Dark circles , also known as periorbital/periocular hyperpigmentation, periorbital melanosis, infra-orbital darkening, infra-orbital discolouration, or idiopathic cutaneous hyperchromia of the orbital region, is a common issue that results in a darkening of the skin surrounding the periorbital area and/or the depression of the lower eyelid. They present as bilateral, round or semi-circular, and homogeneous macules, giving the subject a tired appearance.
Dark circles are caused by various exogenous and endogenous factors. Causal factors include genetics, excessive pigmentation, fragility of blood vessels, poor blood circulation, skin laxity associated with ageing, hormonal fluctuations, sun exposure, rubbing and scratching of the skin around the eyes, and the use of certain ocular hypotensive medications... Other lifestyle-related factors can also contribute to the development of dark circles, including lack of sleep, stress, excessive alcohol consumption and smoking, although this is not clinically proven. Furthermore, the thinness of the eyelid skin makes the small blood vessels under the eyes highly visible.
The etiology and structural variations of dark circles have been classified, thus aiding in the introduction of appropriate modalities based on the type of dark circles, as different forms of dark circles respond to different types of care.
The vascular dark circles can be identified by a blue/pink/purple infra-orbital discolouration, caused by poor circulation leading to a decrease in blood oxygenation. They particularly appear after a state of extreme fatigue and/or stress and are generally accentuated with age or during menstruation;
Generated by an overproduction or a distribution issue of melanin, the pigmented dark circles display a brown/black hue. The appearance of dark circles can also result from the fragility of blood vessels: these can easily rupture, leading to the leakage of haemoglobin into the surrounding area. However, when haemoglobin breaks down, pigmented degradation products form and accumulate locally in the dermis and epidermis, thereby causing a dark discolouration around the eye. This type of dark circle is more prevalent in individuals with medium to dark skin tones;
There also exist structural dark circles which are characterised by a hollow in the periorbital region . This phenomenon also causes, depending on lighting conditions, a structural shadow. This change is related to skin ageing, primarily due to the thinning of the dermis, combined with a thinning and loosening of the collagen and elastin fibre network;
Mixed dark circles are a combination of pigmented type dark circles and vascular type oneswhich can vary in intensity.
As for eye bags, they are identified by observing a periorbital puffiness with a high pre-septal thickness, with or without discolouration. They result either from the accumulation of fluid or fat. Factors that can trigger the formation of bags under the eyes include fatigue, a diet high in salt, the intake of certain muscle-relaxing medications, and excessive consumption of alcoholic beverages...
The adipose pockets are characterised by fatty pads on the periorbital area. They result from a loss of fat with bony prominence ;
The aqueous bags are caused by a dysfunction of the lymphatic tissues, leading to the infiltration of fluid at the infra-orbital edge. Indeed, the eyelid region has a spongy property, which can lead to an accumulation of biological fluid. Compared to fatty bags, malar bags are always present when looking down and do not change much when looking up.