]

==References==
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{{DEFAULTSORT:Periorbital dark circles}}
[[Category:Eye diseases]]
[[Category:Symptoms]]
[[Category:Periorbital conditions]]