28-Year-Old Female with Skin Irritation on her Inner Eyes
A 28-year-old female is experiencing a sudden onset of mild-to-moderate skin irritation on the inner canthus of both eyes. She reports moderate itchiness in both areas (VAS score 5).
Her medical history is unremarkable, except that her mother suffered from atopic dermatitis (AD) on several occasions, self-treated with cosmeceutical creams.
Not only is she quite uncomfortable from the itchiness and cosmetic aspects of the irritation, but she wears contact lens. She relates that she has worn contact lenses since her late teens and has not changed the brand of contact lens solution.
When asked if she had switched cosmetics brands, she related that nothing has changed in her skincare regimen.
What treatment options would be appropriate for the periocular areas surrounding the patient's eyes?
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GARY PRICE5yrI have had some success w/ Eucrisa in similar cases. Patch Testing would also be a good idea if the rash is recurrent.
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Anonymous User5yrSince this patient has no history of atopy until age 28 (despite a family history), I would also consider contact dermatitis to cosmetics as a cause of her symptoms. Patch testing to a North American series would be useful, in addition to aeroallergen skin testing. Irritant conjunctivitis can be treated successfully with ophthalmic NSAIDs (and/or short course of oral vs ophthalmic "soft" steroids) in addition to the topical medications as listed by others.
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Anonymous User5yrThe skin findings may be the effect of rubbing of the eyes, so allergic (vs irritant) conjunctivitis needs to be considered as well. I agree with a short term use of low potency topical steroids (class 7) x 1 week with transition to a topical calcineurin inhibitor for long term use. If conjunctiva are injected, and patient notes allergic rhinitis symptoms, I would add an antihistamine/mast cell stabilizing eye drop. If there is no benefit and/or no associated allergic rhinitis symptoms, then a trial of an ophthalmic NSAID such as ketorolac may also be useful.
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Diane Hentz, PARKVIEW REGIONAL MEDICAL CENTER5yr2.5% HC oint BID for a week, then protopic .03 Bid for a few weeks, then consider patch testing if recurrent. Would also rec a moisturizer: vani cream or cerave cream.
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Diane Hentz, PARKVIEW REGIONAL MEDICAL CENTER5yr2.5% Hydrocortisone oint BID for 10 days then switch to Protopic .03 BID for a few weeks. If recurrent, consider patch test.
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Lawrence Feldman5yrIf severe enough could use a tapering dose of Prednisone to get immediate relief and then allergy patch testing to determine the offending agent
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Scott Osur5yrI would try Elidel or Protopic applied twice daily for 2weeks. If rash persists, I would schedule patch testing. I would wonder if the contact solution might be problematic r perhaps a buildup of residue on contact lenses.
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Lawrence Feldman5yrI would use 2.5% hydrocortisone ointment to area bid for 3 days
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Deepa Lingam5yrProtopic ointment, Elidel, Eucrisa; consider patch testing to cosmeceutical products (which she should avoid at this time)