From the Guidelines
Treatment for periorbital hyperpigmentation should prioritize chemical peels, as they have been shown to be more effective and tolerable than platelet-rich plasma (PRP) therapy, according to the most recent and highest quality study 1.
Overview of Treatment Options
Periorbital hyperpigmentation, also known as dark circles under the eyes, can be addressed through a combination of topical treatments, procedural options, and lifestyle modifications. The goal is to improve the appearance of the periorbital area by reducing pigmentation, enhancing skin texture, and addressing underlying causes.
Topical Treatments
- Topical retinoids like tretinoin 0.025-0.05% cream can be applied nightly to promote cell turnover and collagen production.
- Hydroquinone 2-4% can be used for 8-12 week cycles to inhibit melanin production, with breaks in between to prevent ochronosis.
- Vitamin C serums (10-20% L-ascorbic acid) applied daily can help brighten the skin and provide antioxidant protection.
- Azelaic acid 15-20% cream twice daily offers a gentler alternative for sensitive skin.
Procedural Options
- Chemical peels using glycolic acid (20-70%) or trichloroacetic acid (10-25%) performed every 3-4 weeks for 4-6 sessions can improve pigmentation and are considered more effective than PRP for periorbital hyperpigmentation 1.
- Laser treatments like Q-switched Nd:YAG or fractional lasers may be effective for resistant cases.
- PRP therapy, although less preferred for periorbital hyperpigmentation compared to chemical peels, has shown promise in improving skin texture and reducing wrinkles in the periorbital area 1.
Lifestyle Modifications
Addressing underlying causes is crucial:
- Allergies may require antihistamines.
- Sleep issues should be corrected.
- Iron deficiency may need supplementation.
- Sun protection with SPF 30+ is essential daily to prevent worsening.
Conclusion on Best Approach
Given the current evidence, chemical peels stand out as a preferred procedural option for treating periorbital hyperpigmentation due to their efficacy and tolerability 1. However, a comprehensive approach that includes topical treatments and lifestyle modifications is necessary for optimal outcomes. It's also important to consider individual patient needs and preferences when selecting a treatment plan.
From the FDA Drug Label
HYDROQUINONE USP, 4% SKIN BLEACHING CREAM is indicated for the gradual bleaching of hyperpigmented skin conditions such as chloasma, melasma, freckles, senile lentigines, and other unwanted areas of melanin hyperpigmentation. The treatment for periorbital hyperpigmentation may include hydroquinone as it is used for the gradual bleaching of hyperpigmented skin conditions, although periorbital hyperpigmentation is not explicitly mentioned, melasma is, which can sometimes occur in the periorbital area 2.
- Key points:
- Hydroquinone is used for hyperpigmented skin conditions
- Periorbital hyperpigmentation treatment may involve skin bleaching creams
- Caution should be exercised as the label does not directly address periorbital hyperpigmentation.
From the Research
Treatment Options for Periorbital Hyperpigmentation
- Topical depigmenting agents, such as hydroquinone, kojic acid, azelaic acid, and topical retinoic acid, can be used to treat periorbital hyperpigmentation 3
- Chemical peels, surgical corrections, and laser therapy are also available treatment options 3
- A multimodal approach may be required, encompassing topical bleaching agents, chemical peels, laser therapy, and/or surgery 4
- Sun protection is a cornerstone of therapy, and safety issues are of utmost concern when embarking upon treatments such as chemical peeling, filler injection, and laser therapy 5
Efficacy of Laser Therapy
- Laser therapy is an effective and satisfactory therapeutic choice for treatment of periorbital hyperpigmentation, with a large percentage of patients (76.4%) satisfied with the effect of lasers on the reduction of moderate to high periorbital hyperpigmentation rates 6
- A total of 2.76% of patients responded poorly, 11.4% responded fairly, 45.3% responded well, and 35.9% responded excellently to laser treatment 6
- As a long-term effect, less than 1% of patients received a poor score after their laser treatment, and 43.35% of patients received an excellent response from laser treatment on periorbital hyperpigmentation after 4-6 months of laser therapy 6
Importance of Medical Evaluation
- A complete medical history with ROS and physical examination is encouraged prior to treating the aesthetic component of periorbital hyperpigmentation 5
- Periorbital hyperpigmentation may be a final common pathway of dermatitis, allergy, systemic disorders, sleep disturbances, or nutritional deficiencies, and medical evaluation can help identify the underlying cause 5