eye bags

Marian Grosser studied human medicine in Munich. In addition, the doctor, who was interested in many things, dared to make some exciting detours: studying philosophy and art history, working on the radio and, finally, also for a Netdoctor.

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Dark circles are a dark shade of skin around the eyes, which is usually most noticeable below the eyes. Experts speak of halonation. Dark circles under the eyes are rarely a sign of a disease; it is usually a purely cosmetic problem. Find out everything you need to know about the causes, shapes and treatment options for dark circles under the eyes.

Brief overview

• Formation & causes: Mostly dark circles are based on translucent blood vessels (hereditary or the result of e.g. lack of sleep, fluid or iron, alcohol consumption, smoking, drug abuse, kidney or thyroid diseases). Some dark circles are also caused by hyperpigmentation of the skin (hereditary or the result of e.g. increased UV radiation, certain skin diseases, drugs or certain medications).
• When to the doctor Sudden, long-standing dark circles that cannot be explained (e.g. due to lack of sleep or malnutrition). This is especially true if other symptoms occur.
• Tips: Place moist tea bags (green or black tea), cucumber slices or cold spoons on the affected areas of the skin (only helps with translucent blood vessels!). Make sure you get enough sleep and hydration as well as a healthy diet. Avoid alcohol, nicotine and other drugs. If necessary, conceal the dark circles with a concealer.
• Treatment: If necessary, treatment of the cause, e.g. iron supplements for iron deficiency, therapy of underlying kidney or thyroid diseases. For hyperpigmentation: whitening cream, laser therapy or injection of autologous fat into the area under the eyes. For translucent blood vessels: injecting autologous fat or hyaluronic acid.

Dark circles: treatment

The answer to the question "What helps against dark circles?" depends on the cause of the dark shadows under the eyes.

If hyperpigmentation is the reason for the dark circles, there are various drugs to choose from that can reduce the melanin in the skin (e.g. hydroquinone). However, these bleaching substances should only be applied very carefully and under the guidance of a doctor, as they can sometimes have severe side effects. An alternative are special lasers that the doctor can use to destroy the pigments in the skin in a targeted manner. These two methods can also be combined. Injecting autologous fat into the area under the eyes also makes the vessels less shine through.

If dark circles appear because of the translucent vessels, the treatment looks very different. Bleaching creams would be completely wrong here because they make the skin even thinner and more transparent than it already is. Instead, fat that comes from the patient himself is injected between the skin and the underlying blood vessels (autologous fat transplantation). Alternatively, you can also use hyaluronic acid, but autologous fat is better tolerated and has fewer side effects.

Dark circles: you can do that yourself

Whether in advice magazines, on the Internet or from friends: There are many tips against dark circles. However, you should be careful not to follow them rashly. Namely, some popular home remedies for dark circles can cause problems. For example, moist tea bags or cucumber slices that are placed on the eyes can trigger allergies or irritate the eye.

Many of the tips advertised - including cold teaspoons or washing with cold water - are ultimately based on cooling the eye areas. This causes local blood vessels to contract so that they can be seen less clearly through the skin. The effect is only short-term. And: If hyperpigmentation is the cause of dark circles, these methods do not help at all.

Instead, it makes more sense to avoid typical risk factors for dark circles. Make sure you get enough sleep and drink enough. You should only drink alcohol in moderation and, ideally, refrain from smoking altogether. If that doesn't help, you can use so-called concealers. With these special cosmetic creams you can at least temporarily hide the dark circles under the eyes.

Dark circles: origin and causes

Dark circles make the eyes sunken and often make those affected look sick. In fact, diseases are rarely the cause of dark circles. Most of the time, the dark shadows around the eyes are harmless and have no impact on health.

A basic distinction is made between two different mechanisms for the formation of dark circles: hyperpigmentation and blood vessels showing through the thin skin.

Excessive pigmentation of the skin (hyperpigmentation)

The skin has special pigments, so-called melanins, which help determine the color of the skin. The more of it there is in the skin, the darker it appears. If melanins are increasingly deposited in individual areas, one speaks in medicine of hyperpigmentation or melasma.

If the eye area is affected by hyperpigmentation, it usually shows up in the form of blue or blue-gray circles under the eyes. Causes of such hyperpigmentation are, for example:

• increased UV radiation, for example from extensive sunbathing or frequent visits to the solarium
• Rashes and inflammation of the skin, for example in the context of a contact allergy or neurodermatitis (rubbing and scratching the affected areas also promotes pigment storage)
• Drugs and certain medications
• certain diseases and malformations of the skin (nevus ota, erythema dyschromicum pertans)

Hyperpigmentation can also be hereditary. Often several people in a family have dark circles under the eyes without a specific reason being found.

Translucent vessels

Most of the time, the skin itself is not the cause of dark circles. Instead, the cause lies deeper in many cases:

The eye is surrounded in a circle by a muscle (Musculus orbicularis ori). Because the skin and subcutaneous fat tissue are very thin, especially below the eye (infraorbital), blood vessels that supply this muscle can shine through the skin there. This makes the affected areas look shady and visible dark circles appear.

How much the blood vessels shine through the skin varies greatly from person to person. Among other things, this depends on the skin type and the thickness of the infraorbital subcutaneous fat. Especially very light-skinned, slim people tend to have dark circles under the eyes. There are also many other factors that can help the vessels show through:

• lack of sleep
• Dehydration
• Malnutrition
• Iron deficiency
• Drug abuse, including increased consumption of alcohol and nicotine
• Environmental toxins, for example heavy metals
• certain underlying diseases, such as the kidneys or thyroid gland

Basically, the less oxygen they transport, the more blood vessels shimmer through the skin. Because oxygen-poor blood is darker than oxygen-rich blood. Lack of sleep sometimes leads to poor blood flow to the infraorbital vessels and is therefore often the reason why dark circles suddenly appear.

Some changes in old age can also cause dark circles under the eyes. On the one hand, the subcutaneous fat loses substance with age, on the other hand, the skin becomes slacker. Both contribute to the fact that the vessels shine through more. In addition, the tear trough - a certain section on the inside of the infraorbital area - increasingly collapses, which increases the shadowy effect.

As with hyperpigmentation, genetic factors are also possible for more translucent blood vessels.

Dark circles: when do you need to see a doctor?

Dark circles rarely have serious causes. Especially people who generally tend to have dark circles under the eyes and otherwise have no complaints need not worry. Often the dark circles are hereditary and have no disease value. Even after short nights, dark circles are nothing unusual and usually disappear again soon.

However, if you suddenly notice long-lasting dark circles under the eyes and you are otherwise not used to this, you should mention this fact when you next visit your doctor. This is especially true if you notice other symptoms (such as unusual tiredness, difficulty concentrating, etc.). The information from the doctor-patient conversation about your medical history (anamnesis) and possible examinations (such as blood tests) help the doctor to find out the reason for your dark circles and any other symptoms. If necessary, he will then initiate appropriate treatment.

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