We’ve all probably dealt with dark circles under our eyes at one point or another, and while it’s easy to blame them on a lack of sleep, that’s only one of many factors that might be contributing to that pesky under-eye darkness.
“When people talk about dark circles under the eyes, it seems to be a catch-all phrase,” Dr. Shari Lipner, dermatologist at Weill Cornell Medicine and NewYork-Presbyterian, told HuffPost. “Some people are really referring to dark pigmentation in the under-eye area and some people are speaking about more puffiness or edema, bags under the eyes or just a depression, or even just wrinkles.”
Lipner said it’s important to note that while some of those factors can definitely contribute to the look of dark circles under the eyes, they aren’t all the same thing. Let’s break it down:
Sometimes dark circles really are a result of actual pigmentation of the skin ...
... and there are a few things that contribute to the darker pigmentation some individuals might have under their eyes.
Some people have darker pigmentation on the skin under their eyes than the skin elsewhere on their faces, which leads to the look of dark circles. This factor, according to Dr. Maryam Zamani, an oculoplastic surgeon based in London who treats various eye issues, is oftentimes hereditary and related to genetics. For instance, she noted that Southeast Asian individuals, or those of Southeast Asian descent, are more likely to be predisposed to this type of pigmentation under the eyes.
If you’re unsure whether your dark circles are a result of actual pigmentation or, say, a shadow (more on that later), Zamani offered a simple test: use your finger to pull the skin around the lower eyelid to move it around.
“If you have actual pigmentation, when you move that skin, no matter where you move it, it’s still going to be that color,” she said.
If you have pigmentation under the eyes and you want to reduce the look of it, there are some topical treatments out there that can help brighten and exfoliate, including retinoids and certain acids like glycolic and azelaic, Lipner said.
Zamani also pointed out that hydroquinone, a lightening agent, can be used to reduce the look of dark circles over time. The results of using topical creams will be “very slow, arduous and not hugely successful,” Zamani added, saying “it takes a long time to see a result.”
Inflammatory skin conditions, like psoriasis or eczema
Individuals who have inflammatory skin conditions like psoriasis or eczema on the face may also deal with darkness under the eyes for a couple reasons, Lipner said.
“Number one, eczema and psoriasis are both inflammatory conditions, so that in itself can cause a redness or darkening of the skin,” she explained. “And then the rubbing process, because these diseases tend to be itchy, will definitely exacerbate that.”
Lipner also noted that the pigmentation left behind from these conditions can remain on the skin even after the condition is under control. Dr. Devika Icecreamwala, a board-certified dermatologist based in Berkeley, California, likened the effect to that of certain acne bumps, which sometimes leave behind dark marks on the skin.
“That’s more dependent on your skin,” Lipner said. “People with lighter skin tend to recover faster in terms of post-inflammatory changes, while people with darker skin tend to hold onto pigment a little bit longer.”
The pigmentation left behind by these types of skin conditions can also be treated with the retinoids and/or acids like azelaic or glycolic, Lipner said.
Rubbing your eyes too much.
Excessive eye-rubbing can affect the eye area in different ways, both related to pigmentation and the blood vessels below the skin, according to both Lipner and Icecreamwala.
“When you rub your eyes, the skin may become slightly thicker and darker, it is part of the skin’s defense system,” Lipner explained in a follow-up email. “This is similar to a callus forming on the foot in response to trauma.”
Icecreamwala elaborated, noting that excessively rubbing the eyes is essentially “traumatizing the skin” under the eyes. “The skin is really sensitive, and the more you rub it, the more you irritate it. The skin responds to that with discoloration.”
Excessive rubbing can also lead to broken blood vessels beneath the skin, which lead to the appearance of darkness; since the skin around the eyes is so thin, those underlying broken blood vessels become more visible, Icecreamwala agreed.
That leads us into our next point:
In some cases, what you might perceive as dark circles under your eyes might not be dark circles at all.
As noted above, “dark circles” has become a universal phrase people use to describe a multitude of issues. Sometimes, what people might perceive as dark circles has nothing to do with pigmentation of the skin. Instead, it could be related to shadows left on the skin due to puffiness or, to the contrary, hollowness. Shadows might also be the result of the general structure of one’s face.
Additionally, since we know the skin around the eyes is very thin, and therefore shows what’s underneath, it’s more prone than other parts of the body to appear darker, Icreamwala said. Again, that doesn’t necessarily have to do with the skin’s pigmentation.
Below are the common factors that can contribute to the look of darkness under the eyes without actually changing the color of the skin:
Individuals who are affected by the dreaded allergy season may find they develop darkness under the eyes as a result.
“They’re called allergic shiners,” Zamani said, “because they look like you’ve been popped in the eye twice.”
Under-eye darkness that happens to certain allergy sufferers has to do with the blood vessels under the skin around the eyes, which is the thinnest skin on the face, Icreamwala said.
Allergies trigger histamines in the body, which can lead to dilated blood vessels, as noted in Good Housekeeping. According to Zamani, since the skin around the eyes is so thin ― “it’s see-through,” she said ― and the blood vessels are dilated, you get left with that “purple or darkness” on the lower lids.
Taking an antihistamine and getting a good night’s sleep can “help reduce the appearance of dark circles under the eyes” during allergy season, Zamani said.
People who deal with seasonal allergies might also experience puffiness around the eye area, which Icecreamwala noted is a build-up of fluid. Once that puffiness goes away, she said, it leaves behind a hollowness, which may make the area appear darker.
Icecreamwala said dehydration also plays a role in darkness under the eyes. To illustrate her point, she pointed to excessive alcohol consumption.
“When you drink, you’re losing fluids and electrolytes and you’re losing that fluid underneath your eyes, so it looks more hollow and there’s not as much tissue between your skin and bone socket under your eyes,” she said, adding that in a case like this, the apparent darkness would be the result of a shadow as opposed to pigmentation.
When the skin is dehydrated, Lipner noted it can look a little more mottled or dark, therefore leading to the appearance of darkness under the eyes. One way to address that is with under-eye creams, which she said “can make the skin look lighter [by] improving the skin barrier there.”
Zamani elaborated, saying ingredients like hyaluronic acid, ceramides and peptides are all good for giving your skin moisture.
“If you have moisture locked into your skin, you are making that skin a little bit thicker in that area, and therefore you can’t see the dilated and tortuous vessels as much underneath it,” she said.
Retinoids are also effective for treating the eye area, as they help increase the skin’s thickness by building collagen, Zamani said.
Puffiness of the eye area, Zamani said, is like gray hair: “everybody gets it.” Some people may experience it in their 20s, others in their 30s, some in their 50s and beyond.
That puffiness is caused by a fat prolapse, she said, explaining that we have three fat pads in our lower eyelid area: the medial, the central and the lateral.
“We have a tissue that holds all that back and, for genetic reasons, sometimes contact lens wearers or really allergic people who rub their eyes a lot, that tissue becomes attenuated and thinner,” she said. “When it becomes attenuated and thinner, the fat starts coming forward [and] that creates actual puffiness.”
Then, that puffiness creates a shadow just above the cheek, which might be perceived as darkness under the eyes, she added, noting that dermal fillers can be used to smooth out the area and reduce the shadow. However, she said, that would only mask the problem; the most successful way to treat a fat prolapse is with an eyelid surgery to remove the fat, Zamani said.
Puffiness can also be attributed to edema, which is a buildup of fluid around the eye area from damaged blood vessels, according to the National Eye Institute.
“A lot of people think they have puffy eyes, but they really have volume depletion,” Zamani said.
She explained that as we age, the eyelid-cheek junction becomes elongated, and you can visibly see where the eyelid ends and cheek begins. When we’re kids, there’s little differentiation between where the eyelid ends and the cheek begins, she said. But as we get older, that line sometimes becomes more dominant.
“When that happens, you basically see what people call dark, puffy eyelids, but ... it’s just the elongation of the eyelid-cheek junction,” Zamani said. “If people have that, they think those are dark circles, but actually it’s a shadow. That shadow is what makes the appearance of a bag.”
As we get older, our skin becomes thinner. That includes the eye area, which is already very thin. As a result, the underlying blood vessels become more visible.
Additionally, we lose fat as we age, and as Lipner said, “if you lose the fat pad [under the eye], it’s definitely going to look darker.”
So, what should you do if you’ve got darkness or puffiness that won’t go away?
It’s clear that under-eye circles can be the result of an array of different issues, so your best bet for addressing them is to see a dermatologist or your doctor. In rarer cases, Zamani and Lipner said dark circles could be symptomatic of more serious medical issues, like cardiovascular or kidney problems.
But, Lipner added, when a doctor or dermatologist diagnoses you, “you can really be guided toward the right treatment depending on what the darkness is attributed to.”
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This article originally appeared on HuffPost.