INTRODUCTION
Infraorbital hyperpigmentation (IOH), commonly referred to as "dark circles," is a prevalent and distressing cosmetic concern. Infraorbital hyperpigmentation is often societally associated with fatigue, stress, or sadness, and can be perceived as a visible marker of physical exhaustion and premature aging. These associations can consequently impact self-perception and quality of life for affected patients.
IOH can be observed across all ethnicities, sexes, and ages; however, its prevalence and severity are notably higher in females and skin of color (SOC).1 The pathogenesis of IOH is complex and multifactorial, with several contributing intrinsic and extrinsic factors that interact in diverse ways. This condition is particularly challenging to treat due to its various presentations and underlying causes, which can often coexist within the same patient.
To facilitate diagnosis and guide treatment approaches, IOH has been classified in the literature into 4 subtypes: vascular, structural, pigmented, and mixed.1 However, it is important to highlight that external factors such as environmental exposure and lifestyle habits significantly contribute to the onset and exacerbation of IOH, regardless of the primary subtype. External lifestyle factors such as inadequate sleep, psychological stress, and frequent eye rubbing can aggravate both pigmentary and vascular components of IOH by disturbing skin homeostasis.7 Proposed mechanisms include activation of the hypothalamic-pituitary-adrenal (HPA) axis and stimulation of melanin production.6 Recognizing these influences is essential for accurate assessment and individualized treatment planning.
In this review, we will cover classifications and etiologies of infraorbital pigmentation, differential diagnosis, and highlight treatment modalities. We will also present a case series demonstrating significant improvement in infraorbital hyperpigmentation among patients treated with the 1927 nm diode laser, with no adverse events reported.
Classification
Pigmented
Pigmentary IOH is primarily due to excessive melanin deposition in the infraorbital region. It may be constitutional, often with a familial predisposition, or acquired through post-inflammatory
IOH can be observed across all ethnicities, sexes, and ages; however, its prevalence and severity are notably higher in females and skin of color (SOC).1 The pathogenesis of IOH is complex and multifactorial, with several contributing intrinsic and extrinsic factors that interact in diverse ways. This condition is particularly challenging to treat due to its various presentations and underlying causes, which can often coexist within the same patient.
To facilitate diagnosis and guide treatment approaches, IOH has been classified in the literature into 4 subtypes: vascular, structural, pigmented, and mixed.1 However, it is important to highlight that external factors such as environmental exposure and lifestyle habits significantly contribute to the onset and exacerbation of IOH, regardless of the primary subtype. External lifestyle factors such as inadequate sleep, psychological stress, and frequent eye rubbing can aggravate both pigmentary and vascular components of IOH by disturbing skin homeostasis.7 Proposed mechanisms include activation of the hypothalamic-pituitary-adrenal (HPA) axis and stimulation of melanin production.6 Recognizing these influences is essential for accurate assessment and individualized treatment planning.
In this review, we will cover classifications and etiologies of infraorbital pigmentation, differential diagnosis, and highlight treatment modalities. We will also present a case series demonstrating significant improvement in infraorbital hyperpigmentation among patients treated with the 1927 nm diode laser, with no adverse events reported.
Classification
Pigmented
Pigmentary IOH is primarily due to excessive melanin deposition in the infraorbital region. It may be constitutional, often with a familial predisposition, or acquired through post-inflammatory
