Dark Circles & Under-Eye

Dark Circles & Under-Eye: A Nutritional and Natural-Health Reference

Definition and Clinical Presentation

Periorbital hyperpigmentation (POH), commonly known as dark circles under the eyes, is a very frequent concern among both young and adult patients of any skin type. It is defined as the occurrence of bilateral hyperchromatic macules and patches usually affecting the lower eyelids; this hyperpigmentation can also be present on the upper eyelids, malar region, eyebrows, and neighboring regions.

Periorbital hyperpigmentation or periorbital melanosis is a condition in which the semicircular area underneath the eye turns pigmented, taking on a tan-brown or black hue depending on skin color. At times, the change in hue may also affect the region around the eyebrows, upper eyelids, cheeks, temples, and along the sides of the nose. Depending on one's ethnicity and the type of concern, the dark circles can take on hues like brown, blue, pink, black, and purple.

Periorbital hyperpigmentation is generally categorized into four types based on etiology: pigmented (brown color), vascular (blue/pink/purple color), structural (skin color), and mixed type.

The under-eye area has the thinnest skin on the body — approximately 0.5 mm versus approximately 2 mm elsewhere — making underlying blood vessels, fluid retention, and pigment changes highly visible.

The etiology is multifactorial with a genetic background. Prevalence is higher in darker skin types. It has been estimated as high as 30% in a recent Indian study. Periorbital melanosis is most commonly prevalent in women and may manifest as early as the ages of 16 to 25 in growing adults.

Body Systems and Tissue Structures Involved

The presentation of periorbital dark circles involves several overlapping biological systems and anatomical structures:

The Skin and Dermal Architecture

Dark circles are likely to become more noticeable and permanent with age. As people get older, their skin loses collagen, becoming thinner and more translucent. The area under the eyes also has less subcutaneous fat than other parts of the face and comparatively fewer sebaceous glands.

The Melanogenic System

Aging around the eyes results in periorbital hyperpigmentation; the dark discoloration seen with the appearance of dark circles under the eyes, which frequently also affects the upper eyelids, is due to excess deposition of the skin pigment melanin. Sunlight causes the skin to produce more melanin, the pigment that darkens skin. Periorbital hyperpigmentation occurs when more melanin is produced around the eyes than is usual, giving them a darker color.

The Vascular System

Blood stasis or dilation of the superficial microvasculature, shadowing due to periorbital structural geometry, and thin translucent skin overlying the orbicularis oculi muscle are possible causes of dark circles under the eyes. Hemoglobin breakdown products such as hemosiderin and biliverdin can leak from the vasculature, contributing to pigmentation changes.

Structural and Anatomical Factors

As facial fat descends and fat volume decreases, the somewhat inflexible ligaments can result in orbital rim and facial hollowing. Bony structure and prominence of the orbicularis oculi muscle can contribute to infraorbital dark circles.

The Immune and Inflammatory System

Inflammation from various conditions including atopy and contact dermatitis may lead to hyperpigmentation. Medications such as oral contraceptives or ophthalmic prostaglandin F2α use have been found to increase pigmentation.

Contributing and Associated Factors

Genetic and Hereditary Factors

Family history was the most significant risk factor for periorbital dark circles in a Brazilian population study using hyperspectral imaging. The average age of onset was 24 years, and earlier onset correlated with higher severity scores. In a clinical study of 74 patients with POH, 39 patients (53%) had a family history of POH.

Age and Photoaging

Skin changes around the eyes are one of the first signs of aging, tending to occur in the third decade of life. Many of these changes are directly due to the effects of photoaging — skin damage from ultraviolet radiation. Delicate under-eye skin is susceptible to environmental stresses that increase oxidative stress by free radicals such as UV exposure, smoking, and air pollution, resulting in damage to cellular and extracellular components.

Atopy, Allergy, and Inflammation

Asthma was significantly associated with periorbital dark circle scores in a published Brazilian study, though self-reported allergy was not. Allergies cause the release of histamine, leading to swelling and vascular darkening. Chronic rubbing, eczema, and atopic dermatitis can increase melanin deposition in the epidermal and dermal layers.

Sleep

A lack of sleep and mental fatigue can cause paleness of the skin, allowing the blood underneath the skin to become more visible and appear bluer or darker. However, the relationship between sleep quantity and dark circle severity is less straightforward than commonly assumed. One of the most interesting findings in a Brazilian study was that sleep quantity and quality were not correlated with physician-assessed dark circle severity. A separate investigation similarly elucidated doubts about the insignificant effect of sleep quality on the severity of POH.

Sun Exposure

A history of excessive sun exposure was given by a significant proportion of patients in one study, indicating worsening of POH by sun exposure more than five hours a day.

Hormonal and Systemic Conditions

Dark circles should be distinguished from systemic causes including anemia, hypothyroidism, and adrenal insufficiency. Deranged thyroid profile in patients with POH has been reported in the literature, though one cross-sectional study found this association was not statistically significant. Skin can also become more pale during pregnancy and menstruation due to lack of iron, allowing the underlying veins under the eyes to become more visible.

Lifestyle and Behavioral Factors

Two key factors associated with periorbital hyperpigmentation in one published study were rubbing eyes and prolonged exposure to television. Sleep deprivation and dehydration can worsen venous congestion, and high salt intake and lying flat impair fluid drainage around the eyes.

Dominant Biological Mechanisms

Although typically associated with lack of sleep, risk of periorbital dark circles is primarily hereditary according to a published hyperspectral imaging study. The main factors contributing to the appearance of periorbital dark circles are melanin and deoxygenated blood.

Nutritional Deficiencies Associated with Periorbital Hyperpigmentation

The etiology of POH is multifactorial, including genetic/hereditary factors, post-inflammatory hyperpigmentation, dermal melanin deposition, secondary changes from atopic or allergic contact dermatitis, anemia, stress, faulty habits, periorbital edema, superficial location of vasculature, shadowing due to skin laxity, nutritional deficiencies, and chronic illness.

Iron Deficiency

Iron deficiency is the most clinically documented nutritional cause, present in roughly half of patients with periorbital hyperpigmentation in some studies. Iron deficiency anemia may also cause dark circles under the eyes; 50% of participants with POH in a 2014 study had anemia, and many of those patients reported that the dark circles disappeared once their anemia was treated. Facial pallor due to anemia makes the periorbital region look comparatively darker, and due to low hemoglobin, there is a lack of enough oxygen supply in the periorbital area leading to POH.

Iron deficiency is the most common type of anemia, and this condition is a sign that not enough oxygen is getting to the body tissues. Evidence from observational studies supports this association; however, the data are cross-sectional in nature, limiting causal conclusions.

Vitamin B12

In a clinico-investigational study of 50 patients with periorbital pigmentation, laboratory investigations showed low-serum vitamin B12 (<200 pg/mL) in 6 (12%) of patients; of these six patients, only two had anemia, suggesting that low vitamin B12 can be present in patients with POH independent of anemia status.

It is suggested that deficiency of vitamin B12 causes a decrease in intracellular reduction potential that leads to oxidation of reduced glutathione and a decrease in the GSH/GSSG ratio. Epidermal melanocytes are then stimulated to produce melanin, as the tyrosinase-inhibiting effect of glutathione has been diminished.

Deficiency of vitamin B12 has been known to be responsible for increased pigmentation; however, its role in the etiopathogenesis of POH had not been studied until relatively recently. Hyperpigmentation can be an early clinical feature or the only manifestation of vitamin B12 deficiency. Hyperpigmentation associated with cobalamin deficiency is often encountered in dark-skinned people. About 1 in 5 persons deficient in cobalamin may have this particular dermatological manifestation. The exact pathophysiologic mechanism is not fully understood.

The evidence for vitamin B12's link to periorbital hyperpigmentation specifically derives primarily from case reports and small cross-sectional studies rather than controlled trials, and should be interpreted as preliminary.

Vitamin C

Vitamin C is required for collagen synthesis — the structural protein that gives skin its thickness and resilience. Under the eyes, adequate collagen is what prevents the vascular network from showing through. When vitamin C is deficient, periorbital skin thins and capillary walls weaken, making blood vessels more visible and more prone to minor leakage. The direct evidence linking vitamin C deficiency to dark circles is still emerging rather than definitive.

There is stronger evidence supporting the potential of vitamin C to reduce brown under-eye circles that stem from hyperpigmentation of the periocular region. Ascorbic acid acts on several steps of melanogenesis: it inhibits tyrosinase activity, the enzyme responsible for oxidizing tyrosine into melanin, and reduces oxidation intermediates, thereby limiting pigment formation.

Vitamin K

Endogenous factors contributing to periorbital hyperpigmentation include vitamin K deficiency, alongside genetics/heredity, excessive vascularity, chronic sinusitis, and infraorbital swelling. Vitamin K is involved in coagulation and vascular integrity; the theoretical rationale is that inadequate vitamin K may impair clearance of blood that extravasates under thin periorbital skin. According to a 2021 review, topical vitamin K can reduce the appearance of dilated blood vessels. Oral K1 and K2 support bone and cardiovascular health but have limited direct data for under-eye darkness.

Nutrients, Herbs, and Natural Ingredients Studied in Relation to Periorbital Dark Circles

Vitamin C (Ascorbic Acid)

Traditional Use: Vitamin C-rich plant foods have been used in traditional medicine across many cultures to support wound healing and skin health, though no specific traditional application to periorbital pigmentation has been documented in classical texts.

Scientific Evidence: A clinical trial aimed to evaluate the efficacy of vitamin C, known to increase collagen, on dark circles of the lower eyelid. Fourteen subjects with dark circles of the lower eyelid applied either 10% sodium ascorbate or ascorbic acid glucoside lotion in a split-face design versus vehicle only for 6 months. Melanin index, erythema index, thickness and echogenicity of the dermis at bilateral lower eyelids were measured. The authors found that the treatment increased the thickness of the skin beneath the eye, reducing the visibility of dark circles, suggesting this could be because vitamin C stimulates collagen production. However, the trial included only 14 participants, so more research is necessary to draw firm conclusions.

The effects of vitamin C have not been demonstrated with routine topical application to the skin through robust clinical trials. Available data come from studies involving oral administration or mechanistic research in vitro. The effect of vitamin C on bluish under-eye circles remains hypothetical.

The effectiveness of topical application of vitamin C is limited due to its reduced stability in aqueous solution and poor penetration of the skin. In recent years, different stable derivatives of ascorbic acid have been synthesized and employed in various cosmetic and pharmaceutical formulations.

Niacinamide (Vitamin B3)

Traditional Use: Niacinamide is not traditionally used in pre-modern medicine for periorbital pigmentation. Its application in this context is a modern development in cosmetic dermatology.

Scientific Evidence: A study by Hakozaki et al. in 2002 determined that a 5% niacinamide cream, when applied for 4 weeks, significantly reduced pigmented spots by 11%. A more recent study evaluated a dermatological composition containing niacinamide (alongside arbutin, tranexamic acid, ubiquinone, a DHEA-like component, curcuma oily extract, and marine exopolysaccharides) applied twice daily over 6 weeks. The formulation demonstrated statistically significant improvements in pigmentation intensity, with an average overall reduction in under-eye hyperpigmentation of 47.94%, with no adverse effects observed. This was an open-label, single-arm study, and because niacinamide was combined with multiple other actives, its individual contribution cannot be isolated. Evidence for niacinamide in periorbital hyperpigmentation is preliminary.

Vitamin K

Traditional Use: No well-documented traditional use of vitamin K preparations specifically for periorbital darkening has been recorded in historical medical literature.

Scientific Evidence: A study by Ahmadraji and Shatalebi, 2015, achieved a 16% response rate in the reduction of dark circles using a counter pad containing caffeine and vitamin K in an emulsified emu oil base after 28 days. This was a topical study rather than a supplementation trial, supporting the idea that vitamin K status has a direct bearing on periorbital blood dynamics. Evidence remains limited and primarily from small trials using combination formulations, making it difficult to attribute effects to vitamin K alone.

Caffeine

Traditional Use: Caffeine from plant sources (coffee, tea, guarana) has long been used topically in traditional and folk practices for skin stimulation, though its specific application to periorbital darkening is a modern formulation practice.

Scientific Evidence: Caffeine is a potent vasoconstrictor that has been demonstrated to improve the look of dark circles by constricting or tightening the dilated vessels under the eyes. A study by Rajabi-Estarabadi et al. investigated a topical formulation with tetrahexyldecyl (THD) ascorbate (vitamin C), caffeine, and bioactive peptides, reporting a reduction in the appearance of dark circles of 12.5% at 4 weeks and 20% after 12 weeks of treatment. As with niacinamide, caffeine is consistently studied in combination products, and isolating its contribution remains methodologically difficult.

Collagen Peptides

Traditional Use: Gelatin and bone broth preparations from collagen-rich animal tissues have longstanding use in traditional food-based medicine across Asian, European, and Indigenous cultures to support skin, joint, and connective tissue health. The concept predates the isolation of collagen peptides as a supplement category.

Scientific Evidence: Collagen peptides are used as a bioactive ingredient in nutricosmetic products and have been shown in preclinical studies to improve skin barrier function, to induce the synthesis of collagen and hyaluronic acid, and to promote fibroblast growth and migration. Two placebo-controlled clinical trials assessed the effect of daily oral supplementation with collagen peptides on skin hydration, collagen density, and collagen fragmentation. Oral collagen peptide supplementation significantly increased skin hydration after 8 weeks of intake.

A randomized, double-blind, placebo-controlled trial involving 77 healthy female participants, who received either 5000 mg/day of bioactive collagen peptides (BCP) or placebo for 12 weeks followed by a 4-week washout, found that BCP significantly improved dermal density, hydration, and transepidermal water loss compared to placebo after 12 weeks. Dermal thickness also increased in the BCP group, while no significant changes were noted in the epidermis. While these findings relate to facial and general skin health rather than periorbital dark circles specifically, dermal thickening is mechanistically relevant given that thin periorbital dermis is one of the recognized contributors to dark circle visibility.

Curcumin (from Turmeric, Curcuma longa)

Traditional Use: Turmeric has been a cornerstone of Ayurvedic and traditional South Asian medicine for centuries, employed both topically and internally for inflammatory skin conditions. Topical turmeric paste preparations were traditionally applied to the face for skin brightening and pigmentation concerns.

Scientific Evidence: Curcumin is among a range of naturally-derived topical depigmenting agents that has demonstrated significant benefits in the management of periorbital hyperpigmentation in a review of diverse actives. One study specifically assessed a dermatological composition that included curcuma oily extract, alongside niacinamide and other actives, to evaluate its effects on periorbital hyperpigmentation and skin quality. Curcumin's anti-inflammatory and antioxidant properties are well-documented in the scientific literature, but controlled trials isolating its effect on periorbital dark circles specifically are lacking. Evidence in this context remains preliminary.

Arbutin (from Bearberry, Arctostaphylos uva-ursi)

Traditional Use: Bearberry leaf extracts containing arbutin have been used in traditional European herbal medicine and in traditional East Asian cosmetic preparations for skin lightening. The plant has a history of use in European phytotherapy primarily for urinary conditions, but the skin-lightening application of its extracted constituent is documented in traditional Chinese and Korean cosmetic culture.

Scientific Evidence: Ertam et al. in 2008 found that treatment with a 1% arbutin gel significantly reduced pigmentation by 43.5%, compared with 7.1% in the placebo group. Arbutin inhibits tyrosinase, the enzyme central to melanin synthesis, providing a plausible mechanism. Evidence is from small trials and often in the context of general facial hyperpigmentation rather than exclusively periorbital pigmentation.

Lycopene, Carotenoids, and Antioxidant Nutrients

Traditional Use: Carotenoid-rich foods such as tomatoes, carrots, and leafy greens have been integral to traditional diets associated with skin health across Mediterranean, African, and South Asian cultures, though specific periorbital applications are not documented in classical texts.

Scientific Evidence: Lycopene, beta-carotene, fucoxanthin, and other carotenoid-based compounds are among naturally derived topical depigmenting agents identified in a review of actives studied for periorbital hyperpigmentation. In a placebo-controlled study in 39 subjects with healthy skin, supplementation with carotenoids, vitamin E, and selenium significantly increased skin density and thickness, and improved skin roughness and scaling. These findings pertain to skin health broadly; their extrapolation to periorbital dark circles specifically is inferential.

Hesperidin and Bioflavonoids

Traditional Use: Citrus-derived flavonoids including hesperidin have been used in traditional European and Chinese medicine to support vascular integrity and reduce bruising, in part derived from observations about citrus consumption and vascular fragility.

Scientific Evidence: Hesperidin is discussed in the nutritional health literature as a capillary-strengthening compound relevant to the vascular subtype of dark circles. However, no controlled human trials specifically evaluating hesperidin for periorbital dark circles were identified in the peer-reviewed literature at the time of this review. The vascular mechanism is biologically plausible given hesperidin's documented effects on capillary permeability in other contexts, but this remains an area requiring dedicated clinical investigation.

Pycnogenol (French Maritime Pine Bark Extract)

Traditional Use: Maritime pine bark has a history of use in traditional medicine for venous insufficiency and skin conditions in European herbal practice.

Scientific Evidence: Pycnogenol is identified among naturally derived topical depigmenting actives that have demonstrated benefits in the management of periorbital hyperpigmentation in a published review. Pycnogenol contains oligomeric proanthocyanidins with antioxidant and anti-inflammatory properties. Clinical evidence specifically for its oral or topical use in POH is limited to general pigmentation research, and dedicated periorbital trials are lacking.

Dietary and Lifestyle Factors

Dietary Patterns and Nutritional Adequacy

The lack of nutrients in the diet, or the lack of a balanced diet, can contribute to the discoloration of the area under the eyes. Even in studies focused specifically on nutritional causes, periorbital hyperpigmentation is consistently described as multifactorial — meaning genetics, chronic sun exposure, allergies, vascular anatomy, hormonal changes, and nutritional gaps all interact.

Iron intake deserves particular attention in at-risk groups. Iron deficiency is worth ruling out early, particularly in women during reproductive years, vegetarians and vegans, and anyone with heavy menstrual periods.

Hydration and Sodium Intake

Poor hydration causes skin to look dull and makes the area under the eyes appear sunken. High salt intake and lying flat impair fluid drainage around the eyes.

Sun Protection

Skin changes around the eyes due to photoaging are among the first visible signs of aging, tending to occur in the third decade of life. Many of these changes are directly due to the effects of photoaging from ultraviolet radiation. Reduction of cumulative UV exposure through sun protection is supported by evidence of UV's role in stimulating melanin deposition in periorbital skin.

Allergies and Eye Rubbing

Allergies can cause inflammation and swelling, leading to a dark, puffy appearance. Rubbing itchy eyes can also cause irritation and hyperpigmentation. Addressing allergic triggers has a plausible role in reducing inflammation-driven post-inflammatory hyperpigmentation.

Stress and Screen Exposure

Commonly cited causes of dark circles include excessive pigmentation, vascular perfusion, and lifestyle factors including stress and sleep deprivation. Among habits associated with POH in published studies, prolonged exposure to bright screens including computers, cell phones, and television has been documented.

Smoking and Environmental Exposures

Delicate under-eye skin is susceptible to environmental stresses that increase oxidative stress by free radicals such as UV exposure, smoking, and air pollution, resulting in damage to cellular and extracellular components.

A Note on Evidence Limitations

It is important to emphasize that the nutritional and natural-ingredient evidence base for periorbital dark circles is characterized predominantly by small open-label trials, case reports, cross-sectional studies, and in vitro mechanistic data. Periorbital hyperpigmentation is not one condition. A 2021 systematic review identified at least four distinct mechanisms, including pigment accumulation, vascular pooling, structural shadowing from tear-trough anatomy, and post-inflammatory changes. Each mechanism responds to a different intervention, and only some of them respond to oral supplements at all. Matching the nutritional or natural intervention to the underlying mechanism of the individual's dark circles is therefore a prerequisite for any meaningful evidence-based approach.

References

• Matsui MS et al. Physiological and Lifestyle Factors Contributing to Risk and Severity of Peri-Orbital Dark Circles in the Brazilian Population. Anais Brasileiros de Dermatologia, 2015. PMC4560538.
• Singh A et al. Study of Causative Factors and Clinical Patterns of Periorbital Pigmentation. PMC6536080.
• Rosen N et al. Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment. PMC4924417.
• Malakar S et al. A Study of Clinicopathological Correlation of Periorbital Hyperpigmentation. PMC6042186.
• Frequency of Periorbital Hyperpigmentation Risk Factors. PMC11807928.
• Freitag FM, Cestari TF. Periorbital Hyperpigmentation — Dark Circles under the Eyes; Treatment Suggestions and Combining Procedures. Cosmetics 2021, 8(2), 26.
• Shabbir M et al. Hyperpigmentation as a Primary Symptom of Vitamin B12 Deficiency: A Case Report. PMC9551622.
• Yakubu et al. Reversible Hyperpigmentation in a Patient With Vitamin B12 Deficiency. PMC11283330.
• Vitamin B12 Deficiency Presenting with Hyperpigmentation and Pancytopenia. PMC6069637.
• Skin Hyperpigmentation: An Under-Recognized Dermatological Clue to Vitamin B12 Deficiency. PMC13112176.
• Skin Hyperpigmentation as Initial Manifestation of Vitamin B12 Deficiency: A Case of Delayed Diagnosis. PMC12894786.
• Masaki H et al. Effects of Vitamin C on Dark Circles of the Lower Eyelids: Quantitative Evaluation Using Image Analysis and Echogram. PubMed 19626722.
• Clinical Efficacy of a Novel Topical Formulation on Periorbital Dark Circles: An Objective Analysis. PMC12235579.
• Rajabi-Estarabadi A et al. Effectiveness and Tolerance of Multicorrective Topical Treatment for Infraorbital Dark Circles and Puffiness. Journal of Cosmetic Dermatology, 2024.
• Asserin J et al. The Effect of Oral Collagen Peptide Supplementation on Skin Moisture and the Dermal Collagen Network. Journal of Cosmetic Dermatology, 2015.
• Wang Y et al. The Sustained Effects of Bioactive Collagen Peptides on Skin Health: A Randomized, Double-Blind, Placebo-Controlled Clinical Study. PMC12661388.
• Beneficial Effects of Multi-Micronutrient Supplementation with Collagen Peptides on Global Wrinkles, Skin Elasticity and Appearance. PMC11169317.
• DermNet NZ. Dark Circles Under the Eyes.
• Wikipedia. Periorbital Dark Circles.
• Open Access Government. What Causes Periorbital Hyperpigmentation and How Can You Treat It?