Contact Allergy in Patients with Periorbital Eczema: An Analysis of Allergens

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Abstract
Background: Periorbital eczema may be an expression of a constitutional disease or an irritant or allergic dermatitis. An allergic contact dermatitis is believed to be the most common cause. Objective: We tried to determine which allergens may cause an allergic contact dermatitis and if there exists a leading allergen. Methods: 609 patients with periorbital eczema were assessed with patch testing in 22 hospitals to evaluate the relevance of an allergic contact dermatitis in the pathogenesis of periorbital eczema. Additionally, 116 patients were tested with their own products. Results: 81% of the cases involving the eyelids were women. A relevant allergic contact dermatitis was found in 52% of the patients with periorbital eczema. Furthermore, a positive patch test was present in every third patient with the clinical diagnosis of an atopic dermatitis. Antibiotics, phenylephrine and thimerosal could be determined to be the leading allergens responsible for allergic periorbital eczema. Positive reactions for potassium dichromate and fragrance mix occurred less frequently in patients with periorbital eczema. 132 positive reactions were found in patients tested with their own products, including 33% with a positive reaction to eye ointments, 15% to face creams, 10% to eye shadows, 10% to makeup, 10% to shampoos and 4% to nail varnish. Only 6% reacted to perfume. Conclusion: The data underline the importance of performing patch tests in the case of periorbital eczema, especially in atopic patients.

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