Dear Doctor: I’m a white man in my mid-40s, and I have significant dark areas under and around my eyes. I feel awkward inquiring about this, but people stare and judge, and I’ve become self-conscious. What is the cause? Can you offer any advice on how to lessen these dark areas?

Dear Reader: Ask any dermatologist, and they’ll tell you that dark circles under and around the eyes are a common concern among their patients, men and women alike. We field a lot of questions about them in our practices as well.

While typically not a health issue, dark areas around the eyes can be aging, and they can make someone look tired or ill, even when they’re healthy and fully rested. Our faces are our calling cards to the world. Research shows that within the first few seconds of meeting someone, even before a word has been spoken, we’re unconsciously forming first impressions based on the way the other person looks. It’s not surprising that, despite being benign, dark circles are unwelcome.

When it comes to the cause, there are a few broad categories. One is something known as genetic hyperpigmentation. That is, due to genetics and heredity, the skin beneath or around the eyes is actually a darker hue. Other factors that can lead to changes in pigmentation include sun exposure, allergies and allergic reactions, certain medications and hormonal changes, to name just a few.

Another reason for the appearance of dark circles is that the underlying blood vessels are becoming visible. This can occur when the skin in the area becomes thinner, which happens as we age. Another potential cause is that the blood vessels under and around the eyes have become dilated. Not only does this make them more easily visible, but the blood in the area can pool or leak out, adding to the illusion of darker pigmentation. Poor diet, chronic lack of sleep, excessive use of alcohol or tobacco, physical exhaustion, poor circulation, certain medical conditions and allergies can all contribute to, or exaggerate, this effect.

In some people, the physical structure of the eye area can also play a role in dark circles. Whether it’s the result of aging, genetics or even weight loss, some people have a depression around the eye sockets. These can cause shadowing that reads as dark circles.

Reversing the appearance of dark circles isn’t easy. Treatment options for genetic hyperpigmentation include the use of concealers, lightening creams, chemical peels and laser therapy. For dark areas not due to genetics, changes to lifestyle and behavior may be helpful. These include getting enough sleep. (Your whole body will thank you.) Avoid added salt, which contributes to swelling that can make dark areas more pronounced. If you have allergies, take steps to treat them. Avoid rubbing your eyes, which stretches and stresses delicate tissues and can cause inflammation and capillary damage.

The application of a cold compress can counteract dilation in the under-eye area. Also available are a range of creams that contain vitamin C, caffeine and retinoids to build collagen and constrict blood vessels. Whatever approach you choose, it’s important to be realistic. You’ll be managing the condition, not reversing it.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Hello dear readers, and welcome to another monthly letters column. We’d like to begin by revisiting a recent column about valsartan, a blood pressure medication that is the subject of a Food and Drug Administration recall. The recall is due to impurities found in certain lots of the drug. Since this was a selective recall associated with specific manufacturers only, we included websites where readers can check whether their own prescriptions are affected. Apparently, these sites didn’t make it into every print edition of the column, so we’re repeating the information here today. In the time since our column ran, the valsartan recall has spread to include additional manufacturers of the drug.

Find the list of recalled valsartan drugs at: www.fda.gov/downloads/Drugs/DrugSafety/UCM615703.pdf.

For a list of valsartan meds not part of the recall, visit: www.fda.gov/downloads/Drugs/DrugSafety/UCM615704.pdf.

-- After a column about chicken pox, quite a few of you weighed in to urge anyone who has had chicken pox to get the shingles vaccine. As we’ve written before, we heartily agree. Unfortunately, there is presently a shortage of the new vaccine, Shingrix, which provides better protection than the older one. For local availability, check vaccinefinder.org and Shingrix.com.

-- We recently wrote about post-operative cognitive dysfunction, a condition that can arise in some patients, particularly older ones, following surgery under general anesthesia. A nurse from Lincoln, Nebraska, asked us to point out that among the risk factors for this condition, in which patients experience post-surgical disruption to memory and cognition, are alcohol use and abuse. Patients and caretakers should make the medical team aware of alcohol consumption prior to surgery.

-- Asthma has come up in several recent columns. A case worker who visits families wondered whether the essential oil diffusers she sees in some homes might play a role in asthma flares. The answer is yes. Studies have shown that some diffused essential oils, including eucalyptus, lavender and others, release volatile organic compounds (VOCs) into the air. These, like tobacco smoke, dust, pet dander and other airborne irritants, are environmental components that can act as triggers for bronchospasm.

-- We’ve had several letters in which, for reasons relating to menopause or hysterectomy, women wonder whether they should try hormone replacement therapy (HRT). Hormone replacement therapy has always been -- and, we suspect, always will be -- controversial. This is due to a range of potential side effects, which can be dangerous. Up to 80 percent of women experience menopausal symptoms such as hot flashes, night sweats, weight gain, low energy, mood changes and depression. In a quarter of those women, symptoms are severe enough to warrant therapy. Usually this consists of lifestyle interventions, behavioral interventions and nonhormonal treatments such as Paxil or Effexor.

Only in severe cases should HRT be recommended. In our opinion, HRT should never be used in menopausal women who are asymptomatic. A free and useful app that we recommend to patients dealing with the effects of menopause is MenoPro.

Thank you, as ever, for not only reading the column but for engaging with us as well. Whether it’s a question, correction or kind words, we love hearing from you.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: How does prostate cancer happen? And what are the symptoms? I’m only 43, but I worry that I wouldn’t recognize the signs if I had it.

Dear Reader: Prostate cancer is one of the most common cancers among men in the United States. It occurs in the prostate gland, a male reproductive organ that sits between the penis and the rectum, just beneath the bladder. The prostate, which is about the size of a golf ball, wraps around the urethra, which is the duct through which urine and semen exit the body. One of the roles of the prostate is to produce fluids that nurture and support sperm, and to propel these fluids into the urethra when needed.

When normal cell division goes awry, the chaotic and uncontrolled growth that results is what we know as cancer. In prostate cancer, the rogue cells use hormones known as androgens, which include testosterone, to fuel their growth. Although prostate cancers begin within the gland, they can spread to nearby regions of the body, including the lymph nodes. Some prostate cancers are slow to grow and can take years to be detected. When slow-growing cancers are identified, the risk they pose may be low enough that physicians recommend careful monitoring, often referred to as "watchful waiting." Other prostate cancers are more aggressive and require swift treatment.

The American Cancer Society estimates that more than 174,650 new cases of prostate cancer will be diagnosed this year, and the disease will claim more than 31,000 lives. As you allude to when mentioning your age, the majority of prostate cancers -- about 60 percent -- are diagnosed in men 65 and older. But race plays a role as well. Prostate cancer affects black men at two to three times the rate of white men and at an earlier age. They are also more likely to die from the disease.

Although a screening tool known as a prostate-specific antigen (PSA) test is effective at detecting certain hormonal changes associated with prostate cancer, it has been overused in the past and led to unnecessary treatment. The U.S. Preventive Task Force recommends that for men between the ages of 55 to 69, prostate cancer screening should be a decision made by patients and doctors working together on a case-by-case basis. However, a survey of prostate cancer outcomes by several colleagues at UCLA determined that, due to their elevated risk, black men would benefit from prostate cancer screening guidelines tailored to their unique and specific needs.

When it comes to symptoms, unfortunately prostate cancer is often largely silent in the early stages. As the cancer becomes more advanced and affects the size and shape of the prostate, the gland’s position in the body may lead to symptoms that include:

-- Difficulty urinating.

-- Frequent urination.

-- A diminished stream of urine.

-- Pelvic discomfort.

-- Signs of blood in the semen.

-- Onset of difficulty achieving or maintaining an erection.

-- Discomfort when sitting.

If you develop these symptoms, please talk to your doctor. It doesn’t mean that you have cancer, but you will be taking the first step to finding out what, if anything, may be wrong.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)