Recognizing and Treating Eyelid Dermatitis

Dermatitis is not a pleasant condition on any part of the face; on the thin and delicate tissues of the eyelids, however, the redness, itching, and burning can become unbearable very quickly. It is not an uncommon problem, and it is especially prevalent among those with atopic dermatitis, fragrance allergies, and animal dander allergies (cats, horses, and dogs in descending order).

Like any other kind of dermatitis, dermatitis on the eyelids–also known as periocular dermatitis or periorbital dermatitis–is caused by inflammation characterized by itchy, irritated skin, redness, and swelling. It might progress gradually, beginning with a noticeable but bearable itch with slight redness. Over hours or even days, though, the itching intensifies. Swelling and redness worsen, and oozing might develop. It can also come on suddenly, with a red, intensely itchy rash that demands immediate attention by a Dermatology clinic Provider. One-sided painful blisters and scabs are an emergency because they can be a Herpes virus infection starting on top of active atopic dermatitis.

 

It isn’t clear how prevalent periocular dermatitis is in the population, but it seems to be relatively common. Many physicians find that most eyelid dermatitis patients also have atopic dermatitis or other atopic conditions, such as asthma. 

 

 

 

What Causes Dermatitis on the Eyelids?

 

With the aforementioned prevalence of the condition among people with atopic dermatitis and asthma, it is no surprise that allergy or atopy is the most frequent culprit.  Atopy–derived from the Greek word atopia, or “out of place–refers to conditions caused by a sensitive immune system that leads to dermatitis “anyplace on the skin.” People with atopic disorders experience disruptive immunologic responses to things that are normally benign. Hay fever, eczema, and asthma are all atopic disorders, and having one of these disorders increases a person’s risk of developing the others. Thyroid problems, cataracts and glaucoma are more common in atopic eyelid dermatitis patients.

Allergic contact dermatitis (ACD) also manifests on the eyelids. It’s a common type of eyelid dermatitis. It occurs when the eyelids come into contact with an allergen, with the reaction reaching its peak within 24 hours of exposure. These allergens are often found in cosmetics, and while you’d bank on eyeshadow or mascara being the most common irritants, numerous studies have found nail polish to be a more  common trigger. Pet allergies, metal/jewelry allergies, and fragrance allergies are common versions.

Cosmetics are not the only trigger, though. We frequently touch our eyelids, so the allergens that trigger ACD are often transferred from our hands (the nail polish connection is therefore not quite so surprising). Lotions, pollen, pet dander and fragrances can all be brought to the eyelids when we brush away an errant lash or rub sleepy eyes. Gold particles from jewelry can reach the eyelids and cause ACD.

Allergic contact dermatitis of the eyelids can also be caused by chemicals common in hair dyes, soap, and fragrances. In a Brazilian study, a chemical commonly found in permanent hair dyes triggered ACD on the eyelids while the scalp was unaffected. This testifies to the eyelid’s unique sensitivity. 

Some other triggers of ACD are metals (especially nickel), shellac (a natural resin used in cosmetics, foods, and varnishes), preservatives, topical medications (with antibiotics and corticosteroids being the most common), fragrances, surfactants (widely used chemicals found in detergents and bath products), pet dander, and house dust.

 

Irritant contact dermatitis (ICD) is similar to ACD. It, too, occurs when the skin comes into contact with irritants. Like ACD, soaps and cosmetics are common triggers of irritant contact dermatitis on the eyelids. These two kinds of dermatitis present almost identically, and both are caused by contact with the trigger. However, ICD does not share the immunologic response found in ACD. 

 

 

False eyelashes (or the adhesive used to attach them to the eyelid), nickel, industrial solvents, rubbing alcohol, bleach, and compounds off-gassed by new carpeting or paint can trigger ICD. The condition can also result from rubbing the eyes or from exposure to heat or cold. Fortunately for ICD sufferers, the symptoms tend to abate once the irritant is removed. 

 

Seborrheic dermatitis can cause redness and scaling that looks similar to contact dermatitis. It is most commonly found on the scalp. It can occur on the eyebrows and extend onto the eyelids. Seborrheic dermatitis is caused by excessive sebum production and is frequently triggered by hormonal changes, such as those experienced during puberty. Pityrosporum yeast (aka Malassezia) also triggers seborrheic dermatitis.

 

Although it can look similar to other kinds of dermatitis, seborrheic dermatitis is not caused by contact with irritants or allergens. While it might be accompanied by redness and scaling, severe itching is not a defining symptom of the condition as contrasted with allergic contact dermatitis or atopic eczema.

How is Dermatitis of the Eyelid Diagnosed?

 

Your doctor might suspect you are suffering from dermatitis of the eyelid if they observe redness, swelling, or scaling. If the dermatitis does not readily respond to treatment and elimination of triggers, the doctor might order Patch testing to identify any allergens that might be at work. 

 

Patch tests are conducted by placing patches containing different allergens on the skin of the arms or back. These patches can be left in place for up to 48 hours. When they’re removed, your doctor will evaluate your skin under each small patch for redness or edema.

 

Other tests include intradermal tests, which involves the injection of small amounts of allergens into the skin, and blood tests for IgE immunoglobulins (proteins produced by your immune system in response to specific antigens) contributing eyelid dermatitis.  These may not correlate with cat dander; a week of vacation away from the cat is the best test.

 

If your physician cannot get the symptoms under control, then you should seek the care of a Board-certified dermatologist and possibly an allergist. Under no circumstances should you attempt to diagnose or treat chronic skin conditions without a doctor’s oversight. 

 

Could Complications Arise from Eyelid Dermatitis? 

Untreated dermatitis on the eyes can lead to complications ranging from infection to thinning of the cornea. Staphylococcus Aureus (staph) is the most common pathogen found in these infections. Because the skin of the eyelid is so sensitive, it is easily damaged by rubbing and scratching. Such damage leaves the skin vulnerable to infection. Bacterial conjunctivitis and inflammation of the oil glands in the eyelids (blepharitis) occur more frequently in people with dermatitis. 

People suffering from atopic dermatitis should take note; eczema patients tend to have higher-than-average populations of S. Aureus in the skin microbiome. Atopic dermatitis patients are 67% more likely to experience bacterial conjunctivitis. All patients with chronic eyelid dermatitis should be tested yearly by the Eye doctor for early glaucoma and cataracts.

Other complications can include abrasions to the cornea and corneal thinning (keratoconus), both caused by scratching or rubbing the eyes. Those who have frequent or prolonged flares of eyelid dermatitis, whether caused by ACD, ICD, or eczema, are at increased risk of corneal thinning.  Most complications, as you can see, are caused by touching the affected eyelids.

How is Eyelid Dermatitis Treated? A Look At Eyelid Eczema Cream

 

 

Treatment of dermatitis of the eyelid is similar to treatments of dermatitis occurring elsewhere on the body, with avoidance of triggers, topical steroids and calcineurin inhibitors playing a central role. Because the skin of the eyelid skin is four times thinner than facial skin, only mild steroids (containing only 0.5-1% hydrocortisone) are recommended. Eyelid eczema cream is safe so long as you use the right one at the right time.

 

SmartLotionⓇ is a safe and effective treatment for chronic and recurring seborrheic, atopic and irritant contact dermatitis around the eyes when used properly. This eyelid eczema cream has a small amount of Hydrocortisone USP 0.75%, it will not cause atrophy of the delicate skin around the eyes. Its unique prebiotic formula also supports skin barrier function and helps reduce triggers from yeast and bacteria. Adverse reactions to SmartLotionⓇ are rare, which is important when treating especially sensitive skin. 

 

Dr. Steve Harlan MD, the Board-certified dermatologist who developed SmartLotionⓇ, recommends that most of his adult contact dermatitis patients apply SmartLotionⓇ two to three times a day for up to two weeks. Then, they replace it with a calcineurin inhibitor like Pimecrolimus cream (Elidel®). Many patients can simply avoid triggers and moisturize and do well most of the time without SmartLotionⓇ. 

 

 

 

 

If flares are returning frequently, or there is no improvement after two weeks of SmartLotionⓇ, further investigation is warranted for Allergic Contact dermatitis ACD. Patch testing is then needed at the Dermatology Provider clinic. An Atopic patient who suddenly is experiencing more difficult flares, suggests they have developed a new allergy to something. Removal from the animal dander exposure is also important.

When patch tests are negative, infection is ruled out, and there is no improvement within the first 2-4 weeks, a Board-certified dermatologist may decide to use a short course of oral steroids, along with all the topical therapeutic approaches, to break the cycle. This is not for amateurs however, and it will fail with cat dander allergies if the cat remains in the same part of the house. Patients should ensure that their environment is free of cat dander.  

Topical calcineurin inhibitors (TCIs) – pimecrolimus (Elidel) and tacrolimus (Protopic) – are non-steroidal treatments often prescribed for eyelid eczema. They have fewer adverse effects than topical steroids do, although they may increase photosensitivity. They are usually prescribed for 6 weeks but can be used long-term for persistent symptoms, with medical supervision. 

Patients should ensure that they avoid triggers as much as possible, and cosmetics should not be applied to the eyelids during treatment. Because prescription treatments can sometimes cause photosensitivity, direct sunlight should be avoided during treatment. A week-long vacation from the pet is often needed to sort out the contribution of animal dander to stubborn recurring eyelid dermatitis.

Emollients should be used to maintain the moisture of the eyelids, taking care to use products that do not irritate the skin or the eyes. Cetaphil®, CeraVe®, and Aveeno® all produce moisturizers that are not likely to irritate sensitive skin; these brands are highly recommended by dermatologists. 

As with any other kind of dermatitis, patients should work hard to interrupt the itch-scratch cycle. We instinctively scratch at itchy skin, but doing so during a dermatitis flare kicks off a chain of responses that results in prolonged itching. As you’ve already read, scratching and rubbing your eyes can increase your risks of other complications, too. 

If you suspect that you have dermatitis on your eyelids, you should seek a doctor’s care. Other conditions, such as bacterial infections, can mimic the symptoms of dermatitis. These conditions have different treatments and should be ruled out. Those with diagnosed cases of dermatitis should watch for signs of bacterial infections. Blisters that are red and hot to the touch can indicate a staph infection. A gritty sensation in the eye, reddening of the sclera, and burning in the eye could be caused by bacterial conjunctivitis. These infections should be treated promptly.

 

Did you know you can get eczema on the lips too? Read about it here.  

Finally, cataracts and glaucoma are more frequent in people with atopic eczema. Unsupervised use of topical and oral corticosteroids can worsen or accelerate these conditions. Eye doctors naturally dislike steroids for skin conditions, and they expect patients to be closely supervised by the Dermatology clinic.

 

 

 

  Cee Van

  Medical Writer

  HarlanMD.com