More than meets the eye: Periorbital dermatitis requires expanded patch testing

Key Points

In a population of 1,215 patients who were patch tested for suspected allergic contact dermatitis (ACD) from 1994 through 2004, retrospective analysis showed that 105 (8.6 percent) had some form of eyelid dermatitis (Amin KA, Belsito DV. Contact Dermatitis. 2006 Nov;55(5):280-285).

Of these 105 patients, 54 had dermatitis of the eyelid only, while the remainder had dermatitis of the eyelid plus other body areas, including the face.

"I found that 59 of the 105 patients, or 56 percent, had both upper and lower eyelid involvement," says Dr. Belsito, clinical professor of medicine, University of Missouri, Kansas City.

Additionally, 40 patients (38 percent) had only upper eyelid dermatitis, and six (roughly six percent) had only lower eyelid dermatitis.

After reviewing final diagnoses in the above cases, Dr. Belsito found that among the 40 patients with only upper eyelid dermatitis, 23 patients (58 percent) had ACD.

"The next most common diagnosis, about 38 percent, was seborrheic dermatitis," he says.

Among the six patients with only lower lid involvement, five had ACD; one had irritant contact dermatitis (ICD).

"In all those cases," Dr. Belsito says, "the dermatitis was related to eye medication."

Among the 59 patients with both eyelids affected, the breakdown was as follows:

The total is more than 105, because "in some patients, there was both an underlying nonallergic cause and an allergic cause related to materials patients' eyelids were treated with," Dr. Belsito says.

TRUE test

However, Dr. Belsito says that many of the top 10 causes for these patients' allergies are not present in the thin-layer rapid-use epicutaneous test (TRUE Test; Allerderm).

These materials include the surfactant oleamidopropyl dimethylamine, the preservative 2-bromo-2-nitropane-1,3-diol, the nail lacquer tosylamide formaldehyde resin, and sodium gold thiosulfate.

"These are very important causes for eyelid dermatitis that would be missed by using those standard panels," he says.

Less common allergens excluded by the TRUE Test include amidoamine, methyl hydroquinone, benzoyl peroxide, methyl dibromoglutaronitrile and several others, he says.

Third panel

Fortunately, some of the less common allergens identified by the study are included in the TRUE Test's new third panel, Dr. Belsito says. These include budesonide and other corticosteroids, diazolidinyl urea and imidazolidinyl urea.

The only common causes for allergies diagnosed in the study that are included in the original two-panel TRUE Test are fragrance, nickel sulfate, neomycin, thiuram mix, quaternum-15, cobalt chloride, formaldehyde, colophony, ethylenediamine dihydrochloride, lanolin alcohol, methylchloroisothiazolinone/methylisothiazolinone, thimerosal and p-phenylenediamine, Dr. Belsito tells Dermatology Times.