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.
L81.4 – Other melanin hyperpigmentation
238703005 – Periorbital hypermelanosis
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
- Erythema dyschromicum perstans (ashy dermatosis)
- Fixed drug eruption
- Heliotrope rash of dermatomyositis
- Lichenified periorbital eczema
Drug Reaction Data