Periorbital hyperpigmentation
Alerts and Notices
Synopsis
Many endogenous and exogenous factors can contribute to POH including genetics, postinflammatory hyperpigmentation (allergies, periorbital eczema), drug-related causes (vasodilatory medications, glaucoma medications such as latanoprost, hormonal therapy), procedures (blepharoplasty, rhinoplasty, chemical peels), and environmental / lifestyle changes (sun exposure, lack of sleep, stress, alcohol, caffeine, smoking).
The underlying pathogenetic mechanisms can be summarized as follows: increased melanocyte or melanophage density or increased melanin production; changes in vasculature; or mechanical changes in skin laxity, muscle, or tear trough that contribute to shadowing effect.
Codes
ICD10CM:L81.4 – Other melanin hyperpigmentation
SNOMEDCT:
238703005 – Periorbital hypermelanosis
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Nevus of Hori (also known as bilateral acquired nevus of Ota) – Acquired bilateral macules that range from blue-brown to slate gray in color; they tend to be limited to malar area with some extension into periocular area.
- Lichen planus pigmentosus
- Melasma
- Erythema dyschromicum perstans (ashy dermatosis)
- Fixed drug eruption
- Heliotrope rash of dermatomyositis
- Lichenified periorbital eczema
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:09/18/2018
Last Updated:10/04/2018
Last Updated:10/04/2018
Periorbital hyperpigmentation