Dark circle - Different types and their treatment

Dark circle or periorbital hyperpigmentation (scientific term) is one of the most common skin problems experienced by young adults specially women. Generally we think that it is due to stress or lack of sleep. While that is not incorrect per se, stress or lack of sleep is more of an “aggravating factor” rather than the sole reason behind dark circles. Which means that when you already have an underlying reason for dark circles , the immediate factors (stress, hangover , lack of sleep or eye-strain) will make it more prominent. As you might guess, identification of the root cause will also help us to figure out the best treatment plan. So here we classify dark circles based on their cause and also present the relevant treatment. Please note that it is possible that you might have multiple types present together.

Another skin problem can directly or indirectly cause your dark circle. That could be something very common such as tanning from sun exposure or something very rare like a drug rash or a birthmark (nevus of ota). Also the cause can be indirect like in some cases of skin allergies, you might rub the skin around your eye quite often and it tends to make that area a little darker compared to its surroundings.

How to know : If you stretch the skin beneath your eye (we call it a stretch test) the area will still look slightly darker compared to other parts of your skin.

Treatment : The treatment is usually for the underlying skin condition (if possible) and also to remove the pigmentation. There are a variety of treatments available ranging from a simple cream to Laser. You can see a detailed comparison of all such treatment options in our article on melasma

As because the area is close to the eye and also the skin is a little delicate here, we usually avoid aggressive treatments and creams that might irritate your skin. For example , among creams we might start from a simple non irritating cream like hydroquinone and among chemical peels, we usually prefer mild surface level peels such as arginine or lactic acid peels. However it might differ in your case and your skin specialist is the best judge in deciding the best treatment option for you.

If your skin under your eye or the muscle beneath it becomes thin due to any reason the blood vessels will look closer to the surface and it will give a darker appearance along with a violet tinge. 

There can be many reasons for a thinned out skin but the most common one we see now-a-days is the use of topical steroid cream that you might be applying unknowingly. Please avoid buying any cream from pharmacies without consulting a doctor if you are not sure whether it has steroid or not.

How to know : If you stretch the under eye skin, the dark-violet tint will be even more prominent as the skin will be thinned out even further.

Treatment : there are 2 important treatment approaches here. As you understand one of the reasons is the loss of the muscle beneath your skin, it can be managed by introducing some fat tissue from outside. It is called “autologous fat transplantation”. 

Another approach is to use vascular lasers (Lasers beam that specifically targets the blood vessels with or without pigments) to shrink the blood vessels down to improve the appearance. Ruby or Nd yag lasers are commonly used but it’s better to let your dermatologist handle this part as there are many other deciding factors as well. Please note that Laser is a costly procedure and if not done properly may lead to lots of side effects ranging from skin burn to more serious problems like damage to the eye. So please make sure to do it only by qualified dermatologists as now-a-days you will find that a large number of quacks and salons are also performing lasers without proper certification or quality control. 

Presence of fluid in the area (periorbital edema) can give a darker appearance due to uneven skin tone and shadow effect. It is also commonly called eye bag or puffy eye. 

How to know : It is not difficult to detect the swelling. However the swelling can be due to the presence of fats in this area as well. There are certain clinical tests by which doctors can differentiate between the two.

Treatment : As periorbital edema can happen due to many medical reasons including more serious ones like kidney or liver problems, it is better to be handled by your doctor. Certain laboratory tests might be needed to confirm any diagnosis and only after that the right treatment can be planned.

It is a skin condition that often runs in families. You will see dark spots around the eye and that extends towards the side (towards ear) like a dark band. It's usually present on both sides.

How to know : It can be easily diagnosed by a dermatologist usually just by looking at it.

Treatment : Treatment is similar to other types of hyperpigmentation though unfortunately pigmentary demarcation lines do not respond very well to the treatment. 

During application of eye drops, one or two drops might spill over the surrounding skin. Certain types of eye drops (prostaglandin) can turn the area darker if used for a long period.

How to know : The fact that the darkness started after using the eye drop

Treatment : using an alternate eye drop after consulting the ophthalmologist.

It is seen mostly in older (or middle-aged) people. With age, the fat tissue present around the eye gradually decreases thus a depression forms below the eye. The depression causes a shadow effect which gives an appearance of a dark circle.

How to know : The darkness markedly reduced when the skin is stretched (as described in the stretch test above)

Treatment : As you might guess, the treatment here is to fill up the fat loss. There are multiple approaches to that.

1. Hyaluronic acid based fillers : Though costly, it is usually highly effective and gives immediate results. With good quality products you can expect it to last for years. However, in inexperienced hands, the chances of complications are also high so make sure you visit a qualified dermatologist or plastic surgeon only.
2. Platelet rich plasma therapy : Platelet rich plasma (PRP) therapy has gained significant popularity in recent years as the material is prepared from your own blood and no external chemical is used. If properly done PRP can offer excellent results though the result is not as long-lasting as fillers. Cost is also generally lower compared to fillers.

With age , the skin around the eye becomes gradually thin and wrinkles start to appear. When looked from a distance, wrinkles may give an appearance of darkness due to local shadow effect.

How to know : The darkness completely goes away when the skin is stretched.

Treatment : Some kinds of lasers including co2 laser, erbium , q-switch lasers as well as IPL have been used to improve the surface appearance. Botox is a specific treatment for coarse or deep wrinkles when it is caused by muscle contraction. 

So if you have read this far, you probably have a good understanding of the various reasons behind dark circles and general treatment approaches for the. Rest assured, most dark circles are usually harmless and disappear when the aggravating factor (stress , lack of sleep) is gone. However, if it is persistent you might want to get checked by a dermatologist.