A 45-year-old woman is seen in the allergy clinic with a complaint of red, itchy, scaly rash around the eyes for 5 months. No eye itching but she has occasional sneezing and a history of allergic rhinitis.
Examination is positive for dry skin and macular rash around both eyes, below the orbits.
What is the most likely diagnosis?
Periorbital dermatitis. Differential diagnosis includes atopic dermatitis, contact dermatitis, nonspecific dermatitis.
What would you suggest?
TRUE patch test for contact dermatitis.
If negative, then a skin test with airborne allergens could be considered.
For mild exacerbations, use topical hydrocortisone 1% for up to 1-3 weeks or Elidel. Use topical moisturizer such as Eucerin for dry areas.
Periorbital dermatitis is common and frequently difficult to treat. Patients with periorbital dermatitis often suffer severely because their disease is in such a visible location.
Predominant causes of periorbital dermatitis are:
- allergic contact dermatitis, 32-44%
- atopic eczema, 14-25%
- airborne contact dermatitis, 2-10%
- irritant contact dermatitis, 8-9%
- less frequent causes for secondary eczematous periocular skin lesions were periorbital rosacea, allergic conjunctivitis or psoriasis vulgaris
Risk factors include female gender, atopic skin diathesis and age of 40 years and older.
Common causes of periorbital allergic contact dermatitis are leave-on cosmetic products (face cream, eye shadow) and eye drops with the typical allergens being fragrances, preservatives and drugs.
Exact identification of relevant contact allergens and allergen elimination are essential for successful treatment.
Calcineurin inhibitors are the first-line therapy for facial atopic eczema.
Contact Dermatitis - Approach to Treatment (click to enlarge the image).
Periorbital dermatitis: causes, differential diagnoses and therapy. J Dtsch Dermatol Ges. 2010 Mar;8(3):159-66. doi: 10.1111/j.1610-0387.2009.07216.x. Epub 2009 Sep 14.