Abstract
Purpose :
Eyelid dermatitis is most commonly attributed to an allergic response, yet a literary gap exists on practical prevention of allergic contact dermatitis (ACD) recurrence following allergen identification. This retrospective clinical study identifies common allergens with eyelid involvement and gives a clear clinical approach for effective management of periorbital ACD.
Methods :
Charts of 215 patients diagnosed with dermatitis involving the periorbital skin who were patch tested at Mayo Clinic to our Standard Series, Extended Standard Series, and their own products (151 allergens and 365 patient products) from January 1, 2013 through December 31, 2017 were examined. Positive reaction rates for patients with periorbital involvement were compared to those for patients without periorbital involvement. Findings were also compared to general patch test patient populations as reported by the North American Contact Dermatitis Group (NACDG) on 4871 patients tested from 2013-2014, and to those reported by the Mayo Clinic Contact Dermatitis Group (MCCDG) Standard Series on 2582 patients tested from 2011-2015.
Results :
Periorbital dermatitis allergen groups with the highest positive reaction rates were as follows, in descending order: metals (e.g., nickel in eyewear); shellac (a tackifier in eye makeups); preservatives (e.g., benzalkonium chloride in skin care products, prescription and over-the-counter eye preparations); topical antibiotics (neomycin, bacitracin); fragrances (in cosmetic and cleansing products); acrylates (in artificial/gel nails); and surfactants (including those in tear-free shampoos). The only corticosteroids eliciting positive reactions were budesonide and tixocortol pivalate (used to screen for prednisolone and fluorometholone). These patients showed more common allergy to shellac, benzalkonium chloride, acrylates and surfactants than general patients tested via the NACDG and MCCDG Standard Series.
Conclusions :
The most common contact allergens for patients with eyelid dermatitis were identified. Avoidance of products containing these top seven groups of allergens is straightforward, with initial empiric counseling and usage of readily available, free, on-line allergen avoidance programs (SkinSAFE, Contact Allergen Management Program). Patients not responsive to avoidance are recommended to undergo patch testing.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.