Eczema and the Eye
Donald Rudikoff, Steven R. Cohen, Noah Scheinfeld in Atopic Dermatitis and Eczematous Disorders, 2014
Although the eyelids are commonly involved in atopic dermatitis, allergic contact dermatitis is the most common cause of eyelid dermatitis (Fig 13.4). Eyelid skin is thin (0.55 mm), and antigens can penetrate easily. Most patients with eyelid allergic contact dermatitis are women, and the most common allergens are cosmetic ingredients such as fragrances, surfactants, and preservatives (Amin and Belsito 2006). These chemicals are also found in topical dermatological medications and ophthalmological products (Fig 13.5). Airborne protein antigens such as ragweed, dust mites, pollens, and animal dander can also cause allergic contact dermatitis of the eyelids, as can allergens transferred from the hand such as nickel, nail products, and latex (Guin 2002) (Fig 13.6). Allergic contact dermatitis of the eyelids is usually associated with dermatitis elsewhere on the face or body. Isolated dermatitis localized to the eyelids alone is likely to be seborrheic dermatitis (Amin and Belsito 2006).
Monographs of fragrance chemicals and extracts that have caused contact allergy / allergic contact dermatitis
Anton C. de Groot in Monographs in Contact Allergy, 2021
Results of testing in groups of selected patients (e.g. geriatric nurses with occupational contact dermatitis, individuals with eyelid dermatitis, patients with stasis dermatitis, female hairdressers and their clients, patients suspected of fragrance or cosmetic allergy) are shown in table 3.71.2. Frequencies of sensitization have ranged from 1.7% to 19%. The latter high rate was observed in patients with eyelid dermatitis (6). Other high frequencies of sensitization were observed in patients with former skin symptoms provoked by scented products in the case history (17.2% [3]), physical therapists (13.0% [68]), patients suspected of fragrance or cosmetic allergy (9.3% [2]), geriatric nurses with occupational contact dermatitis (8.2% [64]) and nurses with occupational contact dermatitis (7.4% [26]). Prevalence rates of sensitization to FM II were significantly higher than in control groups in patients with adult atopic dermatitis (63), geriatric nurses (64), patients with stasis dermatitis / chronic leg ulcers (30), and physical therapists (68). Specific causative products were never mentioned.
Amlexanox
Anton C. de Groot in Monographs in Contact Allergy, 2021
A 23-year-old woman with allergic conjunctivitis had been treated with 0.25% amlexanox ophthalmic solution for 11/2 year, when she woke up with itchy redness around her eyes. Patch tests showed a positive reaction to the solution. Later, the ingredients of the product were tested separately, and the patient reacted to amlexanox 1%, 0.25%, 0.1% and 0.025% water and to 1% and 0.25% pet. Her eyelid dermatitis cleared with discontinuance of the ophthalmic solution and topical corticosteroids. Four months later, an otologist prescribed tablets containing 50 mg amlexanox. The first tablet resulted in itching after an hour and the second, a day later, was followed by an erythema multifor-me-like eruption on the patient’s ears, neck, breasts and trunk. A diagnosis of systemic contact dermatitis was made (6). The authors of ref. 6 mention that ‘many cases of contact dermatitis from amlexanox 0.25% ophthalmic solution have been reported’ and cited 6 Japanese literature references from 1990 and 1991 describing at least 13 sensitized patients, including a series of three and one of four. As all reports are in Japanese, details are unknown (7-12). The authors of ref. 13 refer to another study with 4 patients allergic to the same ophthalmic solution (14) and an additional literature reference was found online (15).
Punctal stenosis associated with dupilumab therapy for atopic dermatitis
Published in Journal of Dermatological Treatment, 2021
Debora H. Lee, Liza M. Cohen, Michael K. Yoon, Jeremiah P. Tao
A 31-year old man with severe, refractory AD treated with dupilumab was referred for evaluation of irritation, redness, and tearing of both eyes for approximately 6 months. Notably, symptoms of tearing had developed 2 weeks after the onset of irritation and redness. He had started biweekly dupilumab 300 mg injections for AD 1 year prior and had recently initiated topical prednisolone acetate 1% for his ocular symptoms. Clinical exam revealed bilateral eyelid dermatitis with edema, conjunctival injection, and four severely stenotic puncta (Figure 2). Lacrimal irrigation was not possible due to the severity of stenosis; however, insufficient tear drainage was diagnosed on dye disappearance and Jones I tests (i.e. flow of fluorescein dye through the lacrimal drainage system was found to be inadequate). Given his preference in continuing dupilumab due to otherwise refractory AD, the patient agreed to reassess after resolution of conjunctivitis, for which erythromycin and artificial tears were added. One month later, ocular symptoms persisted, and mild ectropion had developed bilaterally. Patient preferred to add topical prednisolone acetate 0.12% for conjunctivitis and to consider ectropion repair and punctoplasty with silicone stent intubation if epiphora persisted. Over two additional months of follow-up however, his symptoms remained severe and largely unresolved with eyedrops providing only mild relief.
A practical algorithm for topical treatment of atopic dermatitis in the Middle East emphasizing the importance of sensitive skin areas
Published in Journal of Dermatological Treatment, 2019
Ashraf M. Reda, Ayman Elgendi, Ahmed Ismail Ebraheem, Mohammed S. Aldraibi, Mohammed Saleh Qari, Magdy Mohammad R. Abdulghani, Thomas Luger
In a shorter-term clinical study, a significantly greater proportion of adolescents and adults were cleared or almost cleared of facial AD (47% Vs 16%, p < .001) and achieved clearance of eyelid dermatitis (45% Vs 19%, p < .001) after 6 weeks of treatment with pimecrolimus compared with vehicle (35). Similarly, 6 weeks of pimecrolimus treatment in children led to a greater proportion of patients being cleared or almost cleared of facial AD compared with vehicle (75% Vs 51%, p < .001) (36). Furthermore, in a real-life study of 947 AD patients, pimecrolimus was highly effective for the treatment of facial AD when used at the first signs or symptoms of the disease, with over 40% of patients in all age groups with AD of different severities being clear or almost clear of facial AD after 6 months (37).
Dupilumab for the treatment of adolescents with atopic dermatitis
Published in Expert Review of Clinical Immunology, 2020
Sonja Senner, Marlene Seegräber, Surina Frey, Benjamin Kendziora, Laurie Eicher, Andreas Wollenberg
Topical calcineurin inhibitors can be applied without the risk of skin atrophy. This is an advantage especially when anti-inflammatory treatment is required in facial and eyelid dermatitis, as well as in children needing long-term anti-inflammatory therapy. Topical calcineurin inhibitors can be used to treat acute flare-ups. Topical tacrolimus is the only drug specifically licensed for proactive, long-term maintenance therapy of AD [19]. Pimecrolimus 1% and tacrolimus 0.03% are approved for children aged two years or older. Tacrolimus 1% is more effective and approved for patients aged 16 years or older [11,12,15].
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