ASK THE DOCTOR: Genetics plays a role in the circles under the eyes Health

Dear doctor: I am a white person in my mid 40s and I have significant dark areas under and around my eyes. I was embarrassed to ask about it, but people were watching and judging and I became unconscious.

What is the reason? Can you give any tips on how to reduce these dark areas?

Dear reader: Ask any dermatologist and he will tell you that dark circles under and around the eyes are a common problem of their patients, both men and women. We also ask a lot of questions about them in our practice.

Although this is not usually a health problem, dark areas around the eyes can age and they can cause fatigue or soreness, even if they are healthy and completely rested. Our faces are our calling card of the world.

Research shows that during the first few seconds of meeting someone, even before the word has been said, we unconsciously form a first impression based on how the other person looks. Not surprisingly, despite the goodness, dark circles under the circles are undesirable. When it comes to cause, there are several broad categories. One is what is known as genetic hyperpigmentation. That is, due to genetics and heredity the skin under or around the eyes actually has a darker shade. Other factors that can lead to changes in pigmentation include sun exposure, allergies and allergic reactions, some medications and hormonal changes, and these are just a few.

Another reason for the appearance of dark circles is that the underlying blood vessels become visible. This can happen when the skin in this area becomes thinner, which happens with age. Another potential reason is that the blood vessels under and around the eyes dilate. Not only does this make them easier to see, but blood in the area can collect or leak, creating the illusion of darker pigmentation. Malnutrition, chronic sleep deprivation, excessive alcohol or tobacco use, physical exhaustion, poor circulation, certain diseases and allergies – all of these can contribute to or exaggerate this effect.

In some people, the physical structure of the area around the eyes may also play a role in the appearance of dark circles. Whether it is the result of aging, genetics or even weight loss, some people have depression around the eyelids. This can cause shading, which reads like dark circles. Changing the appearance of dark circles is not easy. Treatment options for genetic hyperpigmentation include the use of concealers, lightening creams, chemical peels and laser therapy. For dark areas that are not driven by genetics, changes in lifestyle and behavior can be helpful. These include getting enough sleep. (Your whole body will thank you.) Avoid adding salt, which contributes to swelling, which can make dark areas more pronounced. If you have allergies, take steps to treat them. Avoid rubbing the eyes, which stretches and strains delicate tissues and can cause inflammation and damage to capillaries.

Applying a cold compress can counteract the enlargement under the eyes. Also available are a number of creams containing vitamin C, caffeine and retinoids to build collagen and narrow blood vessels. Whatever approach you choose, it is important to be realistic. You will manage the state, not cancel it.

Eva Glaser, MD, MBA, is a therapist and associate professor of medicine at UCLA Health. Elizabeth Co., MD, is a therapist and associate professor of medicine at UCLA Health.

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