Is there a gold standard for treating periorbital hyperpigmentation? – A narrative review of the latest evidence

Background Periorbital hyperpigmentation (POH) is a common esthetic concern, characterized by light to dark brown pigmentation or violaceous discoloration of the eyelids. It is multifactorial, associated with signs of aging and tiredness, and affects approximately 30% of individuals, predominantly women aged 16–25. Objective This narrative review aims to evaluate the efficacy of various treatments for POH, identifying potential gold standard therapies based on the latest evidence from clinical trials. Methods A comprehensive search was conducted on MEDLINE (PubMed) for clinical trials addressing POH treatments, excluding those focused on cosmetic interventions or the tear through type of POH. The initial search yielded 654 publications, with 18 studies meeting the inclusion criteria, encompassing a total of 619 participants. Results The reviewed studies evaluated a range of treatments, including platelet-rich plasma (PRP), laser therapy, carboxytherapy, chemical peels, microneedle fractional radiofrequency, and autologous fat. PRP showed high patient satisfaction but was less effective compared to chemical peels and emulsified fat in some studies. Laser therapies, particularly Q-switched Nd and carbon dioxide (CO2) lasers, demonstrated favorable outcomes, with CO2 laser showing higher efficacy and patient satisfaction than carboxytherapy and microneedling. Carboxytherapy was effective and well-tolerated but less potent than laser treatments. Chemical peels, especially those involving glycolic acid, showed rapid and significant improvement in pigmentation. Microneedle fractional radiofrequency and Vitamin C mesotherapy also proved beneficial, with the latter achieving the highest patient satisfaction despite procedural discomfort. Conclusion No single treatment modality emerged as a definitive gold standard for POH. Most treatments demonstrated effectiveness in reducing hyperpigmentation but fell short of complete eradication. The choice of treatment should be individualized, considering patient-specific factors and preferences. Further comparative studies are needed to optimize treatment strategies for POH.