Rx for Readers

For over five years, I have suffered from dark rings under my eyes. What should I do?

By JUDY SIEGEL-ITZKOVICH
eye 88 (photo credit: )
eye 88
(photo credit: )
I am a 69-year-old woman. For over five years, I have suffered from dark rings under my eyes; one is now almost a centimeter thick under my right eye, and under my left eye there is now a strong, dark ring. A cosmetician advised me to use a daily sunscreen and concealer over it, but this barely covers the owl-like discoloration around my eyes. I was also given a peeling liquid and peeling cream for use on alternate nights that had to be removed in the morning: Both left my skin itchy and more wrinkled than usual. Neither my mother nor grandmother had this condition. I sleep well. What should I do? - A.B., Jerusalem Veteran Jerusalem dermatologist Dr. Julian Schamroth answers: Pigmentation on the eyelids and around the eyes (peri-orbital hyperpigmentation) is a fairly common and benign condition, more often occurring in females. Occasionally, however, it can be quite prominent and cosmetically disfiguring. People sometimes refer to this as a "raccoon mask" or "raccoon eyes." It may be hereditary, especially in Asians and other dark-skinned people, and on rare occasions may be caused by medications. A mild degree of peri-orbital pigmentation occurs with aging. Lack of sleep does not cause this pigmentation, but tired, droopy eyes might cause some puckering or folding of the lower eyelid skin, thus giving the appearance of pigmentation. However, the majority of cases probably arise due to post-inflammatory pigmentation: In some people, the skin tends to heal with increased pigmentation after it has been injured or damaged by inflammation. Such an "injury" could include physical trauma, rashes such as eczema or dermatitis, allergies to topical creams and cosmetics or even chronic rubbing of the eyes. The sequence of events described by this reader is typical: A cosmetic cream is applied to the eyelids, which causes a mild irritation. The irritation leads to rubbing of the eyelids and the development of post-inflammatory pigmentation. More creams are then applied in a vain attempt to get rid of the pigmentation, but they usually cause more irritation, leading to a cycle of ever-increasing pigmentation. The treatment consists first and foremost of stopping all cosmetic creams, sun-blocks and depigmenting agents. If there is an underlying skin disorder such as eczema (which is easily diagnosed by a dermatologist), then a mild cortisone cream might be prescribed. A depigmenting cream containing hydroquinone could be prescribed. Irrespective of the cause, the pigmentation may take many months to improve, and many cases never completely go away. I am a 60-year-old man being treated with statins for high cholesterol. My doctor did not tell me anything more, but my pharmacist told me that when taking statins, one should take a co-enzyme Q-10 supplement and folic acid because the statin reduces stores of these in the body. Is this true, or just a way for the pharmacy to make more money? - I.T., Tel Aviv Prof. Jeffrey K. Aronson, a senior clinical pharmacologist at Oxford University's department of primary health care in the UK, comments: The Polypill hypothesis, propounded by Wald and Law in the British Medical Journal five years ago and based on a large amount of observational data, is that the risk of cardiovascular disease (heart attacks and strokes) can be reduced by more than 80 percent in those older than 55 or with a history of cardiovascular disease, by attacking four major risk factors. They are low-density lipoprotein (LDL) cholesterol (reduced with a statin), homocysteine (with folic acid), the stickiness of blood platelets (with aspirin) and the blood pressure (with a combination of three different types of drugs in low doses). Adverse effects with this regimen are uncommon and when they occur are usually due to the aspirin. Statins are reported to lower the antioxidant co-enzyme Q10. However, it is not clear that taking oral co-enzyme Q10 obviates any adverse effect that that might have, and there is some evidence that it doesn't. Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.com, giving your initials, age and residence.