By Gary M. White, MD
Here in a child with atopic dermatitis.
Chronic redness and scaling about the eyes occurs in eyelid dermatitis (ED). Women are most commonly affected, but certainly children with atopic dermatitis (AD) will have this as one manifestation of their eczema.
In one study of 74 patients, 89% were women, 46% of cases represented an allergic contact dermatitis, 15% an irritant contact dermatitis, and 23% were the result of atopic dermatitis. Thirteen percent of cases were work related.
Allergic Contact Dermatitis (ACD). In one study of allergens in ED patients, metals, thiomersal, and paraphenylenediamine were most common. Eye-shadow products were particularly relevant, as they may contain significant amounts of nickel, cobalt, or chromium. Other sources of allergens in patients with ACD and ED include contact lens solution, ophthalmic medications, preservatives or other components of cosmetics, nail cosmetics, corticosteroids in nasal spray, glass frames, eyelash curlers, and acrylic monomer in nail products.
Irritant Contact Dermatitis. "Anti-aging" products containing tretinoin, alpha hydroxy acids, etc.
Atopic Dermatitis. Typical AD since childhood.
Seborrheic Dermatitis. Look for redness and scale about the ears, scalp, nose, and/or eyebrows.
Periorbital and periocular eczema developed in two women using nasal steroid spray (tixocortol pivalate) [BJD 1996;135;310].
Workup should include inquiry into the patient's occupation (e.g., any airborne matter, sawdust) and use of potential allergens (e.g., nail polish, makeup, eyeliner), a complete skin examination (to look for signs of atopic dermatitis, psoriasis, or seborrheic dermatitis), inquiry about cosmetics, anti-aging creams, e.g., tretinoin, etc., and patch testing. Inquire about any family history of psoriasis, allergies, hay fever, or asthma.
Therapy is dependent upon the cause. Allergic contact dermatitis and irritant dermatitis can be cured once the cause is removed and mild topical steroid and/or emollient given. Instruct patients not to scratch. For atopic dermatitis and seborrheic dermatitis, see those particular entries. A mild topical steroid (e.g., desonide cream) or tacrolimus ointment are both appropriate here.
For application of a topical steroid on the eyelid margin, use of a steroid appropriate for the eye is useful, e.g., in the US, FML (fluorometholone 0.1% ophthalmic ointment).
In a study of the calcineurin inhibitors for long-term treatment of atopic blepharoconjunctivitis, both tacrolimus and pimecrolimus were safe and effective. Tacrolimus ointment was preferred as it was slightly more effective [Jama derm May 2014 150 571].
One patient who wore contacts was cured when she wore glasses instead for three weeks. The only clue that there was a problem with the contacts was that the optometrist noted an unusual buildup on the contacts.
Psoriasis about the eyes.
Allergic contact dermatitis, here, to nail polish. Courtesy Michael O. Murphy, MD
Seborrheic dermatitis tends to favor the eyebrows and the T-zone.
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