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INTRODUCTION

KEY POINTS

  • Hyperpigmentation is a common disorder affecting individuals with skin of color.

  • Postinflammatory hyperpigmentation (PIH) may be secondary to inflammatory disease, infection, allergic contact or irritant reactions, injury from prior procedures or trauma, sites of papulosquamous or vesiculobullous disease, and medication reactions.

  • Periorbital hyperpigmentation may be secondary to excessive epidermal or dermal melanin deposition, excessive or superficial vasculature or skin laxity, or periorbital fat pseudoherniation.

  • Treatment, which should be directed toward the primary etiology, includes photoprotection, topical bleaching agents, chemical peels, lasers, dermal fillers, and surgical intervention.

  • Although PIH and periorbital hyperpigmentation are not life threatening, they negatively affect quality of life.

Postinflammatory hyperpigmentation (PIH) is a common disorder that occurs in just about all individuals with skin of color [Figure 52-1]. This acquired hyperpigmentation may involve areas of prior inflammatory disease, infection, allergic contact or irritant reactions, injury from prior procedures or trauma, sites of papulosquamous or vesiculobullous disease, and medication reactions [Figure 52-2, A to C].1,2,3 PIH commonly appears on the skin as brown to gray macules or patches.4 Periorbital hyperpigmentation, often colloquially referred to as dark circles, is defined as bilateral, homogeneous, hyperchromic macules and patches primarily involving the upper and lower eyelids, but also sometimes extending toward the eyebrows, malar regions, and lateral nasal root.5,6 Many causal factors have been implicated in the development of periorbital hyperpigmentation [Table 52-1]. Periorbital hyperpigmentation can be much more noticeable in skin of color populations3 and is often a significant cosmetic concern because it can portend a fatigued, sad, or aged appearance.7,8,9

TABLE 52-1Etiology of periorbital hyperpigmentation
FIGURE 52-1.

Hyperpigmentation on the face. (A) Postinflammatory hyperpigmentation from acne in a woman with skin type V. (B) Hyperpigmentation on the face of a woman with skin type VI. (Used with permission of Dr. Barbara J. Leppard.) (C) Hyperpigmentation on the cheek of a Hispanic woman with skin type IV.

Both PIH and periorbital hyperpigmentation can be emotionally distressing for patients, affecting all aspects of their personal and professional lives.4

EPIDEMIOLOGY, ETIOLOGY, AND PATHOGENESIS

PIH affects women and men with ...

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