Evaluation of the etiologic factors in 311 cases with eyelid eczema.

Allergy Unit of the Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University


Mirzoyeva L A
Ozkaya E

The eyelid is one of the most sensitive areas of the human body and the eyelid dermatosis is one of the most disturbing conditions due to its frequency and well-exposed location. Eyelid dermatosis includes a variety of skin diseases with periorbital location, eyelid eczema (EE) being one of the most important and frequent conditions among them. A total number of 311 patients with EE out of 1834 patients with “atopy” and 3367 patients with “contact dermatitis” presented at the Allergy Unit of the Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, between June 1996 and August 2009 were included in this retrospective, methodological, and cross-sectional study. Data were stored and assessed using SPSS for Windows XP Release 11,5 standard version. The aim of the study was to evaluate the etiologic factors and to develop a standard approach in patients with EE. Atopic disease was diagnosed in 152 patients (48.9 %): A total number of 93 (29.9 %) and 25 patients (8.1 %) had atopic dermatitis and atopic skin status, respectively. 145 patients (46.6 %) had isolated EE whereas lesions in other locations accompanied in 166 (53.4 %). Isolated EE was significantly more frequently seen in patients with atopic dermatitis/atopic skin status (p<0.001). EE was significantly more chronic and therapy-resistant among atopics (p=0.008). One hundred fifty eight (50.8 %) patients underwent patch testing. Eighty three of them (52.5 %) had 1 or more positive patch test reactions Eighty one patients underwent patch testing with supplemental series, 12 of them (14.8 %) had at least one positive reaction. The most frequent positive reaction was achieved with nickel sulfate (31.7%), followed by toluene sulfonamide formaldehyde resin (TSFR) (10.1 %), thimerosal (8.2 %), fragrance mix (7.6 %), and neomycin sulfate (7 %). However, current clinical relevance to EE was most frequently seen with TSFR (100 %), the well-known contact sensitizer in nail varnish, followed by fragrance mix (92 %), neomycin sulfate (82 %), and thimerosal (62 %) whereas nickel sulfate was in the 5. place (60 %). The high frequency of clinically relevant positive reactions to thimerosal, an allergen mainly with unknown relevance, was striking. Among supplemental patch test series, clinically relevant positive reactions were mainly seen with allergens from local therapeutics, cosmetic preservatives, and fragrance series. Testing with the patient’s own substances revealed nail varnish and local ophthalmic drugs as the main clinically relevant allergens. The most frequent diagnosis was allergic contact dermatitis (ACD) (34.1 %), followed by AD-related EE (21.2 %), and irritant contact dermatitis (ICD) (20.6 %). Twenty nine point two percents of patients with ACD were atopics. In 12 of them the responsible allergen was the house dust mite, that was diagnosed by atopy patch testing.