Eyelid Dermatitis Research Articles

Eyelid Dermatitis: Common Patterns and Contact Allergens.

Eyelid dermatitis is a common dermatologic concern representing a broad range of inflammatory dermatoses. The most commonly reported cause of eyelid dermatitis is allergic contact dermatitis (ACD), a type IV delayed hypersensitivity reaction caused by exposure to external allergens that is diagnosed via epicutaneous patch testing. The most common contact allergens associated with eyelid dermatitis are metals, fragrances, preservatives, acrylates, and topical medications, which may be found in a variety of sources, including cosmetics, ophthalmic medications, nail lacquers, and jewelry. Management involves strict allergen avoidance with an emphasis on patient counseling. In this review, we discuss the clinical manifestation, evaluation, patch test considerations, and management of eyelid ACD to provide a valuable reference tool in the management of patients presenting with eyelid dermatitis.

Eyelid dermatitis in patch-tested adult patients: a systematic review with a meta-analysis

Eyelid dermatitis (ED) affects a cosmetically significant area and leads to patients’ distress. Despite ongoing and recent research efforts, ED remains a multidisciplinary problem that needs further characterization. We aimed to evaluate the atopic eyelid dermatitis (AED) frequency in ED patients and to perform their clinical profiling. PubMed databases were searched from 01.01.1980 till 01.02.2024 to PRISMA guidelines using a search strategy: (eyelid OR periorbital OR periocular) AND (dermatitis or eczema). Studies with patch-tested ED patients were included. Proportional meta-analysis was performed using JBI SUMARI software. We included 65 studies across Europe, North America, Asia and Australia, with a total of 21,793 patch-tested ED patients. AED was reported in 27.5% (95% CI 0.177, 0.384) of patch-tested ED patients. Isolated ED was noted in 51.6% (95% CI 0.408, 0.623) of 8453 ED patients with reported lesion distribution, including 430 patients with isolated AED. Our meta-analysis demonstrated that the AED frequency in patch-tested ED patients exceeded the previous estimate of 10%. Isolated AED was noted in adult patients, attending contact allergy clinics. Future studies are needed to elucidate the global prevalence and natural history of isolated AED in adults.

Eyelid Dermatitis Caused by Metals in Cosmetic Products: A Scoping Review.

Eyelid Dermatitis Caused by Metals in Cosmetic Products: A Scoping Review.

Contact allergens responsible for eyelid dermatitis in adults.

Allergic contact dermatitis has been established as the most frequent cause of eyelid dermatitis, but it is often misdiagnosed. The purpose of this study was to evaluate the characteristics of patients with eyelid dermatitis who were referred for patch testing. The patients were divided into three subgroups in this retrospective study: patients with only eyelid involvement, patients with involvement of eyelids and other areas, and patients without eyelid involvement. Data was collected on diagnoses, medical history, personal care products and make-up use, occupational dermatitis, and positive allergens. An independent t-test, one-way ANOVA, and chi-squared test were used to analyze the data. A total of 427 patients who referred for patch tests were included in the study. Of these, 139 patients had eyelid dermatitis. Allergic contact dermatitis (ACD) was the most common diagnosis in all three groups referred for patch tests. Use of shaving cream and hair conditioner was significantly higher in patients with only eyelid involvement and nickel sulfate was the most common allergen among them. Patch testing is the gold standard tool in the evaluation of eyelid contact dermatitis, and it is a necessity in the treatment of eyelid dermatitis, for the accurate identification of responsible allergens.

Allergic disorders of the eyelid

Eyelid dermatitis may present with a variety of clinical findings including erythema, pruritus, and edema, and it has a wide differential. Allergic contact dermatitis due to allergen sources in personal care products, cosmetics, and fragrances is a leading cause of eyelid dermatitis and may be challenging to diagnose by clinical examination alone. Expanded patch testing, in addition to careful inspection of the surrounding skin for additional areas of involvement and clinical clues, remains an important tool in differentiating allergic contact dermatitis from other relevant etiologies of eyelid dermatitis including irritant contact dermatitis, atopic dermatitis, seborrheic dermatitis, and rosacea. We present a practical approach to the management of eyelid dermatitis including the use of a topical anti-inflammatory for long-term control of eyelid findings. Further diagnostic workup may be warranted in patients with refractory eyelid dermatitis.

440 Prevalence and burden of rhinoconjunctivitis in atopic dermatitis patients: a cross-sectional study

Abstract Allergic rhinoconjuncitivitis can be highly symptomatic and burdensome and complicates the management of eyelid and facial dermatitis in persons with atopic dermatitis (AD). However, little is known about the prevalence, burden and predictors of allergic rhinoconjunctivitis symptoms in patients with AD, particularly among adults. This study aims to determine the prevalence and predictors of allergic rhinoconjunctivitis severity in patients with AD. A cross-sectional, dermatology practice-based study was performed at an urban academic medical center (n = 507). Atopic dermatitis severity was assessed by investigator-assessed Eczema Area and Severity Index (EASI), body surface area (BSA), investigator’s global assessment (IGA), objective-SCORing AD and patient-reported Global Assessment (PtGA). Impact of allergic rhinoconjunctivitis symptoms was assessed by Rhinoconjunctivitis Quality of Life Questionnaire. The cohort included children (<18 years; n = 36, 7.1%), young adults (18–49 years; n = 281, 55.4%) and older adults (≥50 years; n = 190, 37.5%), males (n = 219, 43.2%) and females (n = 288, 56.8%), Hispanics (n = 43, 8.5%), Blacks (n = 50, 9.9%), White non-Hispanics (n = 349, 68.8%), Asians (n = 51, 10.1%) and multiracial/other race (n = 14, 2.8%); 413 (81.5%) had private insurance. Overall, 246 (48.5%) reported a history of hay fever, and 15 (3.0%) and 416 (82.1%) of patients with AD reported having trouble with one or multiple rhinoconjunctivitis symptoms in the past 2 weeks; 30 (5.9%) and 365 (72.0%) of patients with AD had quite a bit or extreme trouble with one or multiple rhinoconjunctivitis symptoms, respectively. More severe AD overall (EASI, BSA, IGA and PtGA), as well as more severe facial dermatitis, flexural eczema and xerosis were associated with worse rhinoconjunctivitis symptoms, whereas, race, gender and presence of nummular dermatitis were generally not associated with rhinoconjunctivitis symptom severity. Quite a bit or extreme trouble from one or more rhinoconjunctivitis symptoms was reported in 39 (56.5%) patients with clear/almost clear, 85 (74.6%) mild, 135 (82.8%) moderate and 106 (84.8%) severe PtGA scores. In multivariable ordinal logistic regression models that controlled for demographics, AD severity was significantly associated with higher odds of a wide range of nasal and ocular symptoms, as well as rhinoconjunctivitis symptoms negatively impacting daily activities, causing sleep and practical problems, and negative emotions. Allergic rhinoconjunctivitis symptoms occurred in more than 4 out of 5 patients with AD overall, and almost 90% of patients with severe AD. Allergic rhinoconjunctivitis was more common in those with more severe AD, and particularly those with more severe facial dermatitis, flexural eczema and xerosis. Rhinconjunctivitis symptoms negatively impact the lives of patients with AD and warrant appropriate screening and management in clinical practice.

Contact Dermatitis to Ophthalmic Solutions: An Update.

Eyelid and periorbital dermatitis remains a distressing and recalcitrant disease. Contact dermatitis remains the most common cause of eyelid and periorbital dermatitis. Ophthalmic solutions used in the treatment of ophthalmic conditions can often be the cause. This article is an update of our previous study, summarizing the contact allergens involved and the new test concentrations reported to investigate through patch testing. New insights found during the review are also documented.

Facial Dermatoses in Patients With Blepharitis: a Cross-sectional Prospective Analysis.

IntroductionThe relationship between facial dermatoses and blepharitis has been known for a long time.ObjectivesWe aimed to investigate the frequency of accompanying facial dermatoses in patients with blepharitis and their relationship with the severity of blepharitis.MethodsIn this cross-sectional study, 95 patients with blepharitis were examined for attending facial dermatoses. The type of blepharitis, the severity of blepharitis, and the degree of dry eye were determined in the patients. Dermoscopic and microscopic examinations were used in the diagnosis of facial dermatoses. The history of allergic rhinitis was questioned because Demodex species frequently accompany blepharitis, facial dermatoses, and allergic rhinitis patients. Mann-Whitney U test was used compare 2 independent groups. In comparing categorical variables, Pearson chi-Squared, Fishere Exact, and Fisher-Freeman-Holton tests were used.ResultsAt least 1 facial dermatosis was detected in 84.2% patients, and we did not see any facial dermatosis in 15.8% ones. No patients had acne, which is one of the most common facial dermatoses. The most common facial dermatosis detected in our patients was facial demodicosis (57.9%). It was followed by seborrheic dermatitis (22.1%) and rosacea (12.6%), respectively. In addition, 2.1% of the patients had atopic eyelid dermatitis, 23.2% had a history of allergic rhinitis, and 63.2% had ocular demodicosis.ConclusionsIt is essential to perform dermatological examinations of all patients with blepharitis in terms of accompanying facial dermatoses and their early diagnosis.

Dupilumab-induced ocular surface disease: A systematic review

Dupilumab-induced ocular surface disease: A systematic review

Cutaneous and histopathological features of coronavirus disease 2019 in pediatrics: A review article.

Prevalence of dermatological manifestations of coronavirus disease 2019 (COVID‐19) is estimated between 0.25% and 3% in children and adolescents. In this review article, we decided to describe the cutaneous and histopathological manifestations of COVID‐19 infection in pediatrics. We searched published articles in PubMed database for key words of “children” or “pediatric” and “cutaneous” or “dermatology” or “skin” and “COVID‐19” or “SARS‐CoV‐2” or “Coronavirus disease 2019” in abstract or title from December of 2019 until September 2020. Finally, 38 articles were selected. The majority of patients were between 11 and 17 years old with predominantly male gender. Most of the patients were either asymptomatic or had a few general symptoms. The latency time from appearance of general symptoms to cutaneous ones was between 1 day and weeks. Skin lesions faded between 3 and 88 days without any sequelae, spontaneously or with either topical or systemic corticosteroids. Skin manifestations were chilblain‐like (pseudochilblain), erythema multiforme‐like, dactylitis, acral erythema, acute urticaria, livedo reticularis, mottling, acro‐ischemia, generalized maculopapular lesions, eyelid dermatitis, miliaria‐like, varicelliform lesions, and petechiae and/or purpura. Kawa‐COVID‐19 patients were presented more frequently with cardiogenic shock, neurological symptoms, lymphocytopenia, and thrombocytopenia as compared to classic Kawasaki's disease. Furthermore, more number of cases were resistant to the first‐line treatments.

Corneal alterations in eyelid diseases

Corneal changes associated with eyelid disease are frequent and can considerably complicate the course of the disease. They can manifest as refraction anomalies, corneal degeneration, ocular surface disease, corneal infiltrates, corneal vascularization and corneal ulceration up to corneal perforation. Pathophysiologically relevant are compressive forces, exposure, trichiasis and distichiasis, eye rubbing, inflammation and infection. Amultitude of eyelid diseases is associated with diseases of the cornea including eyelid malposition, eyelid tumors, eyelid infections, allergic eyelid dermatitis, blepharitis, meibomitis, and Meibomian gland disease.

Eyelid dermatitis in patients referred for patch testing: Retrospective analysis of North American Contact Dermatitis Group data, 1994-2016

Eyelid dermatitis is a common dermatologic complaint. To characterize patients with eyelid dermatitis. Retrospective analysis (1994-2016) of North American Contact Dermatitis Group data. Of 50,795 patients, 2332 (4.6%) had eyelid dermatitis only, whereas 1623 (3.2%) also had dermatitis of the eyelids and head or neck. Compared with patients without eyelid involvement (n=26,130), groups with eyelid dermatitis only and dermatitis of the eyelid and head or neck were significantly more likely to be female, white, and older than 40years, and to have a history of hay fever, atopic dermatitis, or both (P<.01). Final primary diagnoses included allergic contact dermatitis (eyelid dermatitis only: 43.4%; dermatitis of the eyelid and head or neck: 53.5%), irritant contact dermatitis (eyelid dermatitis only: 17.0%; dermatitis of the eyelid and head or neck: 9.8%), and atopic dermatitis (eyeliddermatitis only: 13.1%; dermatitis of the eyelid and head or neck: 13.8%). Top 5 currently relevant allergens included nickel sulfate (eyelid dermatitis only: 18.6%; dermatitis of the eyelid and head or neck: 22.5%), fragrance mix I (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 18.3%), methylisothiazolinone (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 17.7%), gold sodium thiosulfate (eyeliddermatitis only: 14.7%; dermatitis of the eyelid and head or neck: 11.4%), and balsam of Peru (eyelid dermatitis only: 11.9%; dermatitis of the eyelid and head or neck: 12.6%). Both eyelid-involvement groups were significantly more likely to react to gold sodium thiosulfate, carmine, shellac, dimethylaminopropylamine, oleamidopropyl dimethylamine, and thimerosal (P<.05) compared with the no eyelid involvement group. Lack of specific distribution patterns of eyelid dermatitis and no long-term follow-up data. Patch testing remains a critical tool in evaluating patients with eyelid dermatitis.

Evaluation of the Therapeutic Effectiveness of Combined Action Antiallergic Drugs in Monotherapy of Allergic Conjunctivitis

According to statistical studies in recent decades, there has been an increase of allergic diseases in most countries of the world. Predisposing factors are the deterioration of the environmental situation, the total “chemicalization” of life and the forced use of drugs. Twenty years ago, the World Health Organization called the new century “the century of allergies” and the disease itself as an “epidemic”. As time has shown, these forecasts have come true: from 2001 to 2010, the number of allergic people in the world increased by 20 % and many of these patients suffer from ophthalmic manifestations of the pathology: the eyes are involved in the process in almost every second case. This is due to the fact that the eyes are directly exposed to the environment and a variety of external allergens. The most common disease of an eye-allergic nature is allergic conjunctivitis: approximately 15 % of the total population of economically developed countries suffer from it. Allergic blepharitis, eyelid dermatitis, keratitis, iritis, uveitis, retinitis and optic neuritis are much less common. The following manifestations are typical for allergic conjunctivitis: burning, lacrimation, pruritus, hyperemia of the eyelids and conjunctiva, photophobia. In the case of a transition to a chronic form, pronounced tissue changes are observed. Therefore, timely diagnosis and effective treatment certainly have a positive effect on the quality of life of the patient and the course of the disease. The treatment of patients with allergic conjunctivitis, first of all, consists in the maximum possible restriction of contact with the allergen. During desensitizing therapy, local and general drugs are used. Numerous studies have proven the advantage of targeted and effective antiallergic local therapy compared with systemic exposure. Currently used local ophthalmic antiallergic drugs belonging to various groups. The tactics of their use is determined by the acuity, severity and etiology of the process. When choosing a drug, in some cases, you should focus on the presence of substances that provide a double mechanism of action: a pronounced antihistamine activity in combination with the stabilization properties of mast cells, which has a quick and long therapeutic effect. This study evaluated efficacy of Vizallergol (olopatadin 0.2 %) application in cases of allergic conjunctivitis in 239 patients was evaluated. The medication arrested the symptoms of allergic conjunctivitis in 89 % of patients, at that the mean period of treatment made 10.7 ± 0.3 days. In the treatment of allergic conjunctivitis, the therapeutic efficacy of Vizallergol 0.2 % was comparable to opatanol 0.1 % and was found to be more comfortable for most patients due to the convenience of a single use.

Investigating the role of allergic contact dermatitis in residual ocular surface disease on dupilumab (ROSDD),.

BackgroundThe mechanisms underlying eye-related complications with dupilumab are poorly understood.ObjectiveThis study aimed to determine the incidence and characteristics of ocular complications with dupilumab and the prevalence of comorbid allergic contact dermatitis in the same subpopulation.MethodsThis is a retrospective chart review of 48 patients with atopic dermatitis who received dupilumab. For patients with eye involvement at first follow-up, we discuss the presence of eyelid dermatitis, blepharitis, or conjunctivitis and analyze available patch test findings in patients with ocular complications while treated with dupilumab.ResultsA total of 14 patients (29.2%) showed eye involvement while on dupilumab, all of whom experienced eye involvement prior to dupilumab. The results of the patch test were most commonly positive for emulsifier/surfactants (42.5%) and fragrances (30.4%). Nine patients experienced improvement with allergen avoidance subsequent to patch testing, and four of nine patients’ conditions cleared almost entirely. This is a non-randomized study in a small cohort of patients. Only 18 patients had their disease confirmed by an ophthalmologist.ConclusionAll patients with eye involvement while on dupilumab had a history of eye involvement prior to dupilumab, suggest that dupilumab may encourage rather than cause ocular surface inflammation. Significant improvement after patch testing in nearly half of patients suggests that allergic contact dermatitis contributes to some cases of dupilumab-associated eye complications.

Acrylates: new sources and new allergens.

Acrylates are synthetic thermoplastic resins used in a multitude of products, ranging from bone cement to artificial nails. They represent an important and increasing cause of both occupational and nonoccupational allergic contact dermatitis. Isobornyl acrylate, an acrylic monomer found within ultraviolet-cured inks, adhesives and various medical devices for diabetes, has emerged as an important sensitizer. In addition, long-lasting nail products have played a significant role in the increased prevalence of acrylate allergy. Sensitized individuals classically present with facial or eyelid dermatitis, and some patients experience associated fingertip and nail changes. This manuscript reviews these two important sources of acrylate allergy and summarizes other potential new exposures, including surgical glues and wound-care products.

Eyelid dermatitis. Experience in our Cutaneous Allergy Unit between 1980 and 2018.

Eyelid dermatitis. Experience in our Cutaneous Allergy Unit between 1980 and 2018.

Ocular Co-Morbidities of Atopic Dermatitis. Part I: Associated Ocular Diseases.

Ocular diseases associated with atopic dermatitis (AD) may be sight-threatening. A general understanding of the pathophysiology, diagnosis, and treatment of atopic eye disease may assist dermatologists in knowing when to refer to ophthalmology and in co-managing these diseases with ophthalmologists. Ocular diseases associated with AD include eyelid dermatitis, keratoconjunctivitis, keratoconus, cataract, and retinal detachment. AD patients are also at higher risk for bacterial and viral ocular infections. The objective of this article is to provide a current review of ocular diseases that commonly affect AD patients. The pathogenesis, clinical manifestations, diagnosis, and treatment of ocular co-morbidities of AD will be discussed.

Tacrolimus ointment in the management of atopic keratoconjunctivitis

Atopic keratoconjunctivitis is frequently associated with atopic eyelid dermatitis. It may require topical steroids, the prolonged use of which may cause ocular complications. Tacrolimus is an immunosuppressant used topically on the skin in atopic dermatitis. The purpose of this study is to evaluate the efficacy and tolerability of tacrolimus 0.1% ointment applied to the eyelids in atopic keratoconjunctivitis. This is a single center, retrospective study carried out between June 2014 and February 2017. Patients presenting with atopic keratoconjunctivitis uncontrolled by first-line medical treatment were included. The main outcome was change in functional symptoms as evaluated by the NEI-VFQ25 and OSDI quality of life scores. Secondary criteria were visual acuity and topical steroids use. Among the 18patients included, the mean age was 37.9±16.8years. The first follow-up visit occurred on average 68.3±55.3days after initiation of treatment. The NEI-VFQ25 score improved significantly for seven of the sub-scores (P<0.05), and the mean OSDI decreased significantly from 52.3±26.2 to 22.0±27.0 (P<0.001), demonstrating a decrease in ocular symptoms. A significant reduction in the number of patients requiring topical steroid treatment was observed. There was no significant change in visual acuity. Tacrolimus 0.1% ointment applied to the eyelids appears to be an effective treatment in the management of atopic keratoconjunctivitis.

Eyelid Dermatitis and Contact Sensitization to Nickel: Results from an Italian Multi-Centric Observational Study.

Due to the sensitizing constituents of eye cosmetics, allergic contact dermatitis is considered a frequent cause of eyelid dermatitis. An association between eyelid dermatitis and nickel contained in make-ups remains controversial. The study aimed to assess the association between nickel allergy, the use of pigmented makeup products and self-reported eyelid dermatitis. This multi-centric, cross-sectional study enrolled 165 women sensitized to nickel (patients) and 103 women without intolerance to metals (controls). We recorded: demographics, atopy, use of pigmented eye cosmetics (mascara, eyeshadow, eyeliner, eyebrow pencil), and previous eyelid dermatitis. Among the patients, any co-sensitization to cosmetics or metals was recorded. 87.3% of the patients and 91.3% of the controls reported their use of eye make-up; 44.9% and 52.4%, respectively, reported previous episodes of eyelid dermatitis, without significant differences. The occurrence of eyelid dermatitis was significantly associated with the use of eye make-up products, both in general and considering each product separately. Age, atopy, or co-sensitization to other metals or cosmetics did not affect the occurrence of eyelid dermatitis. Nickel allergy should not be considered the main risk factor for eyelid dermatitis. The use of pigmented eye make-up may be a triggering factor for eyelid dermatitis, probably due to an irritant action.

Cutaneous and Mucosal Manifestations of Sjögren’s Syndrome

Sjögren's syndrome is currently considered an "autoimmune epithelitis," as exocrine glands, especially salivary and lacrimal, are progressively destructed by an immune-mediated process associated with specific serum autoantibodies and local lymphocyte infiltrate. Xerostomia remains a key complain in patients with Sjögren's syndrome but should be evaluated also for other causes such as xerogenic medications, followed by radiation and chemotherapy for head and neck cancers, hormone disorders, infections, or other connective tissue diseases. Further, xerophtalmia (also known as dry eye) frequently associated with keratoconjunctivitis sicca cumulatively affects approximately 10-30% of the general population with increasing incidence with age and is more frequently secondary to non-autoimmune diseases. On the other hand, numerous patients with Sjögren's syndrome manifest signs of systemic dryness involving the nose, the trachea, the vagina, and the skin, suggesting that other glands are also affected beyond the exocrine epithelia. Skin involvement in Sjögren's syndrome is relatively common, and various manifestations may be present, in particular xeroderma, eyelid dermatitis, annular erythema, and cutaneous vasculitis. Additional skin non-vasculitic manifestations include livedo reticularis which may occur in the absence of vasculitis, and localized nodular cutaneous amyloidosis possibly representing lymphoproliferative diseases related to Sjögren's syndrome. The treatment of skin and mucosal manifestations in Sjögren's syndrome is similar regardless of the cause, starting from patient education to avoid alcohol and tobacco smoking and to pursue dental hygiene. In conclusion, a strict collaboration between the dermatologist and the rheumatologist is essential in the adequate management of Sjögren's syndrome skin and mucosal manifestations.