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 (Lab 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, <0.001) and the ΔL by colorimetry (r=0.35, =0.004). Factors associated with subjective dissatisfaction were female sex (r=0.38, =0.002), higher Fitzpatrick skin type (r=0.42, =0.001), fewer hours of sleep (r=-0.28, =0.03), and use of concealer (r=0.35, =0.004). Factors associated with objective measures were higher Fitzpatrick skin type (r=0.36, =0.0007 and r=0.28, =0.009, respectively), family history of PDC (r=0.34, <0.001 and r=0.20, =0.05), and history of eczema (r=0.45, <0.001 and r=0.20, =0.0504). Clinical severity grading correlated with colorimetric severity (r=0.36, =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.