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Contact Allergens Responsible for Eyelid Dermatitis in Adults
abstract
This abstract is available on the publisher's site.
Access this abstract nowAllergic 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.
Additional Info
Contact allergens responsible for eyelid dermatitis in adults
J Dermatol 2024 May 01;51(5)691-695, T Yazdanparast, M Nassiri Kashani, M Shamsipour, F Izadi Heidari, F Amiri, A FiroozFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The etiology of eyelid dermatitis, like many instances of allergic contact dermatitis, may be straightforward or very perplexing. History may be very helpful with medications or personal care products applied to the eyelids, aiding in pointing to the proper culprit, but may also be misleading when an "ectopic" allergen is not obvious. The presentation of allergic dermatitis may also be misleading in terms of the correct cause. Some patients present with chronic irritation of the eyelid margins only, whereas others present with acute swelling of all eyelids or chronic changes of all eyelids. Many years ago, I was stumped by a patient who had been seeing an allergist and an ophthalmologist for chronic conjunctivitis and blepharitis attributed to seasonal environmental allergens. Luckily, I was able to obtain the patient's ophthalmic medication ingredients from the manufacturer and identified an allergic reaction to the beta blocker that was the active ingredient of the medication.1 My normal patch-testing haptens at that time would have missed the true cause of his chronic condition. Another perplexing problem with establishing the correct allergen is the fact that the eyelids, being so thin, have been shown to demonstrate a significant incidence of false-negative results on patch testing. An article by Grey and Warshaw discusses this dilemma and offers information on alternative methods of testing that may be required to identify the relevant allergens.2
The bottom line is to be aware of the benefits and the limitations of history and patch testing when seeing patients with eyelid dermatitis who are likely to have an allergic etiology.
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