Eyelid Dermatitis: Why You Should Be Getting Patch Tested

What is Eyelid Dermatitis?

Eyelid dermatitis refers to the inflammation of the eyelid skin, often resulting in redness, swelling, itching, and scaling. It includes several types of dermatitis, including allergic contact dermatitis, irritant contact dermatitis, atopic dermatitis (eczema), and seborrheic dermatitis. The delicate skin around the eyes is particularly susceptible to irritants and allergens, making it prone to dermatitis.

Allergic Contact Dermatitis (ACD) of the Eyelid

Allergic contact dermatitis is the most common cause of eyelid dermatitis, found in approximately 74% of patients. ACD occurs when the skin is exposed to an allergen that the patient is allergic to, triggering an immune response that leads to inflammation. The eyelids are especially vulnerable due to their thin skin and frequent exposure to potential allergens. Patients with atopic dermatitis are also more susceptible to developing ACD due to their impaired skin barrier.

Potential Causes of Allergic Contact Dermatitis

1. Cosmetics and Skincare Products: These are the most frequent culprits. Ingredients in eye shadows, mascaras, eyeliners, and makeup removers can trigger ACD. Common allergens include fragrances, preservatives, and colorants. Preservatives like methylisothiazolinone and formaldehyde releasers, as well as fragrances, are well-known sensitizers.
2. Metals: Nickel and gold are another common allergens that can cause eyelid dermatitis. These metals might be present in eyelash curlers, tweezers, or even in the pigments of some eye makeup products. They can also be found in eyeglasses.
3. Topical Medications: Medications applied near the eyes, such as antibiotic ointments or corticosteroid creams, can cause ACD. Neomycin and bacitracin are also common allergens found in topical antibiotic preparations, and I find some of my patients use these antibiotics on their eyelid dermatitis when they believe the rash is from an infection.
4. Airborne Allergens: Pollen, dust mites, and animal dander can settle on the eyelids, causing contact dermatitis. This is often exacerbated by touching or rubbing the eyes with contaminated hands.
5. Hair Dyes and Nail Products: Paraphenylenediamine (PPD) in hair dyes and toluene sulfonamide formaldehyde resin in nail polishes can cause ACD. These allergens can be transferred to the eyelids through hand contact. Patients often asks me why their scalp or their fingers are not affected, and this is because the skin in these areas are much more resistant to allergenicity than the skin on your eyelids.
6. Glasses and Contact Lenses: The materials in frames or the preservatives in contact lens solutions can also be potential allergens.

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Symptoms of Allergic Contact Dermatitis

The symptoms of ACD on the eyelids can vary but typically include:

• Redness and swelling of the eyelids
• Intense itching and burning sensations
• Dryness and scaling of the skin
• Crusting and oozing in severe cases
• Sensitivity to light in some instances

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Diagnosis of Allergic Contact Dermatitis

Diagnosing allergic contact dermatitis involves a thorough clinical examination, patient history, and specific diagnostic tests. Two tests we use are skin biopsies and patch testing.

1. Skin Biopsy: A skin biopsy involves removing a small sample of the affected skin for examination under a microscope. This test is useful for confirming the diagnosis of dermatitis and ruling out other conditions that might mimic ACD, such as infections or autoimmune conditions.
2. Patch Testing: Patch testing is the gold standard for identifying specific allergens responsible for ACD. During this test, small amounts of potential allergens are applied to the skin, usually on the back, using adhesive patches. These patches are left in place for 48 hours and then removed. The skin is examined for reactions at 48 hours and again at 72-96 hours. A positive reaction, indicated by redness, swelling, or a blistering response at the site of a specific allergen, confirms sensitivity to that allergen.

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Treatment Options for Allergic Contact Dermatitis

Treating allergic contact dermatitis primarily involves identifying the trigger, avoiding exposure to the allergen, and treating residual symptoms.

1. Identify the Allergen: The first step is identifying specific allergens through patch testing. Once identified, the primary goal is to avoid contact with these substances.
2. Use Databases Such as CAMP: The Contact Allergen Management Program (CAMP) Database helps identify personal care products, cosmetics, and household items that are free from specific allergens. After patch testing, patients receive a list of their allergens, which can be input into the CAMP Database to generate a customized list of safe products.
3. Reading Labels: Learn to read product labels and ingredient lists to recognize and avoid specific allergens.
4. Treat the Symptoms: Despite patients' best efforts, flares still occur. The use of a topical corticosteroid, a calcineurin inhibitor, or an emollient can help treat flares. Speak with your dermatologist to find the right medication for you.

Conclusion

Eyelid dermatitis is often due to allergic contact dermatitis. Even if you have a history of atopic dermatitis, identifying potential allergens may improve your symptom control. While eyelid dermatitis can be challenging and uncomfortable to manage, taking steps to identify allergens is crucial. At Pure Dermatology, we can create patch tests specifically designed for individuals with eyelid dermatitis to help you identify potential allergens and develop a management plan. If you suspect you have eyelid dermatitis, contact us now or book an appointment with one of our board-certified dermatologist to start identifying the underlying causes of your rash.

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