Periorbital Eczema Research Articles

PD16: Are you sure it is periorbital eczema?

PD16: Are you sure it is periorbital eczema?

Allergic contact dermatitis by ophthalmological medications in Brazil: experience of a dermatology department

Topical treatments in ophthalmologic therapy are significant for the development of allergic contact dermatitis (ACD) in the periorbital region. Preservatives, antibiotics, glucocorticoids, and beta-blocker eye drops are defined as drugs with the highest sensitizing potential. The unavailability of patch test batteries containing substances of ophthalmological use makes it difficult for this diagnosis. In the present report, we describe six patients who developed ACD induced by different agents presenting in eye drops, confirmed with the cutaneous patch tests. The ACD diagnosis due to ophthalmic medications can be challenging, since many different agents can cause it, and the sensitivity of these cutaneous tests is low. Thus, early diagnosis is essential to avoid the complications of ACD on the skin and ocular disorders related to chronic periorbital eczema.

Genotype–phenotype correlation in boys with X‐linked hypohidrotic ectodermal dysplasia

X-linked hypohidrotic ectodermal dysplasia (XLHED), the most frequent form of ectodermal dysplasia, is a genetic disorder of ectoderm development characterized by malformation of multiple ectodermal structures such as skin, hair, sweat and sebaceous glands, and teeth. The disease is caused by a broad spectrum of mutations in the gene EDA. Although XLHED symptoms show inter-familial and intra-familial variability, genotype-phenotype correlation has been demonstrated with respect to sweat gland function. In this study, we investigated to which extent the EDA genotype correlates with the severity of XLHED-related skin and hair signs. Nineteen male children with XLHED (age range 3-14 years) and seven controls (aged 6-14 years) were examined by confocal microscopy of the skin, quantification of pilocarpine-induced sweating, semi-quantitative evaluation of full facial photographs with respect to XLHED-related skin issues, and phototrichogram analysis. All eight boys with known hypomorphic EDA mutations were able to produce at least some sweat and showed less severe cutaneous signs of XLHED than the anhidrotic XLHED patients (e.g., perioral and periorbital eczema or hyperpigmentation, regional hyperkeratosis, characteristic wrinkles under the eyes). As expected, individuals with XLHED had significantly less and thinner hair than healthy controls. However, there were also significant differences in hair number, diameter, and other hair characteristics between the group with hypomorphic EDA mutations and the anhidrotic patients. In summary, this study indicated a remarkable genotype-phenotype correlation of skin and hair findings in prepubescent males with XLHED.

Periorbital dermatitis-a recalcitrant disease: causes and differential diagnoses

Periorbital dermatitis is common and frequently recalcitrant to treatment. Due to the exposed and visible location, patients often suffer severely from periorbital dermatitis. To determine the frequency and causes of periorbital dermatitis including contact sensitizers. We investigated two cohorts of patients (Erlangen and IVDK without Erlangen) between 1999 and 2004. The differences between the two cohorts with periorbital dermatitis [Department of Dermatology at University Hospital Erlangen (n = 88) and the German Information Network of Departments of Dermatology (IVDK) collective (n = 2035)] were determined by the MOAHLFA (male, occupational dermatosis, atopic eczema, hand dermatitis, leg dermatitis, facial dermatitis, age > or = 40 years) index. Statistically significant factors for periocular eczema are female sex, atopic skin diathesis and age > or = 40 years. In both cohorts allergic contact dermatitis was the main cause of periorbital eczema (Erlangen 44.3%, IVDK 31.6%), followed by periorbital atopic dermatitis (Erlangen 25%, IVDK 14.1%), airborne dermatitis (Erlangen 10.2%, IVDK 1.9%), irritant contact dermatitis (Erlangen 9.1%, IVDK 7.6%), periorbital rosacea (Erlangen 4.5%, IVDK 2.2%), allergic conjunctivitis (Erlangen 2.3%, IVDK included in 'others') and psoriasis (Erlangen 2.3%, IVDK included in 'others'). The most relevant allergens/allergen sources inducing periorbital eczema were consumers' products (facial cream, eye shadow and ophthalmic therapeutics) (31%), fragrance mix (19%), balsam of Peru (10%), thiomersal (10%) and neomycin sulphate (8%); 12.5% of patients with allergic periocular dermatitis could be exclusively elucidated by testing patients' own products. Our data demonstrate the multiplicity of causes for periorbital eczematous disease manifestation, which requires patch testing of standard trays as well as consumers' products to elucidate the relevant contact sensitization.

Acute Bilateral Diffuse Corneal Opacity in a Child

To report a case of acute bilateral corneal opacity related to bacterial blepharoconjunctivitis. Interventional case report. An 18-month-old boy had bilateral red eyes with discharge and periorbital eczema. Bilateral corneal opacity suddenly developed 1 week later. All clinical assessments and laboratory evaluations of viral infection and autoimmune profiles were negative except for growth of coagulase-negative staphylococcus and propionibacterium acnes from conjunctival discharge. After systemic and topical antibiotic treatment, the opacity and inflammation of both eyes decreased. The left cornea became clear, but the right eye had a sequela of corneal opacity with stromal neovascularization and conjunctival scarring. Penetrating keratoplasty was performed in the right eye 6 months later. Histology at that time showed neovascularization in the deep stroma with perivascular mononuclear cell infiltration and decreased endothelial cells. Acute bilateral corneal opacity is rare but may occur in children with bacterial blepharokeratoconjunctivitis. Ocular surface inflammation may be induced by bacterial toxin reaction. Combined use of antibiotics and steroids may save the vision in such patients.

Doubtful Value of Patch Testing for Suspected Contact Allergy to Ophthalmic Products

Sir, Allergic contact dermatitis is the most common cause of peri-orbital eczema (1). It may be caused by allergens brought in contact with the eyelids by hand transfer (like toluene sulfonamide-formaldehyde resin in nail polishes), by airborne contact (like sesquiterpene lactones) or, most frequently, by direct application of cosmetics or topical ophthalmic medicaments. The percentage of sensitization due to cosmetics, such as moisturizing creams or eye-shadows, is estimated to range from 2.5% to 26% (2, 3). However, topical ophthalmic drugs, eye drops and contact lens solutions play a considerable role too. We studied 62 patients with eyelid dermatitis, closely related to the use of topical ocular products, with the aim of discerning the role of ophthalmic products in eyelid allergic contact dermatitis.

Topical tacrolimus alcohol induced flush presenting as food allergy

Rationale Topical treatment with tacrolimus may be complicated by ingestion related flushing after consuming small amounts of alcohol that can be mistaken for food allergy. Methods The case history of a representative patient with an alcohol induced reaction to local tacrolimus treated dermatitis is reviewed. Results A patient with a history of allergic rhinitis, atopic dermatitis, oral allergy syndrome and fish anaphylaxis was evaluated for ingestion related facial eruptions which began shortly after instituting topical tacrolimus to his peri-oral and peri-orbital eczema. Food allergy was first thought to be the problem with beer the most frequent trigger. Over time, it became clear that alcohols, including neutral spirits like vodka, were also implicated. An in office challenge was done with less than 1 ounce of white wine. Within 2-3 minutes of ingestion, there appeared an intense, non-pruritic erythema restricted to the areas of applied tacrolimus (peri-oral and peri-orbital distribution). In discussions with Fujisawa (maker of Protopic® brand of topical tacrolimus) they acknowledged receiving other anecdotal reports of topical tacrolimus related alcohol induced flushing. On this basis tacrolimus use was discontinued and within 2 weeks, the alcohol flush reaction disappeared but the eczema returned. Since the initial case presentation, this practice has seen two more patients with similar stories and response to tacrolimus cessation. Conclusions A careful history including alcohol use should be obtained in patients who use topical tacrolimus presenting with new skin complaints, as these may be evidence of an avoidable drug interaction and not worsening of atopic disease or an additional food allergy.

Periorbitales Kontaktekzem durch das Cholinergicum Aceclidin

In addition to atopic eczema contact allergies are the main cause of recurring periorbital eczema. There are only few case reports about periorbital contact dermatitis due to topical therapy of glaucoma, especially of parasympathicomimetics causing contact eczema. We report about a 69-year old female patient with bilateral periorbital eczema. Because of a glaucoma she received several local antiglaucomatosa within the last years. The patch-test revealed an allergic reaction for Aceclidin (Glaucotat®). Contact allergies due to topical cholinergica are only rarely found. However, their sentitization potential shouldn't be underestimated, especially in the group of glaucoma-patients.

Skin complaints in buildings with indoor climate problems

The Sick Building Syndrome (SBS), as defined by the World Health Organization (WHO), is a combination of both common and unspecific symptoms. Few studies have been published with detailed descriptions of clinical findings. One of the few dermatological references with a close relation to sick buildings is the so-called “low humidity occupational dermatoses.” Since 1982, an increasing number of outpatients from buildings with indoor climate problems have been investigated at the Department of Dermatology in Umeå, Sweden, The most common findings regarding work-related diseases have been seborrheic dermatitis, facial erythema, periorbital eczema, rosacea, urticaria, and “itching folliculitis.” It is suggested that physical, chemical, and psychological factors are of importance in producing these symptoms.

Glaucoma Induced by Application of Corticosteroids to the Periorbital Region

Reports of ocular complications from local and systemic corticosteroid therapy have been published¹; two reports^2,3document glaucoma provoked from the application of corticosteroid ointment to the periorbital region. This serious complication, which develops insidiously, has been noted in a recent article in theArchives.⁴We report two more such cases. <h3>Report of Cases</h3><h3>Case 1.—</h3> A 68-year-old woman had her intraocular pressure (IOP) routinely measured in 1972 because of mild diabetes mellitus. Her IOP was 30 mm Hg in the right and 32 mm Hg in the left eye by Goldmann's applanation tonometry. For two years she had applied prednisolone ointment, 5 mg/g of ointment on both eyelids several times daily for a periorbital eczema. She had no history of glaucoma, and her IOP in 1969 was 20 mm Hg in the right and 18 mm Hg in the left eye. The corrected visual acuity was 20/20