Periocular Dark Circles: Correlates of Severity

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.

Evaluation of the effectiveness of picosecond KTP and fractional thulium lasers on pigmented-type periorbital dark circles

OBJECTIVE

To determine the effectiveness of picosecond KTP in reducing peri-ocular dark circles caused mainly by excessive pigmentation and to compare Picosecond KTP with Thulium laser ability in reducing the intensity and extent of peri-ocular dark circles.

MATERIALS AND METHODS

This split-face prospective study included twelve women with periorbital dark circles (pigmented or mixed-pigmented type). The left lower eyelid was treated using the PicoHi machine (HIRONIC Ltd), a full beam Q-switched Nd-YAG provided by KTP crystal (523 nm) at settings of 0.3 J/cm2, 5 mm, 5 Hz, and 300 Ps. Whereas the right lower eyelid was treated using the Lavieen machine (WON TECH Co., Ltd), a fractional Thulium laser (1927 nm) at setting 1320 mJ/cm2, 30 × 15 mm, 1500 microseconds. Patients received a series of 3 treatment sessions, given at 4-week intervals.

RESULTS

The 532-nm full beam Q-switched KTP and fractional Thulium lasers were more likely to induce post-inflammatory hyperpigmentation rather than decrease the pigmentation. The risk is higher with a Q-switched KTP laser, which may be attributed to the skin tone of the participants. Nonetheless, some improvement in the pigmented type of PDCs, although not detected clinically, was documented by the VISIA software.

CONCLUSION

No solid conclusion can be drawn from the results of the study. Picosecond KTP and Thulium lasers may have a role in reducing PDCs yet more studies should be performed in order to determine the exact impact these lasers have.

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.

Effectiveness and tolerance of multicorrective topical treatment for infraorbital dark circles and puffiness

BACKGROUND

Treatment of infraorbital dark circles and under-eye puffiness is challenging due to its multifactorial nature and lack of broadly applicable, effective treatments. A daily skincare treatment option that is multimodal, effective, and tolerable across a broad patient population is an unmet need.

AIM

A multicorrective topical eye cream (MTEC) formulated with Tetrahexyldecyl (THD) ascorbate (vitamin C), prebiotic Inula Helenium, bioavailable peptides, botanical extracts, chrysin, and caffeine is hypothesized to improve the appearance of infraorbital dark circles and under-eye puffiness by targeting microvasculature congestion and permeability, melanin accumulation and hemoglobin degradation-related pigmentation, and skin health.

METHODS

An IRB approved, open-label, 12-week clinical study set out to evaluate the efficacy and tolerability of the MTEC across a broad patient population including varying ethnicities and Fitzpatrick Skin Types (FST). Female subjects (n = 40) ages 35-60 years old, with moderate-to-severe under-eye dark circles, moderate under-eye puffiness, and mild-to-moderate fine lines were enrolled into the study. Objective (Chromameter, VISIA® imaging, and Laser Doppler) and subjective assessments (clinical grading and self-assessment questionnaire) were conducted at baseline and post-baseline timepoints.

RESULTS

Thirty-seven subjects completed the study, and the MTEC efficaciously demonstrated short-term and long-term improvements in objective and subjective assessments across a broad patient population. Specifically, the MTEC demonstrated significant improvement of infraorbital dark circles, mainly by the reduction in microvasculature congestion and permeability, melanin, and hemoglobin degradation-related pigmentation.

CONCLUSION

Topical application of the MTEC may offer an effective and tolerable treatment option for infraorbital dark circles and puffiness.

Stress and its impairment of skin barrier function

BACKGROUND

The principal function of skin is to provide a barrier to water loss and percutaneous penetration of exogenous substances. Any compromise of the skin homeostasis can lead to dryness, itchiness, or even pathogenic conditions. This study aimed to explore the relationship among psychological stress, skin homeostasis, sleep quality, and emotion.

METHODS

This prospective observational study was conducted using a random sample of medical students from Shanghai Medical College, Fudan University. A questionnaire including the validated Chinese version of Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI) was distributed. The skin barrier function was measured by the transepidermal water loss (TEWL), hydration of skin. Dermoscopic images of the nose and infraorbital skin were obtained. We compared the skin homeostasis, sleep quality, and emotional state of medical students at different time points of the semester and explored the correlation between the variables.

RESULTS

As the semester progressed, the sleep quality and severity of anxiety of medical students got significantly worse, and they were closely related to the impaired skin barrier function. Both irregular schedule and stress can aggravate dark circles.

CONCLUSIONS

Mental stress can do harm to skin barrier through poor sleep and severe anxiety. The amount of sebum was positively correlated with the severity of anxiety while blackheads are mainly influenced by season change. Dermoscopy has a unique role in assessing blackheads and dark circles.

Tear trough ligament reset as a new method for tear trough deformity and dark circles correction

Tear trough deformities and dark circles are important parts of periorbital aging. In this study, the tear trough ligament was reset to correct the tear trough deformity, and its effect on dark circles was analysed. The medical records of 60 patients who underwent eye bag plastic surgery between January 2021 and February 2022 were analysed (30 had traditional eye bag plastic surgery and 30 had the tear trough ligament reset). The tear trough deformity score and the dark circle score showed that the corrective effect on the tear trough deformity in the reset group was better than in the traditional surgery group at six-month follow up (mean (SD) tear trough rating scale (TTRS) score = 4.82 (0.95) vs 5.92 (1.00), p < 0.0001; L* value 55.27 (2.90) vs 47.51 (3.00), p < 0.0001). The satisfaction of patients in the reset group was significantly higher than it was in the traditional surgery group (25/30 vs 18/30, p = 0.045). Tear trough ligament reset is a safe and effective surgical method of periorbital rejuvenation, especially for beauty seekers with obvious tear trough deformities.