Dark circles: the main causes and how to tell which you have

Key takeaways

• There are three main types: pigmented (brown), vascular (bluish or purple) and structural (shadows). Many people have a mix.
• In Indian studies, the constitutional or family type is the most common, followed by darkening from eczema, allergy and rubbing.
• Eye rubbing, allergies and inadequate sleep are worth addressing whatever the type.
• Anaemia and uncorrected eyesight problems have been reported alongside dark circles and are worth checking.
• Knowing your type matters because creams, peels, lasers and fillers each help a different cause.

Why do so many Indians have dark circles?

Under-eye darkness is one of the most common things people mention to me, sometimes as a side note at the end of a consultation for something else. "Doctor, and these dark circles, anything for them?"

An Indian study published in the Indian Journal of Dermatology in 2014 looked at 200 patients with dark circles. The most common type was constitutional, meaning the person's natural, often inherited pattern, in about half the patients. The next most common was darkening after inflammation, from eczema, allergies or rubbing. Women made up the large majority, and the most common age group was 16 to 25.

See, what happens is, brown skin around the eyes is thin and its pigment cells are active. Anything that irritates it, rubbing, allergies, harsh products, adds pigment. And because the skin is thin, the blood vessels and the shape of the bone underneath show through more.

What are the types of dark circles?

A 2016 review in the Journal of Clinical and Aesthetic Dermatology, written by Indian authors, describes these types:

Most of my patients have a mixed picture. That is very important to understand, because a cream for pigment will do nothing for a hollow, and a filler will do nothing for brown pigment.

How can I tell which type I have?

Try these at home, in daylight, facing a window:

1. The stretch test. Gently stretch the skin under your eye sideways with a fingertip. The review describes it: pigment stays the same, a shadow improves or disappears, and if the colour becomes more purple, it suggests visible blood vessels or thin skin.
2. The light test. Look in a mirror with light coming from the front, then from above. If the darkness gets much worse with overhead light, a hollow or bag is casting a shadow.
3. The colour test. Brown points to pigment. Blue, purple or pink points to vessels.
4. The morning test. If puffiness and darkness are worse in the morning or after a salty dinner, fluid is part of it.
5. The side profile. Look side-on. A visible groove from the inner corner of the eye suggests a tear trough hollow.

In clinic I use magnification and sometimes a Wood's lamp, though the Indian study notes that Wood's lamp assessment of pigment depth may be unreliable in Indian skin. Basically, good daylight and a careful look tell me most of what I need.

What makes dark circles worse?

The 2014 Indian study and the 2016 review list several factors. Some were statistically linked; others were common but not proven as causes.

• Family history. Very common, and you cannot change it.
• Eye rubbing. Common in people with allergies, eczema or long screen time. Rubbing inflames skin and adds pigment.
• Allergies and eczema. Allergic rhinitis and eczema around the eyes cause itching, rubbing and post-inflammatory darkening.
• Inadequate sleep. In the Indian study, it was one of the factors significantly associated with dark circles.
• Uncorrected eyesight. Uncorrected short-sightedness was also significantly associated, possibly from squinting and rubbing. Worth an eye check if you have not had one.
• Anaemia. Half the patients in the Indian study had anaemia. That does not prove anaemia causes dark circles, but a haemoglobin check is sensible, especially for women.
• Sun exposure. UV is said to worsen under-eye pigment.
• Some eye drops. Certain glaucoma drops can darken the skin around the eyes; this usually reverses after stopping, under your eye doctor's advice.
• Ageing. Fat loss and skin thinning deepen the tear trough, so shadows become more visible.

Stress, alcohol and smoking are often blamed. The review notes they are possible contributors but not clinically proven.

When are dark circles a sign of something else?

Usually they are cosmetic. But get checked if: - Darkness appeared suddenly or is only on one side - There is swelling, redness, itching or scaling - You feel unusually tired, breathless or look pale, which can point to anaemia - You have puffiness of the face or ankles as well - You recently started a new eye drop or medicine

What can I do while I work out the cause?

• Stop rubbing. If your eyes itch, treat the allergy.
• Sleep on a regular schedule. Not as a cure, but because poor sleep was linked with dark circles.
• Get an eye test if you have not had one in a while.
• Check haemoglobin if you have symptoms of anaemia.
• Use sunscreen around the eyes and sunglasses outdoors. The review advises care with chemical sunscreens very close to the eyes; a mineral one may be gentler.
• Avoid harsh products near the eyes, including strong acids and unlabelled lightening creams.

Once you know your type, my article on dark circle treatments that match the cause explains the options.

How we approach this at Dr Tvacha

Under-eye dark circles are one of the concerns we treat at our centres in Thane, Andheri, Bandra and Dahisar. I start by working out which type, or mix, you have, and whether anything medical like anaemia, allergy or eyesight needs attention first. The Rs 499 skin consultation covers this, tests are at actual cost, and the plan and fees are written down before you pay. Read about the Second Layer Skin Plan, or find a centre. If hollows are the main issue, the Long Game Anti-ageing Plan may also be relevant.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.