Periocular dermatitis

Periocular dermatitis is an inflammation of the skin that appears around the eyes, especially on the upper and lower eyelids or at the outer corners.

It is a very common condition because the skin of the eyelids is the thinnest and most delicate in the whole body, which makes it especially sensitive to irritants, allergens and environmental factors.

Although it rarely represents a serious problem, it can be very bothersome and significantly affect quality of life.

It should not be confused with perioral dermatitis, which appears around the mouth; when the same process affects the mouth, nose and eyes at once, these are simply different locations.

No. Periocular dermatitis is not passed from one person to another and, in most cases, it is not caused by an infection.

There are multiple causes and, frequently, several act at the same time. The most common are:

• Atopic dermatitis.
• Allergic contact dermatitis.
• Irritant contact dermatitis.
• Cosmetics, facial creams, sunscreen, make-up and make-up removers.
• Hair dyes and nail polish (when the eyes are touched afterwards).
• Eye drops and preservatives present in artificial tears.
• Environmental allergens such as pollen or dust mites.
• Prolonged use of topical corticosteroids.
• Skin diseases such as rosacea or seborrhoeic dermatitis.

Patients may present with:

• Redness.
• Itching, burning or stinging.
• Dryness and scaling.
• A feeling of tight skin.
• Swelling of the eyelids.
• Small fissures.
• Sensitivity to water or make-up.

In some cases there is also watering or a foreign-body sensation when the inflammation affects the eyelid margin.

Not always. Many periocular dermatitis cases are not allergic. There are three main groups:

1. Irritant dermatitis. This is the most common. The skin reacts because its protective barrier is altered.

2. Allergic dermatitis. It occurs when the immune system develops an allergy to a specific substance. To identify it, patch testing (Patch Test) may be needed.

3. Dermatitis associated with skin diseases, such as atopic dermatitis, rosacea, seborrhoeic dermatitis or, less frequently, psoriasis.

Among the most frequent culprits are:

• Anti-wrinkle creams, retinol, exfoliating acids and highly concentrated vitamin C.
• Fragrances and preservatives.
• Waterproof make-up, eyelash glues, extensions and eyelash tints.
• Sunscreen, shampoos and nail polish.
• Eye drops.

It is worth remembering that even a product used for years can start to cause an allergy.

The skin specialist usually makes the diagnosis through:

• Clinical history.
• Physical examination.
• A review of all the products used.

In some patients, patch testing (Patch Test), an ophthalmological assessment or microbiological studies may be requested if an infection is suspected.

Treatment depends on the cause and generally combines three pillars:

1. Remove the trigger. This is the most important step. Without identifying the cause, the dermatitis usually returns.

2. Repair the skin barrier. Repairing creams, moisturisers specific for eyelids, fragrance-free products and mild cleansers are recommended.

3. Medication. Depending on each case, low-potency topical corticosteroids for a few days, calcineurin inhibitors (tacrolimus or pimecrolimus), antihistamines if there is a lot of itching, or antibiotics if a secondary infection appears may be used.

Self-medication with corticosteroids around the eyes is not advisable.

• Make-up.
• Retinol and exfoliating acids.
• Perfumes and new cosmetics.
• Rubbing the eyes.
• Very hot water.
• Harsh make-up removal wipes.

If the cause is correctly identified, many cases improve in one or two weeks. However, when the trigger persists, flare-ups can recur for months.

Periocular dermatitis tends to relapse if contact with the allergen continues, irritation persists, atopic dermatitis or rosacea are not controlled, or the responsible products are used again.

Seek a medical assessment if you have:

• Repeated episodes.
• Significant swelling of the eyelids.
• Intense pain.
• Changes in vision.
• Abundant discharge.
• Lesions that do not improve after 1–2 weeks.
• Suspected allergy to cosmetics or medicines.

• Use hypoallergenic cosmetics.
• Introduce only one new product at a time.
• Avoid applying facial treatments very close to the eyelid margin.
• Wash your hands before touching your eyes.
• If you use nail polish or hair dyes and have repeated flare-ups, discuss it with your skin specialist.
• Do not use corticosteroids for weeks without medical supervision.

Periocular dermatitis is a very common condition usually caused by irritation, contact allergies or inflammatory skin diseases. Identifying the trigger and restoring the skin barrier are the keys to lasting improvement. An early diagnosis by a skin specialist helps avoid relapses and choose the most appropriate treatment for each patient.