Periorbital Hyperpigmentation: Review of Etiology, Medical Evaluation, and Aesthetic Treatment

April 2014 | Volume 13 | Issue 4 | Original Article | 472 | Copyright © April 2014

Wendy E. Roberts MD

Generational and Cosmetic Dermatology, Rancho Mirage, CA

tion. He presented with a dark blue/grey patch involving the right suborbital area. The etiology of his infraorbital pigmentation was diagnosed as PIH. His first line treatment was two treatments with fractional photothermolysis with 1550-nm fractionated erbium-doped fiber laser (Fraxel Restore, Solta Medical, Haywood, CA). This was followed by four weeks of once nightly application of triple combination bleaching agent containing Fluocinolone acetonide 0.01% , 4% Hydroquinone, .05% Tretinoin (Triluma, Galderma, Houston Texas).
table 10


Treatment Options

POH remains a complex entity. While we have excellent randomized controlled studies looking at treatments for periorbital rejuvenation primarily for the elimination of rhytids and facial hyperpigmentation; there is a lack of evidence based studies for the treatment of POH. We do have excellent case reports, use studies, large global patient studies and anecdote to guide us in making safe and efficacious clinical treatment plans.


Periorbital Hypermelanosis is a complex entity with a multifactoral etiology and an expanding knowledge base. It is most often observed in darker races and may be considered to be normal variants of pigmentation. There is most likely a familial component as it may be seen in family members over generations. Though patients are distressed and usually seek medical attention because of their appearance it is not strictly a cosmetic issue and may be a sign for underlying health issues. POH has specific histology and may be a final common clinical pathway of dermatitis, allergy, sleep disturbances or nutritional deficiences that lend itself to medical, surgical and cosmeceutical treatments. A complete medical history with ROS and Physical Examination is encouraged prior to treating the aesthetic component. Sun protection is a cornerstone of therapy. Cosmetic camouflage may be used during treatment. Procedural and surgical treatments may improve the appearance of POH. Safety issues are of utmost concern when embarking upon treatments such as chemical peeling, filler injection, and laser therapy as not to worsen the pigmentation. Without intervention POH usually progresses over time so early intervention and management is encouraged.


The author has not disclosed any relevant conflicts. Wendy E. Roberts is a consultant/speaker/advisor for the following companies for Allergan, Kythera, La Roche Posay, L’Oreal, MelaScience, Neostrata, SkinMedica, Top MD, Theraplex, and Valeant.


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