Determination of Melanin and Haemoglobin in the Skin of Idiopathic Cutaneous Hyperchromia of the Orbital region (ICHOR): A Study of Indian Patients

Abstract

Background: Idiopathic cutaneous hyperchromia at the orbital region (ICHOR) is a cutaneous hyperchromia characterised by bilateral darkening of the eyelid and orbital skin that contrasts with the adjoining facial skin. ICHOR is frequent in dark skin. It interferes with the face appearance which often causes difficulties in societal acceptance and may impact quality of life.

Objective: The aim of this investigation was to study the epidemiology, clinical features and risk factors associated with ICHOR in Indian patients and also to study the distribution of melanin and haemoglobin in ICHOR patients. This study also assessed the relevance of SIAscopy technique (spectrophotometric intracutaneous analysis (SIA)), a new objective non-invasive method to measure melanin and haemoglobin concentration in vivo.

Materials and methods: Thirty-three patients diagnosed with ICHOR at the All India Institute of Medical Sciences, New Dehli, India, were included in the study. Epidemiological data were collected through a self-administrated questionnaire. Standard photographs were taken from each patient and SIAscopy measurements were done on dark circles and normal skin.

Results: Surprisingly our study showed no significant correlation between ICHOR prevalence and family history, atopic and contact dermatitis, contemporaneous melasma and hormonal factors. The study confirms that sun exposure is a risk factor of dark circles aggravation. Indeed patients tend to reduce sun exposure after the onset of dark circles. SIAscopy analysis reveals significant differences in the concentration of total melanin, of dermal melanin and of haemoglobin between ICHOR skin and normal skin of the same patient.

Conclusion: This study confirms that melanin deposits and blood stasis in dark circles may play a role in ICHOR pathogenesis and cause the darkening of skin under eyes. SIAscopy provides objective diagnostic information about ICHOR.

Keywords: Idiopathic cutaneous hyperchromia of the orbital region; dark circles around the eyes; periorbital pigmentation.

Figure 1

Schema representing the SIAscopy technique

Figure 2

Typical photographs obtained with the Canfield VISIA CR^® device (Canfield Imaging Systems, Fairfield, USA); From left to right, Skin VISIA standard flash, Cross Polarised and c-Ultra violet-A (UVA) lightening, respectively

Figure 3

Graphic representation of SIAscopy results: Total melanin, Dermal melanin and haemoglobin content in dark circle versus normal skin