Treatments of Periorbital Hyperpigmentation: A Systematic Review

BACKGROUND Periorbital hyperpigmentation (POH) is an aesthetic concern for patients. Etiologies of the condition include pigmentary, structural, vascular, and mixed causes. OBJECTIVE To systematically review the current literature for treatment of POH. METHODS A systematic literature review was performed on PubMed. Search terms included infraorbital dark circles, dark circles, periorbital hyperpigmentation, idiopathic hyperchromia AND orbital, under-eye circles, ICHOR (idiopathic cutaneous hyperchromia of the orbital region), dark circles AND treatment, and filler AND dark circles. RESULTS A total of 39 studies were included. Effective treatments for POH include lasers, topical creams and serums, fillers, chemical peels, carboxytherapy, plasma-rich platelet injections, blepharoplasty, and normobaric oxygen. CONCLUSION Soft tissue fillers and autologous fat grafting are most effective in treating dark circles due to volume loss. Blepharoplasty surgery is best when excessive skin laxity is the underlying cause. Various topical creams and chemical peels are useful in treating pigment-based POH, whereas lasers are mildly to moderately beneficial for both vascular and pigment types. Given the scarcity of high-quality evidence supporting these results, recommendations should be interpreted selectively. Additional randomized clinical trials studying POH will be helpful.

Automated summary

Effective treatments for periorbital hyperpigmentation include lasers, topical creams and serums, fillers, chemical peels, carboxytherapy, plasma-rich platelet injections, blepharoplasty, and normobaric oxygen. Soft tissue fillers and autologous fat grafting are most effective in treating dark circles due to volume loss, while blepharoplasty surgery is best for excessive skin laxity. Topical creams and chemical peels are useful for pigment-based periorbital hyperpigmentation, and lasers are beneficial for both vascular and pigment types.