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

A 58-year-old African American female, Fitzpatrick skin type 5 (Roberts Skin Type F5/H3/G3/S2), who presented with complaints of darkening skin globally but reporting she felt “especially tired around the eyes”. Her occupation was in school transportation and she was outside every day with no sun protection. She also reported 5 hrs or less of sleep per night. On physical examination she had severe mid facial descent also with a significant tear trough deformity and suborbital shadowing. Though this patient would be an excellent candidate for mid face filling she was not amenable to this and just wanted to look more refreshed until the school year was out. Her first line treatment was microdermabrasion that gave her no downtime and did not pose a risk for her daily exposure to sun. She was also started on a routine daily SPF 30, foundation mineral makeup and counseled to get more sleep. At 2 months she noted an increased luminosity and eveness to her skin with decreased pigmentation of her face globally which included the undereye area. This case demonstrates how simple counseling in skin care may improve the appearance of some cases of POH.

A 27-year-old African American Male, Fitzpatrick skin type 5 (Roberts Skin Type F5/ H 1/ G1/ S3) presents with an unknown history of increasing hyperpigmentation of the right suborbital area. He had a positive history for atopy and had used a variety of unknown products to treat the hyperpigmenta-