Fragrance Series Testing in Eyelid Dermatitis

Contact allergens responsible for eyelid dermatitis in adults

Allergic contact dermatitis has been established as the most frequent cause of eyelid dermatitis, but it is often misdiagnosed. The purpose of this study was to evaluate the characteristics of patients with eyelid dermatitis who were referred for patch testing. The patients were divided into three subgroups in this retrospective study: patients with only eyelid involvement, patients with involvement of eyelids and other areas, and patients without eyelid involvement. Data was collected on diagnoses, medical history, personal care products and make-up use, occupational dermatitis, and positive allergens. An independent t-test, one-way ANOVA, and chi-squared test were used to analyze the data. A total of 427 patients who referred for patch tests were included in the study. Of these, 139 patients had eyelid dermatitis. Allergic contact dermatitis (ACD) was the most common diagnosis in all three groups referred for patch tests. Use of shaving cream and hair conditioner was significantly higher in patients with only eyelid involvement and nickel sulfate was the most common allergen among them. Patch testing is the gold standard tool in the evaluation of eyelid contact dermatitis, and it is a necessity in the treatment of eyelid dermatitis, for the accurate identification of responsible allergens.

Allergic contact dermatitis of the eyelids: An interdisciplinary review

PURPOSE

A review of the published literature on the pathogenesis and treatment of eyelid allergic contact dermatitis and ocular surface involvement.

METHODS

Literature search of MEDLINE (Ovid) was conducted using for allergic contact dermatitis and disease of the eyelid or periorbital skin. Dates included in search criteria were from January 1, 2010 to January 12, 2023. 120 articles were reviewed by at least two authors.

RESULTS

Allergic eyelid contact dermatitis(ACD) is a Type IV hypersensitivity reaction to chemical exposure of sensitized eyelid skin. Most patients improve with avoidance strategies. Understanding chemicals that may trigger eyelid ACD, identifying allergens with patch testing, and use of topical steroids can help patients with this challenging disease.

CONCLUSIONS

Recalcitrant allergic eyelid dermatitis can be addressed by an interdisciplinary team and avoidance strategies based on patch testing.

Contact Dermatitis in Children

Contact dermatitis (CD) is commonly encountered in the pediatric population. Allergic and irritant are the two forms of CD and both cause significant clinical problems in children, but they are often underrecognized. The skin lesions in CD may be polymorphic and closely mimic other common pediatric skin diseases. The diagnosis usually requires patch testing after obtaining a detailed history and performing a physical examination. Metals, fragrances, and certain preservatives are the most common causative agents in children. This article discusses the pathophysiology, diagnosis, and management of this common skin condition in the pediatric population. [Pediatr Ann. 2021(5):e198-e205.].

Eyelid dermatitis in patients referred for patch testing: Retrospective analysis of North American Contact Dermatitis Group data, 1994-2016

BACKGROUND

Eyelid dermatitis is a common dermatologic complaint.

OBJECTIVE

To characterize patients with eyelid dermatitis.

METHODS

Retrospective analysis (1994-2016) of North American Contact Dermatitis Group data.

RESULTS

Of 50,795 patients, 2332 (4.6%) had eyelid dermatitis only, whereas 1623 (3.2%) also had dermatitis of the eyelids and head or neck. Compared with patients without eyelid involvement (n = 26,130), groups with eyelid dermatitis only and dermatitis of the eyelid and head or neck were significantly more likely to be female, white, and older than 40 years, and to have a history of hay fever, atopic dermatitis, or both (P < .01). Final primary diagnoses included allergic contact dermatitis (eyelid dermatitis only: 43.4%; dermatitis of the eyelid and head or neck: 53.5%), irritant contact dermatitis (eyelid dermatitis only: 17.0%; dermatitis of the eyelid and head or neck: 9.8%), and atopic dermatitis (eyelid dermatitis only: 13.1%; dermatitis of the eyelid and head or neck: 13.8%). Top 5 currently relevant allergens included nickel sulfate (eyelid dermatitis only: 18.6%; dermatitis of the eyelid and head or neck: 22.5%), fragrance mix I (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 18.3%), methylisothiazolinone (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 17.7%), gold sodium thiosulfate (eyelid dermatitis only: 14.7%; dermatitis of the eyelid and head or neck: 11.4%), and balsam of Peru (eyelid dermatitis only: 11.9%; dermatitis of the eyelid and head or neck: 12.6%). Both eyelid-involvement groups were significantly more likely to react to gold sodium thiosulfate, carmine, shellac, dimethylaminopropylamine, oleamidopropyl dimethylamine, and thimerosal (P < .05) compared with the no eyelid involvement group.

LIMITATIONS

Lack of specific distribution patterns of eyelid dermatitis and no long-term follow-up data.

CONCLUSION

Patch testing remains a critical tool in evaluating patients with eyelid dermatitis.

Allergic Contact Dermatitis to Fragrances

Allergic contact dermatitis to fragrance is common. The prevalence of fragrance allergy in the general population is between 0.7% and 2.6%. In patch-test populations, the positive reaction rate to fragrances ranges from 5% to 11%. The most common fragrance screeners in most baseline series include fragrance mix 1, fragrance mix 2, and Balsam of Peru. The addition of hydroxyisohexyl 3-cyclohexene carboxaldehyde, hydroperoxides of limonene, and hydroperoxides of linalool to screening series can further aid in the diagnosis of fragrance allergy. In the proper clinical setting, supplemental patch testing with an additional fragrance or essential oil series should be considered.

[Atopic keratoconjunctivitis: One allergy may mask another. A clinical observation with two types of hypersensitivity reactions: IgE-mediated and non-IgE-mediated]

Allergies are frequently implicated in ophthalmologic practice. These typically benign allergies can be potentially severe for the ocular surface and have an impact in everyday life. We relate, through a case of keratoconjunctivitis involving 2 types of hypersensitivity, the various triggers and therapeutic choices to allow a more effective treatment.

Contact Dermatitis for the Practicing Allergist

This article provides an overview of important practice recommendations from the recently updated Contact Dermatitis Practice Parameter. This updated parameter provides essential recommendations pertaining to clinical history, physical examination, and patch testing evaluation of patients suspected of allergic contact dermatitis. In addition to providing guidance for performing and interpreting closed patch testing, the updated parameter provides concrete recommendations for assessing metal hypersensitivity in patients receiving prosthetic devices, for evaluating workers with occupational contact dermatitis, and also for addressing allergic contact dermatitis in children. Finally, the document provides practical recommendations useful for educating patients regarding avoidance of exposure to known contact sensitizers in the home and at work. The Contact Dermatitis Parameter is designed as a practical, evidence-based clinical tool to be used by allergists and dermatologists who routinely are called upon to evaluate patients with skin disorders.

Contact dermatitis: a practice parameter-update 2015

This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org.