Shadows Under the Lens: Clinico-Dermoscopic Study of Periorbital Hypermelanosis - A Cross-Sectional Study

Objectives: This study aimed to evaluate the clinical and dermoscopic patterns of periorbital hypermelanosis (POH) and to identify its association with socio-demographic and lifestyle factors, with a focus on skin phototypes and modifiable risk contributors. Material and Methods: A hospital-based observational study was conducted in the Dermatology Outpatient Department over a span of 24 months, enrolling 100 patients presenting exclusively with POH. Detailed history, dermatological examination, and dermoscopic evaluation using a polarised and non-polarised handheld dermoscope were carried out. Patients were classified based on dermoscopic patterns, and statistical correlation was analysed between POH and socio-demographic, clinical, and lifestyle parameters using chi-square tests. Results: The majority of participants were females (62%) and aged between 31 and 40 years (30%). Most had skin phototypes III–IV (65%). Common lifestyle risk factors included sun exposure (54%), inadequate sleep (46%), prolonged screen time (≥4 hours/day, p = 0.014), smoking (p = 0.048), and lack of sunscreen use (p = 0.032). Dermoscopically, the pigment network was the most observed pattern (40%), followed by brownish homogeneous (35%), greyish granular (15%), and vascular structures (10%). A significant association was found between pigment network and phototype III–IV (p = 0.01), and between the brownish homogeneous pattern and the same phototype group (p = 0.04). Greyish granular and vascular patterns were more commonly seen in phototypes V–VI, but not statistically significant (p = 0.08). Cosmetic use and family history were reported in 60% and 35%, respectively. Conclusion: POH was more prevalent in females and individuals with skin phototype III–IV. The pigment network was the predominant dermoscopic pattern. The condition showed significant associations with modifiable lifestyle factors such as poor sleep, digital eye strain, smoking, and inadequate photoprotection. Dermoscopy emerged as a valuable non-invasive diagnostic aid in classifying POH patterns and correlating them with skin phototypes. Early identification and modification of risk factors may aid in better management outcomes.