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home : columns : ask the doctors June 24, 2019

4/1/2019 8:33:00 AM
Genetics play a large role in under-eye circles

Dear Doctor: I'm a white man in my mid-40s, and I have significant dark areas under and around my eyes. I feel awkward inquiring about this, but people stare and judge, and I've become self-conscious. What is the cause? Can you offer any advice on how to lessen these dark areas?

Dear Reader: Ask any dermatologist, and they'll tell you that dark circles under and around the eyes are a common concern among their patients, men and women alike. We field a lot of questions about them in our practices as well.

While typically not a health issue, dark areas around the eyes can be aging, and they can make someone look tired or ill, even when they're healthy and fully rested. Our faces are our calling cards to the world. Research shows that within the first few seconds of meeting someone, even before a word has been spoken, we're unconsciously forming first impressions based on the way the other person looks. It's not surprising that, despite being benign, dark circles are unwelcome.

When it comes to the cause, there are a few broad categories. One is something known as genetic hyperpigmentation. That is, due to genetics and heredity, the skin beneath or around the eyes is actually a darker hue. Other factors that can lead to changes in pigmentation include sun exposure, allergies and allergic reactions, certain medications and hormonal changes, to name just a few.

Another reason for the appearance of dark circles is that the underlying blood vessels are becoming visible. This can occur when the skin in the area becomes thinner, which happens as we age. Another potential cause is that the blood vessels under and around the eyes have become dilated. Not only does this make them more easily visible, but the blood in the area can pool or leak out, adding to the illusion of darker pigmentation. Poor diet, chronic lack of sleep, excessive use of alcohol or tobacco, physical exhaustion, poor circulation, certain medical conditions and allergies can all contribute to, or exaggerate, this effect.

In some people, the physical structure of the eye area can also play a role in dark circles. Whether it's the result of aging, genetics or even weight loss, some people have a depression around the eye sockets. These can cause shadowing that reads as dark circles.

Reversing the appearance of dark circles isn't easy. Treatment options for genetic hyperpigmentation include the use of concealers, lightening creams, chemical peels and laser therapy. For dark areas not due to genetics, changes to lifestyle and behavior may be helpful. These include getting enough sleep. (Your whole body will thank you.) Avoid added salt, which contributes to swelling that can make dark areas more pronounced. If you have allergies, take steps to treat them. Avoid rubbing your eyes, which stretches and stresses delicate tissues and can cause inflammation and capillary damage.

The application of a cold compress can counteract dilation in the under-eye area. Also available are a range of creams that contain vitamin C, caffeine and retinoids to build collagen and constrict blood vessels. Whatever approach you choose, it's important to be realistic. You'll be managing the condition, not reversing it.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.

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