Periocular dermatitis management

Periocular dermatitis is a commonly occurring dermatological disorder. Its incidence is around 5% with a clear preponderance of women (80 to 90%) attributed to the more frequent use of cosmetic products.^1,2
It may be caused by allergic or irritant contact dermatitis, and various skin disorders as atopic dermatitis, seborrheic dermatitis, etc.¹

Most commonly reported cause of periocular dermatitis¹

In 50 to 70% of patients, periocular dermatitis is accompanied by other cutaneous localizations.³

Eyelid contact dermatitis

It is an inflammatory reaction caused by contact, direct or indirect (through hands), with a trigger substance and may be due to allergy or irritation.⁴
Upper, lower or both eyelids on one or both sides can be affected.⁴

Clinical features^3,4

Eyelid allergic contact dermatitis

It is the most frequent eyelid contact dermatitis and it is caused by an immune reaction to an allergen.^4,5
Allergic contact dermatitis involves a delayed-type hypersensitivity reaction (type IV hypersensitivity) and involves immune memory cells.^4,6

Main allergic products and components ^4,7,8

Eyelid irritant contact dermatitis

Irritant eyelid contact dermatitis is a condition that expresses mostly within a professional frame and may be triggered by contact (direct or hand-held) with irritating substances and/or physical triggers.^4,6
It is an innate inflammatory reaction due to injury to the skin. Unlike allergic contact dermatitis, it does not involve specific antibodies (immunoglobulins) or specific immune cells (memory T cells).^4,6

Main irritating factors⁴

Even if it can occur in anyone, it is more common in people with sensitive skin and any skin pre-existing inflammation compromising the skin barrier function may make it more vulnerable to irritant contact dermatitis.⁴

Differential diagnosis⁴

Management

Avoidance of allergens and irritants is the cornerstone of the management.^1,4,9

Medical treatment:

• Short courses of mild topical corticosteroids or calcineurin inhibitors may be required to treat active inflammation.^1,9,10
• Second-line treatment includes phototherapy and systemic immunomodulators.⁹

Adjunctive therapy:^6,10

• Careful cleaning with plain water or preferably by thermal water-spraying
• Gentle wiping with sterile gauze compress rather than cotton pad
• Reducing xerosis during chronic presentation by application of moisturizers
• Once eyelid contact dermatitis treated, the use of adapted non-irritating cleansers and cosmetics may be recommended

Tips for your patients⁴

• Avoid rubbing and scratching
• Only touch eyelids with clean, rinsed hands
• Wash eyelids with plain water or use a cream cleanser designed for sensitive skin
• Avoid all contact with allergens detected by patch tests – this is necessary life-long.
• Avoid eyelid cosmetics while the dermatitis is active.
• Wear protective wrap-round spectacles if exposed to cold, wind, dust particles etc. Spectacles can also make it easier to stop scratching and rubbing the eyelids.

Periocular seborrheic dermatitis

Seborrheic dermatitis, condition causing skin to become oily or flaky, can irritate the eyelids, inducing an anterior blepharitis.^4,13
Periocular seborrheic dermatitis represents 3 to 16% of all periocular dermatitis.²

Clinical features¹⁴

Blepharitis is an inflammation of the edges of the eyelids, that may extend to the eyelid, even on its inner face or in the eye. In most cases, both eyes are affected.
The symptoms tend to be worse in the morning.

Main symptoms of blepharitis:

• Itchy, sore and red eyelids that stick together
• Crusty or greasy eyelashes
• Burning, gritty sensation
• Photophobia and eye discomfort
• Swollen eyelid margins
• Abnormal eyelash growth or madarosis in severe cases

Management of blepharitis¹⁵

A daily eyelid-cleaning routine can help control the symptoms and prevent permanent scarring of the eyelid margins. It should be performed once or twice a day after the condition is under control, or more often during flare-ups.

• Application of warm compresses over closed eye for several minutes to loosen the crusty deposits on eyelids
• Using a washcloth moistened with warm water and a few drops of diluted baby shampoo to wash away any oily debris or scales at the base of eyelashes.
• Rinsing eyelids with warm water and gently pat it dry with a clean, dry towel

Tips for your patients:

• Avoid anything that irritates eyes, such as eye makeup and contact lenses
• Stop using eye makeup when eyelids are inflamed. Makeup can make it harder to keep eyelids clean and free of debris. Makeup could also reintroduce bacteria to the area or cause an allergic reaction
• Try over-the-counter artificial tears. These lubricating eyedrops may help relieve dry eyes.

More severe cases may require topical (ointments, creams or eye drops) or oral antibiotics.