Periocular Dark Circles: Correlates of Severity

Abstract

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.

Stress and its impairment of skin barrier function

“…Despite the significantly dropped sleep quality during the final‐examination period, one thing that cannot be ignored is that students often have irregular routine during the holidays, which can lead to severe dark circles at the beginning of the semester. A study showed that the vascular type of dark circles was predominant in Chinese population, 18 and this type may show changes mostly in a * skewing toward greenness rather than significant L * changes 19 . It is worth mentioning that although Δ L * and ΔE are commonly used to evaluate dark circles, the values of the two indices in our study were small with almost no fluctuation, which indicated that the dark circles severity of participants was generally mild.…”

“…A study showed that the vascular type of dark circles was predominant in Chinese population, 18 and this type may show changes mostly in a* skewing toward greenness rather than significant L* changes. 19 This study had some limitations. First, the self-administered surveys relied on subjective measures of sleep and emotion.…”

“…However, it is worth noting that those are almost all cross‐sectional studies, and we need to pay attention to day‐to‐day fluctuations in severity. Fluctuation in sleep quality has been shown to cause edema and dermal pigment 19 . Besides sleep, researchers also noticed that the majority of patients had aggravation of dark circles during periods of stress which may be due to the effect of increased MSH secretion 17 .…”

“…Fluctuation in sleep quality has been shown to cause edema and dermal pigment. 19 Besides sleep, researchers also noticed that the majority of patients had aggravation of dark circles during periods of stress which may be due to the effect of increased MSH secretion. 17 Considering that the most commonly used methods are physician evaluation and colorimetric analysis, we innovatively introduced dermoscopy and designed a prospective study.…”

Skin Pigmentation and Cosmetic Considerations for Even Skin Tone

“…While the etiology is multifactorial, prominent causative factors include familial, UV, inadequate sleep, post-inflammatory hyperpigmentation following atopic dermatitis, allergic contact dermatitis, lichen planus pigmentosus, erythema dyschromicum perstans [47] tear-trough depression, and periorbital edema [43,48,49]. Basis the clinical pattern of pigmentation and vasculature, POH can be classified into (a) constitutional, which involves the presence of a curved band of dark brown to black pigmentation on the skin of the lower eyelids, (b) postinflammatory pigmentation, marked by the presence of irregular patches of dark brownish or gray pigmentation on the skin of Skin Pigmentation and Cosmetic Considerations for Even Skin Tone DOI: http://dx.doi.org/10.5772/intechopen.108693 the lower, upper, or both the eyelids with lichenifed eczema in surrounding areas, (c) vascular, involving bluish discoloration of the lower eyelids and visible greenish blue veins that become more prominent on stretching of the overlying skin, (d) the shadow effect, involving the presence of deep tear trough over the medial aspect of the inferior orbital rim that disappears with direct lighting, and (e) mixed highlighted by presence of periorbital blue, purple, or pink hue with puffiness associated with palpebral bags, blepharoptosis, and loss of fat with bony prominence [43,50,51].…”