Dark circles: purple, brown or hollow?

"You look tired." For people with dark circles, it is a familiar phrase, often heard after a good night's sleep. And the frustration grows when eye cream, concealer and eight-hour nights make little difference.

The reason is simple: "dark circles" is not one single thing. The same dark area under the eyes can result from blood vessels visible through very thin skin, from excess pigment, or from a shadow created by the shape of the face. Each cause responds to different things. And, in most people, there is more than one at the same time.

Vascular dark circles: the purple that comes from below

The skin of the lower eyelid is the thinnest on the body (Ha et al., 2005). Beneath it lies a muscle (the orbicularis oculi) and a network of small veins. When the skin is very thin and translucent, the colour of these structures shows through: bluish, purplish or slightly pinkish.

How to recognise them:

• Bluish, purple or pinkish colour, more intense at the inner corner of the eye.
• More visible on fair, thin skin.
• They get worse with tiredness, bad nights' sleep, crying, heat, alcohol and menstrual periods.
• They may improve slightly in the morning or through the day.

What makes them worse:

• Lack of sleep. In a study in which observers rated photographs of the same people after they had slept well and after sleep deprivation, darker dark circles and heavier eyelids were among the signs that contributed most to looking tired (Sundelin et al., 2013).
• Allergies and nasal congestion. Allergic rhinitis hinders venous drainage in the area and is associated with so-called "allergic shiners", common in children.
• Ageing. The skin becomes even thinner and loses supporting fat, making the vessels more visible.
• Rubbing the eyes, which inflames and may add a pigmented component.

It is not, as a rule, a sign of illness. But dark circles that appear suddenly or accompanied by other symptoms deserve assessment (see below).

Pigmented dark circles: the brown that is in the skin

Here the problem is excess melanin in the skin of the eyelids, sometimes also at depth. Specialists call it periorbital hyperpigmentation (Sarkar et al., 2016).

How to recognise them:

• Brown colour, sometimes greyish, surrounding the lower eyelid and, often, the upper one too.
• More frequent in intermediate and darker phototypes.
• Often present since childhood or adolescence, with other family members showing the same pattern.
• Little influenced by sleep.

Causes and associated factors:

• Hereditary or constitutional, the most common cause.
• Post-inflammatory hyperpigmentation, from atopic dermatitis, contact dermatitis (to cosmetics, eye drops) or from the habit of scratching and rubbing.
• Sun, which intensifies any pigmentation.
• Extension of melasma or of dermal pigmented spots (such as naevus of Hori, more frequent in people of Asian origin).
• Medicines: some glaucoma drops from the prostaglandin analogue family can darken the skin of the eyelids. Do not stop them without speaking to your ophthalmologist.

Pigmentation may be epidermal (more superficial, better response to treatment) or dermal (deeper, greyish, more persistent). At the consultation, Wood's lamp helps tell them apart.

Structural dark circles: when shape casts the shadow

In this type, the skin may be of normal colour. The dark is a shadow, created by the relief of the area.

Two main situations:

• Tear trough (or dark circle groove): a depression between the lower eyelid and the cheek, more marked at the inner corner. It may be constitutional (present from youth, especially in people with little cheekbone projection) or worsen with age, with loss of volume and bony support in the midface.
• Eyelid bags: the fat that sits behind the orbital septum projects forwards with age, forming a bag. Beneath it a shadow is created that looks like a dark circle.

How to recognise them:

• The dark area changes with the lighting: it is worse with overhead light (lifts, bathrooms) and better with light from the front.
• It improves when you look up or tilt your head back.
• Often there are also bags or a visible step between the eyelid and the cheek.

For morning puffiness (which also creates shadow but is temporary), there is a dedicated article: Waking up with puffy eyes: causes and what helps.

Most are mixed

A classification study of 65 patients with dark circles, assessed with Wood's lamp and ultrasound, found this distribution (Huang et al., 2014):

The study was carried out in an Asian population and the proportions may vary in other populations, but the main message is consistent with clinical practice: there is almost always more than one component. A person may have thin (vascular) skin, a little hereditary pigment and a groove that becomes more pronounced with age. That is why a treatment aimed at a single cause often has only a partial effect.

Tests at home: which type do you have?

You need a mirror, good natural light and one minute.

1. Stretch test

With your finger, gently stretch the skin of the lower eyelid to the side.

• If the colour stays the same, there is pigment (brown component).
• If the colour becomes more purple or bluish, the skin is thin and there is a vascular component.
• If the dark area disappears or improves a great deal, it was mainly shadow (the structural component).

2. Light test

Look at yourself with light coming from above and then with light from the front (for example, facing a window).

• If the dark circle changes a lot with the direction of the light, it is mainly structural.

3. Look-up test

Tilt your head back and look at the ceiling.

• If the dark circle softens, there is a shadow or bag component.

4. Pressure test

Gently press the area.

• If it blanches and returns, there is a vascular component.

5. Your history

Have you had dark circles since childhood and relatives with the same pattern? Think hereditary pigment. Do they get much worse with tiredness? Think vascular. Did they appear or worsen with age? Think structural.

These tests give good guidance, not a diagnosis. At a consultation, examination with Wood's lamp and a dermatoscope adds precision.

What helps with each type

For everyone

• Sunscreen up to the edge of the eyes and sunglasses. The sun worsens pigment and breaks down the collagen that gives the skin thickness.
• Do not rub your eyes. Treat the allergies that lead to scratching.
• Remove make-up gently, letting the product work instead of rubbing.
• Get enough sleep. It does not resolve pigmented or structural dark circles, but it stops the vascular component from getting worse.

Vascular

• Gentle retinoids, with slow adaptation: by stimulating collagen, they can make the skin slightly thicker and less translucent over months. Start slowly: the skin around the eyes is easily irritated.
• Cold in the morning (cold compresses), which temporarily constricts the vessels.
• Topical caffeine and vitamin K: used in many eye creams, with small studies and a modest effect (Ahmadraji and Shatalebi, 2015).
• Treat allergic rhinitis, if present.
• Peach or salmon colour corrector, which neutralises the bluish tone.

Pigmented

• Gentle depigmenting agents: azelaic acid, niacinamide, vitamin C, kojic acid, arbutin. The effect is slow.
• Hydroquinone and triple combinations: only on medical prescription; prolonged use of corticosteroids on the eyelids requires great caution.
• Superficial peels adapted to the eye area, in the clinic, with preparation.
• Lasers, in selected cases, by a doctor.
• A stronger orange or peach colour corrector, depending on skin tone.

Structural

• Creams have a limited effect, because they do not restore volume.
• Tear trough filler with hyaluronic acid: it can soften the shadow. It is a medical act in a delicate area, with specific risks (prolonged swelling, a bluish tone if the product sits too superficially and, rarely, serious vascular complications). It is not suitable for everyone, especially when there are significant bags.
• Blepharoplasty, when fat pads are the main cause.
• Restoring support to the midface (cheekbones) may, in some cases, indirectly improve the eyelid-cheek transition.

Because most dark circles are mixed, a good plan usually combines several of these approaches. See also Eye creams: what to expect.

When dark circles should be seen by a doctor

In the vast majority of people, dark circles are an aesthetic matter. But there are situations that deserve medical assessment.

At Luxmed, the assessment of dark circles begins by identifying which components predominate: vascular, pigmented or structural. From there we define home care, skin treatments suited to the eye area and, when indicated, medical referral.

This article is for information purposes and does not replace a medical consultation. The results of any treatment vary from person to person.

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