Examination is positive for dry skin and macular rash around both eyes, below the orbits.
What is the most likely diagnosis?
Periorbital dermatitis. Differential diagnosis includes atopic dermatitis, contact dermatitis, nonspecific dermatitis.
What would you suggest?
TRUE patch test for contact dermatitis.
If negative, then a skin test with airborne allergens could be considered.
For mild exacerbations, use topical hydrocortisone 1% for up to 1-3 weeks or Elidel. Use topical moisturizer such as Eucerin for dry areas.
Summary
Periorbital dermatitis is common and frequently difficult to treat. Patients with periorbital dermatitis often suffer severely because their disease is in such a visible location.
Predominant causes of periorbital dermatitis are:
- allergic contact dermatitis, 32-44%
- atopic eczema, 14-25%
- airborne contact dermatitis, 2-10%
- irritant contact dermatitis, 8-9%
- less frequent causes for secondary eczematous periocular skin lesions were periorbital rosacea, allergic conjunctivitis or psoriasis vulgaris
Risk factors include female gender, atopic skin diathesis and age of 40 years and older.
Common causes of periorbital allergic contact dermatitis are leave-on cosmetic products (face cream, eye shadow) and eye drops with the typical allergens being fragrances, preservatives and drugs.
Exact identification of relevant contact allergens and allergen elimination are essential for successful treatment.
Calcineurin inhibitors are the first-line therapy for facial atopic eczema.
Contact Dermatitis - Approach to Treatment (click to enlarge the image).
References
Periorbital dermatitis: causes, differential diagnoses and therapy. J Dtsch Dermatol Ges. 2010 Mar;8(3):159-66. doi: 10.1111/j.1610-0387.2009.07216.x. Epub 2009 Sep 14.
http://www.ncbi.nlm.nih.gov/pubmed/19751221
http://www.feingold.org/Research/PDFstudies/Feser2010.pdf
1 comment:
Just so you know, Eucerin cream has methylisothiazolinone/methychloroisothiazolinone in it which I am allergic to and I kept slathering all over myself to help my eczema...all the while it was making it worse!! PLEASE be aware of this. I called the Eucerin company to let them know this and they might have taken it out since then, but WATCH OUT!! Eucerin is NOT necessarily hypoallergenic. If you cannot get rid of your eczema, please get an allergy patch test. This has been a HUGE blessing in my life to know I was allergic to this chemical that is in MOST shampoos, conditioners, lotions, body washes, baby wipes, etc. My eczema has completely healed on my legs and the palms of my hands since avoiding this chemical (it took 6 months to clear it from my system).
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