The causes of skin spots under the eyes, i.e. pigmented spots, are mainly congenital and acquired. 1. Congenital causes: Freckles or nevus of Ota are common. Freckles are pigmented spots or blotches occurring on the face. Generally, female patients start to occur at the age of 5-6 years old, and most of them occur on the double cheeks, around the eyes, and on the cheeks. Skin damage can gradually increase with age and sunlight exposure, and is often related to genetic factors. Nevus of Ota is a pigmented spot or patch that occurs around the eyes, often related to genetic factors, distributed in the area of the trigeminal nerve distribution of pigmented patches, unilateral distribution. 2. Acquired causes: pigmented spots occurring under the eyes, clinically seen in chloasma, mostly related to female estrogen or progesterone levels, aggravated by sun exposure. Therefore, it mostly occurs in middle-aged women during pregnancy, breastfeeding and amenorrhea. Patients should pay attention to avoiding light and sunshine, live a regular life, don’t stay up late and be in a happy mood, which can reduce or remove chloasma on the face. There may be other reasons for the spots under the eyes, so it is recommended to go to the hospital in time to improve the examination to clarify the cause of the disease and then give targeted treatment or therapy.