More Than A Cover-Up: Options For Patients With Periorbital Hyperpigmentation
Periorbital hyperpigmentation is a skin disorder that appears in those with darker skin pigmentation. It is also known as idiopathic cutaneous hyperchromia of the orbital region or, commonly, “dark circles.” The discoloration may be present on the upper, lower or both eyelids.1 It can be a significant cosmetic concern for patients, especially when they feel it makes themselves appear sad, tired, stressed or older than they are.2 But it also could be a warning sign of more serious medical problems, including disorders of the liver, heart, thyroid or kidneys;2,3
Periorbital hyperpigmentation is caused by various external and internal factors, which makes it very complex to treat. The factors can include genetics, excessive pigmentation from melanin deposited in the epidermis and dermis, post-inflammatory hyperpigmentation due to contact or atopic dermatitis, periorbital edema, excessive vascularity, reduced thickness of the epidermis, and tear troughs associated with aging.2,4
Latanoprost, bimatoprost and other prostaglandin analogs can also cause periorbital hyperpigmentation. These are often used as ocular hypotensive eye drops for patients with glaucoma or lash growth. When bimatoprost drops cause this condition, it usually develops between three and six months after initiating the treatment. The likely mechanism of action is due to an increase in melanogenesis in dermal melanocytes and increased transfer of melanin granules to the basal epidermis. However, the hyperpigmentation typically reverses when the treatment is discontinued.4
Potential Treatment Options
- Here are some potential options to consider:
- Periorbital hyperpigmentation caused by melanin is typically treated with hydroquinone and similar ingredients along with lasers
- Hydroquinone is an antagonist of tyrosinase, a copper-containing enzyme that factors heavily in pigmentation. A range of hydroquinone concentrations can be compounded. Using around 2–8% concentration may stabilize the melanocytes and decrease pigmentation locally3
- Kojic acid binds to copper, also blocking the tyrosinase pathway3
- Cases caused by vascularity are often treated by targeting the vessel walls to stabilize them, and the use of ascorbic acid (vitamin C), phytonadione (vitamin K1) and tretinoin may help3
- Ascorbic acid can effectively lighten pigmentation, possibly due to an increase in dermal thickness that reduces dark discoloration from underlying congested blood4
- Retinoids are vitamin A derivatives, like tretinoin, that decrease the appearance of hyperpigmentation through multiple pathways. They promote collagen synthesis and reorganization. They also decrease melanin content3
- Mixed-type periorbital hyperpigmentation may respond best to combination therapy3
- Concealers and cosmeceuticals are the least invasive options. Optical diffusers can reduce the appearance of dark circles, but these only cover up the condition3
Hydroquinone and ascorbic acid are not new to this clinical area, but having a base that can stabilize them is. PCCA’s W06™ Anhydrous Topical Gel is a base that has a water activity below 0.6 (Aw < 0.6). It was created to accommodate challenging active pharmaceutical ingredients like hydroquinone and ascorbic acid while giving longer beyond-use dates by default. As well as being a great base, W06 provides moisture and softens the skin.
Contact Pavilion Compounding Pharmacy today to ask our pharmacists about treatment options. We can work with you and your medical provider to create a custom treatment plan individualized to your needs..
1. Vashi, N. A., Wirya, S. A., Inyang, M., & Kundu, R. V. (2017). Facial hyperpigmentation in skin of color: Special considerations and treatment. American Journal of Clinical Dermatology, 18(2), 215–230. https://doi.org/10.1007/s40257-016-0239-8
2. Jage, M., & Mahajan, S. (2018). Clinical and dermoscopic evaluation of periorbital hyperpigmentation.Indian Journal of Dermatopathology and Diagnostic Dermatology, 5(1), 42–47. https://doi.org/10.4103/ijdpdd.ijdpdd_2_18
3. Daroach, M., & Kumaran, M. S. (2018). Periorbital hyperpigmentation − An overview of the enigmatous condition. Pigment International, 5(1), 1–3.
4. Sarkar, R., Ranjan, R., Garg, S., Garg, V. K., Sonthalia, S., & Bansal, S. (2016). Periorbital hyperpigmentation: A comprehensive review. The Journal of Clinical and Aesthetic Dermatology, 9(1), 49–55.
5. PCCA ApothagramBy Sara Hover, RPh, FAARM, PCCA Clinical Compounding Pharmacist