Pathophysiologic Aspects of Dark Eye Circles and Impact on Associated Quality of Life in Participants with Various Fitzpatrick Skin Types.

Purpose: Dark eye circles (DECs) are a prevalent cosmetic concern for understanding the pathophysiological properties and etiology of DECs is crucial for effective treatment. This study assessed baseline DEC characteristics and associated quality of life (QOL) impacts in participants with varying DEC severities and Fitzpatrick Skin types (FSTs). Participants and Methods: Adult with DECs across FSTs were enrolled into this observational study. Assessments were grouped as follows: clinical (investigator grading of DEC severity, DEC type, and puffiness), biophysical (spectrophotometry, corneometry, tewametry, and BTC-2000 elasticity/laxity measurements), imaging (standardized photography, 3D imaging, and dynamic optical coherence tomography [D-OCT]), and patient-reported outcomes (FACE-Q and participant questionnaires). Results were summarized descriptively by DEC severity and FST; statistical testing was performed for D-OCT comparisons across FST groups. Results: All 42 participants who completed the study had at least mild DEC severity in both lower and upper eyelids, with severe DEC incidence similar on the upper and lower eyelid. Most exhibited multiple DEC types (ie, pigmented, vascular, shadow effect) and mild eye area puffiness. Participants with mild DECs had the highest mean eyelid skin elasticity. Participants with moderate DECs showed transepidermal water loss (TEWL) measurements suggestive of high hydration and barrier function in the lower eyelid skin. Participants of all DEC severities were bothered by their upper and lower eyelids. Those with severe DEC reported on the FACE-Q more negative perceptions of their facial skin age and eyelid appearance and were less confident or positive about their facial appearance. DEC severity was highest in participants with FST V-VI. Pigmented and shadow effect DECs were observed more in FST III-IV and V-VI, whereas vascular DECs appeared most in FST I-II. Spectrophotometer results showed that the difference between control and lower eyelid skin was broadly similar across FST groups. D-OCT revealed that the FST V-VI group had significantly thinner vascular networks, but significantly higher epidermal thickness (P < 0.05) than the other FST groups. Participants with FST V-VI felt more positive perceptions about their skin age; however, types III-IV and V-VI were more bothered by their lower eyelids than types I-II. Conclusion: DECs are present on the upper and lower eyelids and participants are bothered by both areas regardless of severity. DEC characteristics varied according to severity and FST and influenced participant-based perception of eyelid appearance, facial age, and confidence.