Abstract
Case study A 40-year-old female patient presents with an intermittent, itchy rash around both eyelids, but particularly affecting the skin around the right eye. There is no history of eczema or allergies, but the symptoms are worse after a recent manicure.
Reproduced with permission from DermNet New Zealand.
This is allergic eyelid contact dermatitis.
There is often no past history of skin problems, eczema or skin sensitivity. A contact allergy can develop after repeated contact with the substance and the allergen is therefore not necessarily new to the sufferer.
The eyelid dermatitis is caused by indirect contact with the allergen by transfer of small amounts of the substance from fingers to eyelids. The asymmetrical nature of the rash is characteristic of a contact dermatitis. The rash usually appears several days after contact with the allergen. The allergen produces a delayed hypersensitivity reaction (type IV hypersensitivity).
Diagnosis is therefore not obvious to the uninitiated. Previous exposure may not have produced a similar reaction and the dermatitis is a delayed reaction rather than an immediate and more obvious one. Intermittent exposure to the allergen may further confound identification of the causal link, as may the lack of an association by the patient between nail cosmetics and an eyelid problem.
A careful history will help confirm the diagnosis. Nickel, rubber and various cosmetics may be implicated, as may cleansers, sunscreens, eye-drops, contact lens solutions and a wide variety of other potential allergens. Detail about skin care, hobbies and employment should be sought in the history. Patch testing can confirm sensitivity to the suspected allergen.
Treatment involves avoidance of rubbing, scratching and contact with the suspected or proven allergen. Short courses of mild topical steroids (for example 1% hydrocortisone cream) or calcineurin inhibitors (for example pimecrolimus 1% cream) may be required if inflammation and itching are particularly troublesome.