Physiological and lifestyle factors contributing to risk and severity of peri-orbital dark circles in the Brazilian population

The Frequency of Periorbital Hyperpigmentation Risk Factors

BACKGROUND

Periorbital hyperpigmentation (POH) is a common complaint worldwide. Although this cosmetic condition is not a medical concern, it can impact emotional well-being. Few investigations have evaluated the association of various factors with POH, which is contradictory in some ways.

AIM

The present study is conducted to elucidate the accurate impact of risk factors on the severity of POH.

PATIENTS/METHODS

This cross-sectional study was performed on 116 patients attending a skin Outpatient Department in Iran from March to August 2022. A complete physical examination divided patients into mild, moderate, severe, and very severe classes. Valid questionnaires were filled out by participants about their demographic data, underlying diseases, and their habits. The chi-square and linear regression tests were done. All data were analyzed using SPSS version 24.

RESULT

Among demographic factors, positive family history had a significant association with POH. There was a significant association between POH and stress, prolonged exposure to sun or television, and taking hormonal pills. Surprisingly, sleep quality was not significantly related to POH. In addition, there was a relationship between POH and some underlying diseases.

DISSUASION

The present study agreed with others about the significant impact of factors like family history, prolonged sun exposure, stress, and anemia. The current investigation elucidated doubts about the insignificant effect of sleep quality on the severity of POH. In contrast to previous studies, a remarkable relationship between POH and atopy was not revealed.

CONCLUSION

POH is an undesirable condition. Two key factors associated with this cosmetic problem are rubbing eyes and prolonged exposure to television.

Comparison of the Effectiveness of Platelet-Rich Plasma Versus Tranexamic Acid Plus Vitamin C Mesotherapy in the Treatment of Periorbital Hyperpigmentation: A Split-Site, Randomized Clinical Trial

BACKGROUND

Periorbital hyperpigmentation (POH) is a common cosmetic problem with a negative impact on the patient's self-confidence, leading to a decrease in the quality of life. Current treatments include topical agents and mesotherapy, but research remains limited.

AIMS

Due to the undesirable effect of the available treatments, the present study was designed to compare the effectiveness of platelet-rich plasma (PRP) injection and intradermal injection of tranexamic acid plus vitamin C mesotherapy as a therapeutic method to treat POH.

METHODS

Patients received an intradermal injection of PRP randomly on one side and an intradermal injection of tranexamic acid + vitamin C on the other side of their face, for three sessions with an interval of 3 weeks. Digital photography was taken, and data were assessed based on physician global assessment (PGA) and patient satisfaction.

RESULTS

Eighteen patients were studied. Among all, 12 patients had a positive family history, 2 had asthma, and 4 had a history of atopic dermatitis. Even though patient satisfaction was higher in the PRP group than in mesotherapy, it was not statistically significant. Both groups showed similar rates of improvement. However, improvement rates did not significantly differ based on various factors including gender, skin type, family history, or medical history. Age and the age of disease onset also did not significantly affect the improvement rates.

CONCLUSION

Both methods revealed successful results in the reduction of POH. Comparing the efficacy of these two methods showed that both treatments had similar improvements.

The Impact of Carboxytherapy and Treatments Combining Carboxytherapy and Selected Chemical Peels on Vascular and Pigmentary Components of the Dark Circles

Objective

Particular attention is given to the enhancement of melanin-related pigmentation (dark circles, photoaging) and vascular circles, which are commonly located in the tear trough. The objective of the study is to provide an objective evaluation of the impact of carboxytherapy and the treatment regimen combining carboxytherapy with lactobionic acid (20%, pH 2.1) or ferulic acid (14%, pH 4.0-5.0) and ascorbic acid (12%) on skin defects in the eye area.

Materials and Methods

A group of 39 Caucasian people were subjected to a series of five carboxytherapy treatments (right eye area) and five treatments combining carboxytherapy with a selected chemical peel for the skin around the eyes (left eye area). The efficacy of therapy was assessed based on parameters (MI and EI) measured with the Mexameter probe. Measurements were made in the tear trough and the middle of the lower eyelid.

Results

We demonstrated that a series of carboxytherapy (right side) significantly statistically influenced the EI parameter (in different measurement points: P <0.0001, P = 0.015, P = 0.002), which reflects the intensity of vascular circles under the eyes. Improvement of this parameter by 7.2 units was also shown in the tear trough in 82.1% of participants after the application of carboxytherapy combined with acids (left side) on the valley of tears for this parameter (EI). Lactobionic acid and carboxytherapy were associated with a statistically significant improvement (P = 0.011) in the tear trough. In this study, a reduction in the combined pigmentation (MI plus EI) for both the right and left sides (p = 0.001 and p = 0.015, respectively) was observed.

Conclusion

The study provides objective evidence for the effectiveness of sole carboxytherapy and carboxytherapy combined with acids in the reduction of dark circles, in particular vascular circles in the tear trough. Lactobionic acid, ferulic acid, and ascorbic acid can be used as safe supplements to enhance carboxytherapy.

Electrical stimulation of the lower eyelid orbicularis oculi muscle improves periocular dark circles

BACKGROUND

We developed and tested the safety and efficacy of a cosmetic device to improve dark circles using electrical muscle stimulation of the orbicularis oculi muscle.

METHODS

Overall, 18 participants (36 eyes) were studied. The following five items were evaluated before and after the intervention:(1) the Clinical Dark Circle Score using clinical findings and photographs, (2) transcutaneous oxygen partial pressure (TcPO2) on the lower eyelid, (3) thermography, (4) two-dimensional laser blood flowmetry, and (5) spectrophotometry.

RESULTS

The mean score at baseline was 2.0 ± 0.90 (mean ± standard deviation), and that at the end of the study was 1.2 ± 1.0 (Wilcoxon signed-rank sum test, p < 0.0001), indicating a significant reduction. The spectrophotometer showed a significant decrease in a* and L* values before and after use (Wilcoxon signed-rank sum test, p < 0.0001). There was also a weak negative correlation between the change in score and the change in blood flow and TcPO2 measured using a laser perfusion device (Spearman's rank correlation coefficient, r = -0.32 and -0.39, respectively). Stratified analysis of the baseline score showed a strong negative correlation between the change in score and the change in spectrophotometric a* in the subjects/group with mild periocular dark circles (Spearman's rank correlation coefficient, r = -0.46). Contrastingly, no correlation was observed for any of the measurements in the subjects/group with severe periocular dark circles. After 1 month, no device-related ophthalmic adverse events were observed in any of the participants.

CONCLUSION

Electrical muscle stimulation could improve periocular dark circles, especially in the subjects/group with mild periocular dark circles, and was safe.

The effect of Salix alba L. bark extract on dark circles in vitro and in vivo

OBJECTIVE

Dark circles in the infraorbital area are a common cosmetic concern among individuals because they exhibit fatigue and are undesirable across all ages. Of the dark circle etiologies, blood stasis by poor-vascular integrity can cause darkening of the lower eyelid skin, which might be alleviated by reduced endothelial permeability. In this study, we investigated the effects of Salix alba bark extract (SABE) on the synthesis of hyaluronic acid (HA) in fibroblasts and vascular integrity protection from inflammatory cytokine. We also performed a clinical trial investigating the effect of SABE on dark circles.

METHODS

To confirm the effect of SABE on HA synthesis in human dermal fibroblasts (HDFs), we performed ELISA and real-time PCR. We investigated the interaction HDF-secreted substance with vascular integrity, and human dermal microvascular endothelial cells (HMEC-1) were treated with conditioned medium (CM) from HDF treated with or without SABE. Subsequently, we conducted a clinical study on 29 subjects by having them apply SABE containing cream for 8 weeks.

RESULTS

Salix alba bark extract treatment increased HA synthesis and regulated HMW-HA-related gene expressions in HDF. CM from SABE-treated HDF alleviated endothelial permeability and led to improved vascular integrity in HMEC-1 cells. Treatment with the cream containing 2% SABE for 8 weeks improved the parameters measuring dark circles, skin microcirculation and elasticity.

CONCLUSION

Our results showed that SABE could protect against dark circles in vitro, and that topical treatment of SABE improved the clinical indexes of dark circles in a clinical study. Therefore, SABE can be used as an active ingredient for improving dark circles.

Treatment of periorbital hyperpigmentation using sublative fractional radiofrequency (SFR)

BACKGROUND

Periorbital hyperpigmentation (POH) is a common cosmetic concern. Numerous techniques of treatment have been assessed with variable results.

AIM

The purpose of this research is to assess the efficacy of non-ablative radiofrequency, Sublative fractional Radiofrequency (SFR) on POH treatment.

METHODS

In this research study, nine patients with POH and the age range of 25-57 years, were enrolled. The patients were treated by non-ablative radiofrequency SRF. The outcomes were assessed by biometric assessment. The skin lightness and melanin content of the periorbital skin were assessed by colorimeter and Mexameter. Skin elasticity was assessed by Cutometer. The skin ultrasound imaging system was used to evaluate the diameter and density of the epidermis and dermis. Visioface was used to evaluate the skin color and wrinkles. Also, patient's satisfaction and physician's assessment were assessed.

RESULTS

The results showed that the lightness and elasticity of the periorbital skin were significantly increased after treatment. Also, the melanin content of the skin was decreased. The denser skin layers were seen in both dermis and epidermis. The Visioface results displayed the reduction in the percent change of the skin color and wrinkle (p < 0.05). Similarly, the physician and patients' assessment confirmed the outcomes. No serious adverse effect was reported.

CONCLUSION

In conclusion, the SFR technique is an effective and satisfactory therapeutic choice for treatment of POH.

Microneedle fractional radiofrequency in the treatment of periorbital dark circles

BACKGROUND

Periorbital hyperpigmentation (POH) is a common disorder in the patients. Women are more upset with POH in compare to males. Several methods have been used to the POH, with different efficacy and adverse reactions.

AIM

The aim of the present study is to evaluate the efficacy of microneedle fractional radiofrequency (MRF) in treating POH.

METHODS

So, nine patients with POH and the age range of 25-57 years, were treated by microneedle fractional radiofrequency (MRF). The outcome was evaluated via biometric assessment. The colorimeter was used to assess the skin lightness. Mexameter was used for evaluated the amount of Melanin in the periorbital skin. Cutometer was used for skin elasticity assessment. The skin ultrasound imaging system was utilized to estimate the epidermis and dermis diameter and density. Furthermore, Visioface was applied to assessed the skin color and wrinkles. Also patient's satisfaction and physician's assessment were evaluated.

RESULTS

The results displayed that the periorbital skin lightness 32.38% ± 5.67 and elasticity of the R2: 40.29% ± 8.18, R5: 39.03 ± 5.38 and R7: 42.03% ± 14.16 were significantly improved after treatment (p < 0.05). Also the melanin content of the skin was decreased (49.41% ± 9.12). The skin layers were denser in the dermis and also in the epidermis (skin density: 30.21% ± 10.16 and skin thickness: 41.12% ± 13.21) (p < 0.05). The results revealed the decrease in the percent change of the skin color (30.34% ± 9.30) and wrinkle (area: 25.84% ± 6.43 and volume: 30.66% ± 8.12) (p < 0.05). Similarly, the physician and patient's assessment were confirmed the obtained outcomes.

CONCLUSION

In conclusion, the microneedle RF technique is practicable, effective and safe method for periorbital dark circles treatment.

Skin Aging Exposome in Skin of Color Populations: Review of the Literature

BACKGROUND

As life expectancy increases, the comorbidities related to aging require greater attention. Skin aging exposomes were only recently defined and need additional delineation, particularly in Skin of Color (SOC) populations.

OBJECTIVE

The primary objective is to shed the light and summarize the existing literature on skin aging exposome in SOC populations.

MATERIALS AND METHODS

We performed an extensive search in the PubMed and Google Scholar databases. We included peer-reviewed studies in SOC populations around the world regarding one or more of the skin aging exposome factors, and we grouped and organized the studies under each factor of the skin aging exposome.

RESULTS

Some environmental exposome factors are preventable or modifiable, for example, by applying broad-spectrum sunscreens with visible light protection, improving nutrition, and smoking cessation. Other factors such as air pollution will require more complex solutions. Our search revealed a paucity of references on skin aging exposome factors in SOC populations.

CONCLUSION

We identified the need for more dedicated studies in SOC populations to advance knowledge on skin aging exposome factors. This knowledge will provide a better understanding of approaches to minimize extrinsic skin aging in these populations.

Optical characteristics of the skin with dark circles using pump-probe imaging

Pump-probe imaging was first used for quantitative analysis of melanin in dark circles' skin to improve the ability to diagnose and treat dark circles on human skin. This study aimed to compare the distribution characteristics in melanin of lower eyelid skin tissues and to determine whether pump-probe imaging has potential for the classification of dark circles in vivo. Specimens obtained from 15 patients undergoing blepharoplasty were examined using pump-probe imaging. Furthermore, adjacent slices were respectively treated with hematoxylin-eosin (HE) and ferrous sulfate (FeSO₄) staining for cross-references. Subsequently, the melanin content index (MCI) and mean fluorescence intensity (MFI) were quantitatively analyzed by the pump-probe imaging. The distribution of melanin granules in the pump-probe image and FeSO₄ staining was consistent. Meanwhile, the tissues of the skin with dark circles and normal skin demonstrated significant differences in MCI and MFI. These differences can be used to distinguish the skin with dark circles from the normal skin. Pump-probe imaging could be used for the analysis of the microstructure and spectral characteristics of melanin granules in skin with dark circles. Significant differences were noted between the pigmented type of dark circles and the other two groups (normal skin and the vascular type of dark circles), while no significant differences were found between normal skin and the vascular type of dark circles.

A randomized comparative study of the effect of two different flow rates of carboxytherapy in the treatment of infraorbital dark circles

BACKGROUND

Carboxytherapy is a minimally invasive, relatively safe modality that has been used for the treatment of dark circles; however, different flow rates and different injection techniques have been described in the literature.

AIM

To study the effect of the flow rate on the therapeutic outcome of carboxytherapy in infraorbital dark circles.

METHODS

Eighty patients with infraorbital dark circles were divided into two equal groups: Group A received carboxytherapy at a flow rate of 30 ml/min, and group B received carboxytherapy at a flow rate of 60 ml/min. Patients received weekly sessions for 6 weeks, and the treatment response was evaluated 6 weeks after the last treatment session.

RESULTS

Significant improvement of the dark circles was detected in both treatment groups. However, no significant difference in the treatment response was found when both flow rates were compared. The frequency of development of side effects was significantly higher in the group receiving CO₂ at a flow rate of 60 ml/min. No significant difference in the overall post-treatment patient satisfaction between the two groups was detected.

CONCLUSION

Carboxytherapy is an effective therapeutic modality for infraorbital dark circles. Lower flow rates achieve therapeutic responses similar to higher flow rates but with fewer side effects.

Periocular Dark Circles: Correlates of Severity

Background

Periocular dark circles (PDCs) are a common cosmetic complaint. Grading systems based on objective measures have been used but no standard system is in place.

Objective

To determine factors associated with subjective and objective PDC severity.

Methods

Enrolled patients (n=100) completed a questionnaire comprised of demographic variables, medical history, and self-perception of PDC. Those perceiving PDC graded dissatisfaction on a 10-point scale. Clinical severity (grades 0~4) and subtype (constitutional, post-inflammatory, vascular, shadow effects, or others) were determined. A Konica Minolta CR-400 chromameter was used to obtain colorimetry measurements (L^*a^*b^* values). The objective average difference in darkness (ΔL^*) between the periocular region and the cheek was determined. Comparisons were made using Spearman correlation coefficients (r).

Results

Patient dissatisfaction correlated with both clinical severity (r=0.46, p<0.001) and the ΔL^* by colorimetry (r=0.35, p=0.004). Factors associated with subjective dissatisfaction were female sex (r=0.38, p=0.002), higher Fitzpatrick skin type (r=0.42, p=0.001), fewer hours of sleep (r=-0.28, p=0.03), and use of concealer (r=0.35, p=0.004). Factors associated with objective measures were higher Fitzpatrick skin type (r=0.36, p=0.0007 and r=0.28, p=0.009, respectively), family history of PDC (r=0.34, p<0.001 and r=0.20, p=0.05), and history of eczema (r=0.45, p<0.001 and r=0.20, p=0.0504). Clinical severity grading correlated with colorimetric severity (r=0.36, p=0.0003).

Conclusion

Overall, subjective dissatisfaction was associated with clinical severity. However, factors associated with subjective severity did not necessarily overlap with factors associated with objective severity. These findings highlight the importance of patient-reported grading. There may be added value in incorporating a component of subjective grading into the traditionally objective PDC grading scales.

Periorbital Hyperpigmentation—Dark Circles under the Eyes; Treatment Suggestions and Combining Procedures

Periorbital hyperpigmentation (POH) is a frequent concern among both young and adult patients. The etiology is multifactorial with a genetic background. Prevalence is higher in darker skin types. It has been estimated as high as 30% in a recent Indian study. Females are often more disappointed by POH than males. Treatment has to consider underlying pathologies and patients’ needs. We present our treatment algorithm for POH. In this study, 74 patients with POH, 64 females (86.5%) and 10 males (13.3%), were treated. Of these, 39 patients (53%) had a family history of POH. The age range of patients was 18−57 years (average: 36.1 years). In case of tear trough deformity, soft tissue augmentation was used by injection of hyaluronic acid gel, calcium hydroxylapatite, or autologous fat. Blepharoplasty with partial fat pad resection or repositioning via arcus marginalis release was used to correct severe orbital fat herniation and excess of the lower lid skin. Melanin hyperpigmentation of the skin was improved by sessions of Q-switched 1064 and 532 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. Small vessels (capillaries and veins) were targeted by a 1064 nm long-pulsed Nd-YAG laser. Sessions of intense pulsed light (IPL) or CO2 fractional laser were employed to improve skin texture and fine lines. Topical hyaluronic acid-based formulations may be used as adjuvant self-treatment by patients. For pigmented and mixed-type POH, ultraviolet light protection is recommended as a maintenance treatment. By the use of various technologies, treatment can be individually tailored.

A validated photonumeric scale for infraorbital dark circles and its application in evaluating the efficacy of a cosmetic treatment product in a split-face randomized clinical trial

OBJECTIVE

As a result of their complex aetiology and periodicity, dark circles are difficult to characterize and measure, with current assessment techniques relying on specialist equipment, image analysis or proprietary grading scales. There is therefore a need to develop and validate a photonumeric scale for assessing infraorbital dark circles, which can provide an objective and consumer relevant tool for evaluating this condition and the efficacy of treatment products and procedures.

METHODS

A panel of expert clinical evaluators reviewed approximately three thousand facial photographs collected over a 5-year period and selected images representing a dynamic range of dark circles. A 10-point photonumeric scale was created, with corresponding descriptors and images for each grade of the scale. To rigorously validate the scale, linearity, sensitivity and precision were assessed by colorimetry and in-clinic evaluation. Reproducibility was assessed photographically with both experienced and inexperienced clinical evaluators, whereas intragrader repeatability was assessed live in-clinic. The scale was then employed in a split-face randomized clinical trial on 58 subjects to evaluate the efficacy of a cosmetic treatment product over 8 weeks.

RESULTS

Colour analysis of the images showed the scale was linear, with statistically significant correlations observed when colour data (CIElab; Individual Typology Angle) were plotted against the corresponding grades (r > 0.9, P < 0.001). Colour difference (Delta E) was calculated between the infraorbital zone and the surrounding skin, and when data were plotted against the grades, a statistically significant correlation was observed (r = 0.99, P < 0.01). The magnitude of the Delta E suggested that changes in grade are visibly perceptible to the human eye, and therefore, the scale is sensitive and clinically relevant. Intergrader reproducibility showed strong correlation (0.96) and >90% agreement between experienced evaluators, whereas intragrader repeatability assessment showed >90% perfect agreement between grades. Use of this scale in a clinical trial demonstrated the efficacy of a cosmetic product, with a mean statistically significant (P < 0.001) decrease in grade of 0.74 compared to baseline, and 0.59 versus the untreated control, after 8 weeks of treatment.

CONCLUSION

Our photonumeric scale for infraorbital dark circles is sensitive and robust and provides an objective and easy-to-use tool to evaluate dark circles and their treatment.

Periorbital Discolouration Diagnosis and Treatment: Evidence-Based Review

Infraorbital dark circles are a significant esthetic concern with few publications however offering evidence-based recommendations for their classification and consequent management. A literature review has been undertaken to classify dark circles based on etiology: shadowing, vascular, idiopathic hyperpigmentation, post-inflammatory hyperpigmentation, constitutional and offer an analysis of current treatment modalities and their effectiveness in managing specific types of infraorbital circles. This review aims to provide a detailed account of dark circle etiology, assessment and management.

Identification Of Three Key Factors Contributing To The Aetiology Of Dark Circles By Clinical And Instrumental Assessments Of The Infraorbital Region

BACKGROUND

The aetiology of infraorbital dark circles is complex and multi-factorial. The aim of this research was to measure and characterize dark circles and to determine the physiological changes associated with the occurrence of this aesthetically unpleasing issue.

MATERIALS AND METHODS

Clinical, photographic and instrumental assessments were performed on Caucasian skin to determine the most appropriate methodologies to measure dark circles, comparing different zones of the infraorbital region in subjects with and without dark circles. Exploratory studies were also carried out on African and Far East Asian skin, as well as on tracking the natural variation of dark circles over seven days in Caucasian subjects.

RESULTS

Under-eye dark circles in Caucasian subjects are characterized by significantly darker coloured skin and higher colour deviations between the dark circle region and surrounding areas of skin. Multispectral image analysis produced a higher melanin index in subjects with dark circles, suggesting hyperpigmentation in the affected area, in addition to a higher haemoglobin index. The higher haemoglobin index, combined with preliminary assessments of the vascular network by videocapillaroscopy, suggests there may be more dilated, thicker or increased numbers of capillaries in subjects with dark circles. Ultrasound analysis showed a significant difference in skin thickness between the two groups of subjects linking the appearance of dark circles to thinner skin under the eye. Many of these trends were also observed in African and Far East Asian skin. The results also showed intra-individual, intra-day and inter-day variability of dark circle intensity in subjects with Caucasian skin.

CONCLUSION

Three key physiological factors associated with the occurrence of infraorbital dark circles are hyperpigmentation, a tendency for more dilated, thicker or increased number of capillaries and thinner skin in the under-eye area. The combination of these three factors provides a robust indication of the presence of infraorbital dark circles.

Influence of facial threading on various physiological parameters of the skin: non-randomized trial involving adult women in Taiwan

BACKGROUND

Facial threading involves the removal of hairs to restore facial skin smoothness. However, its effectiveness has not been rigorously evaluated.

OBJECTIVE

To evaluate effects of facial threading on skin roughness, hydration, melanin index, and vellus hair on the face, complemented by a subjective evaluation of the tactile feel of the skin and improvement in skin color.

METHOD

Participants who had not used exfoliators for two weeks before the experiment were included. Each participant underwent one session of facial threading every 21 days, for a total of 3 sessions. A three-dimensional skin roughness instrument and a multifunctional skin testing system were used to evaluate changes in roughness, hydration, and pigmentation on the forehead, cheeks, and corners of the mouth. A photomicrographic camera was used to record changes in vellus hair. Subjective reports of skin smoothness and color were recorded.

RESULT

Eighteen participants completed the study. Facial threading produced a significant decrease in skin roughness on the forehead (22.42%, p = .013), right cheek (77%, p = .02), and left corner of the mouth (33.02%, p = .001). Subjective improvement in tactile feel of the skin and coloring were reported.

STUDY LIMITATIONS

The study did not include randomization, with further limitations of a small sample size and a single site.

CONCLUSION

Facial threading reduced skin roughness by 26.74% after three threading sessions, with improved subjective assessment of tactile feel and coloring. Future research should include a comparison with other cosmetic products with similar beautifying effects or a control group.

Periocular dermatoses

The periocular area may be affected by infectious or noninfectious diseases such as inflammatory dermatoses, systemic disease, drug reactions, benign and malignant lesions, traumatic lesions, and esthetic complications. We present a review of the most common periocular dermatoses.