Periocular Dark Circles: Correlates of Severity

BACKGROUND: Periocular dark circles (PDCs) are a common cosmetic complaint. Grading systems based on objective measures have been used but no standard system is in place. OBJECTIVE: To determine factors associated with subjective and objective PDC severity. METHODS: Enrolled patients (n=100) completed a questionnaire comprised of demographic variables, medical history, and self-perception of PDC. Those perceiving PDC graded dissatisfaction on a 10-point scale. Clinical severity (grades 0~4) and subtype (constitutional, post-inflammatory, vascular, shadow effects, or others) were determined. A Konica Minolta CR-400 chromameter was used to obtain colorimetry measurements (L(*)a(*)b(*) values). The objective average difference in darkness (ΔL(*)) between the periocular region and the cheek was determined. Comparisons were made using Spearman correlation coefficients (r). RESULTS: Patient dissatisfaction correlated with both clinical severity (r=0.46, p<0.001) and the ΔL(*) by colorimetry (r=0.35, p=0.004). Factors associated with subjective dissatisfaction were female sex (r=0.38, p=0.002), higher Fitzpatrick skin type (r=0.42, p=0.001), fewer hours of sleep (r=−0.28, p=0.03), and use of concealer (r=0.35, p=0.004). Factors associated with objective measures were higher Fitzpatrick skin type (r=0.36, p=0.0007 and r=0.28, p=0.009, respectively), family history of PDC (r=0.34, p<0.001 and r=0.20, p=0.05), and history of eczema (r=0.45, p<0.001 and r=0.20, p=0.0504). Clinical severity grading correlated with colorimetric severity (r=0.36, p=0.0003). CONCLUSION: Overall, subjective dissatisfaction was associated with clinical severity. However, factors associated with subjective severity did not necessarily overlap with factors associated with objective severity. These findings highlight the importance of patient-reported grading. There may be added value in incorporating a component of subjective grading into the traditionally objective PDC grading scales.