Dark Circles under the Eyes
Eye

DEFINITION

Infraorbital dark or hypercromic circles refer to the conditions that present with darkening of the infraorbital eyelids

EPIDEMIOLOGY

• confirmed in both genders with an high prevalence (no data because of its floating and transitory nature, lack of etiologic explanation, considered a cosmetic nuisance)
• appear since childhood when congenital
• otherwise show up in grown-up people and get worse along ageing
• more pronounced in certain ethnic groups: blacks and Asians (because of pigmentation irregularity)
• frequently seen in multiple members in the same family (hereditary)

SYMPTOMS

The infraorbital areas appear as bluish, dark (cyanotic)

DC AS A SYMPTOM OF

• Neuroblastoma
• Insomnia
• Hay fever
• Children who have allergic rhinitis might have DC, or use the palm of their hand to push their nose up as they try to stop the itching (called the "allergic salute")
• Airborne Allergy (the DC are the so called "shiners")

DIAGNOSIS

• Histopathological examination
  • dermal melanocytosis based on the findings of the anti-S100 protein and Masson-Fontana silver stainings
• Objective exam
• laboratory tests
  • spectral reflectance of the skin to calculate erythema index (EI), melanin index (MI) and oxygenation index (OX)
  • image processing (to calculate EI and MI)
  • measurement of MI on in vitro model
  • dermal thickness
  • echo density

PATIENT RISK FACTORS

Vascular

Genetic

Acquired

• Sistemic or local edema :
  • eyelid region seems to have a "sponge" property that helps the accumulation of fluid (see the worsening in the morning or after a salty meal)
• Lifestyle factors, such as smoking and drinking alcohol and caffeinated sodas
• Quali condizioni generali possono rendere più evidente l'edema?
  • Edema on Wikipedia (in Italian)

Hormonal

Genetic

• Infraorbital dark circles are observed in dermal melanocytosis, such as naevus of Ota (definition and clinical aspects and management – 2003) and acquired bilateral naevus of Ota-like macules (Hori's naevus)
• Pigmentary disorder (vitiligo)

Acquired

• Estrogens decrease
  • 2009: Cholesterol regulates melanogenesis in human epidermal melanocytes and melanoma cells
  • menopause
  • oral contraceptives
  • inhibitors of aromatase
• Pigmentary disorder (melasma)

Exogenous

• Ageing and UV lead to collagenasis releasing, then to collagen degeneration and so to skin laxity
• Aggressive lower eylid blepharoplasty
• Sun exposure, which prompts your body to produce more melanin
• fatigue and lack of sleep (see daily fluctuation of the lesions intensity)

INFRAORBITAL AREA SPECIFIC FACTORS THAT ACCENTUATES DC

anatomical (due its structure)

• Periocular area: skinny
• concave, sunken orbital area
• association with a tear trough:
  • depression centred over the medial inferior orbital rim, that deepens as patients age because the infraorbital fat is displaced anteriorly, creating shadowing below it on the dependence of lighting conditions

histological

• dermal melanin deposition (dermal melanocytosis):
  • thickening of the dermis, caused by edema, leads to an enhanced incidence of diffused light reflection from the pigments, which then results in increased darkness of the skin
• postinflammatory hyperpigmentation secondary to atopic or allergic contact dermatitis (eczema)
• lower eyelid complex looses fat (Evaluation of dark circles of the lower eyelid: comparison between reflectance meters and image processing and involvement of dermal thickness in appearance - 2008):
  • skin becomes loose and contracted, causing: leaving the melanin in the dermis (pigment in skin) contracted, more concentrated, causing: darker appearance
• accumulation of insoluble hemosiderin, (may represent a pathological finding encountered in various other skin diseases)
• Quali condizioni generali e locali fanno aumentare la sintesi di melanina? quale è la funzione della melanina? Io dico che c'entra la vitamina D. Perchè si ispessisce il derma?
  • Melanin
  • Vitamin D production in the skin and Vitamin D triggering Melanogenesis
  • Dermis thickening

vascular (due to the local circulation):

• periorbital edema and stasis
• increased vascularity (excessive subcutaneous vascularity)
• decreased blood oxygen saturation rate in eyelid skin
• When skin temperature falls, the amount of cutaneous blood decreases because blood vessels in the skin contract
• amount of blood in the lower eyelid is larger and velocity of blood flow is slower than that in the cheek. As a result, stasis or congestion of cutaneous blood tends to occur and DC may appear
• Nasal congestion
  • dilates and darkens the veins that drain from your eyes to your nose
• Quali condizioni generali possono rendere più evidente l'edema e la angiogenesi?
  • Angiogenesis is stimulated by eg inflammatory cytokines and low pH in tissue. pH decreases as a result of oxygen deficiency, which in turn is due to an insufficient blood supply

physiopathological (due to tissue function and activity):

• Eyelid skin is thinner (0.4–0.5 mm thick) and looser than other sites, due to reduced quantities of collagen, elastin, and glycosaminoglycan
• translucency of the lower eyelid skin overlying the orbicularis oculi muscle
  • Orbicularis oculi muscle lies right beneath the skin with little or no subcutaneous fat and the darkness may be due to the visible prominence of the subcutaneous vascular plexus or vasculature contained within the muscle, causing: violaceous appearance (accentuated during menstruation)
• the properties of the dermis in the eyelids
• various cutaneous disorders
• therapeutic interventions
• individual chromatic tendency
  • based on 'weak' or 'strong' melanocytes and their tendency to respond to trauma or inflammation with either hypopigmentation or hyperpigmentation
• Ageing:
  • loss of subcutaneous fat (pseudoherniation of orbital fat) and check descent, causing: hallowness aspect and unveiling of the orbital vasculature, causing: bluish color due to the dermal capillary network

Dark Circles Search

Mayo clinic opinion

file	user	date
iperpigmentazioni.pdf	mp	16/07/2009