When an atopic dermatitis flare-up affects the skin around the eye, it is also referred to as eyelid eczema. Red, cracked, itchy or dry skin around the eye and especially on the upper and lower eyelids are typical symptoms. Eyelid eczema occurs in around 15 – 20 % of atopic dermatitis patients.
The skin that directly protects our eyes is much more sensitive and thinner than other areas of our body. However, it is precisely these characteristics that promote the formation of eczema. Our eyelids are one of the most vulnerable areas of skin on our body: each season they are exposed to the environment without protection.
Atopic dermatitis or allergy? Finding the right diagnosis
Atopic dermatitis is in itself a cause of inflammation of the skin around the eyes. However, many people affected by atopic dermatitis also suffer from allergies. Another very common cause of eyelid eczema is so-called allergic contact dermatitis. This contact dermatitis is an allergic reaction to certain substances. Some examples of such triggers are:
- Cosmetic products (mascara, make-up)
- fragrances
- nail polish
- certain metals in the air (nickel, gold)
- environmental factors such as cold and wind
Even if the irritants are not applied directly to the eye, they can cause symptoms there. In the case of eyelid eczema, both parts of the eye are usually affected. If only a single eyelid is affected, this may instead be an indication of allergic contact dermatitis. Do you find that your atopic dermatitis can be treated and controlled successfully for the most part, but your eyelids are still red and itchy despite using anti-inflammatory ointments? In that case, it makes sense to consult a dermatologist or an allergist. The doctor will ask you about existing allergies and diagnoses and, if necessary, carry out an allergy test.
Note:
Atopic dermatitis of the eye can have different diagnoses. The diagnosis requires a medical assessment by a dermatologist or allergologist. If you notice that you are allergic to certain substances or products or that the usual treatment is not successful, talk to your doctor about it.
However, if symptoms of conjunctivitis appear in addition to those of eyelid eczema, this is a warning sign. Red, itchy, watery eyes, swollen eyelids and a foreign body sensation are the first signs of the allergic eye disease “atopic keratoconjunctivitis” (AKC). AKC can be very severe and can even lead to blindness. An ophthalmologist should therefore be consulted immediately in the event of suspicion.
Protect your eyes through the correct behavior
Scratching or rubbing of affected areas can cause the atopic dermatitis flare-up on the eye to spread or cracks to appear. Therefore, try to avoid intensive rubbing or scratching. Initially, cold packs can relieve the itching.
Topical glucocorticoids, i.e. anti-inflammatory ointments that are applied thinly to the eyelids for a short time, are best suited for medicinal treatment. They are commonly known as “cortisone”. These ointments quickly lead to an improvement in symptoms and should only be applied for a short time and not more than once a day.
An alternative to cortisone-containing ointments are topical calcineurin inhibitors. These are also anti-inflammatory ointments that can be applied to the eyelid in the short term. A dermatologist can prescribe the right medication for your individual skin condition.
Tip:
Store your ointments in a cool environment. They should not be kept too cold (below the minimum temperature stated on the packaging), but the cooling effect when applied to the skin can help to alleviate itching or burning.
Proper care for the sensitive skin around the eyes
In addition to medical treatment, regular basic care is important. Go easy on your skin and it is best to avoid aggressive cleansing products or soaps. Wash your face with cold to lukewarm water and consistently care for it by using moisturising and replenishing creams.
When applying creams and drying your face, be careful not to apply too much pressure by rubbing or massaging. Instead, you can use a soft towel to pat dry and apply the creams gently.
Coping strategies for dealing with eyelid eczema
Do you look in the mirror and feel insecure because the red or scaly patches on the skin around your eyes are immediately noticeable? You’re not alone: many people with atopic dermatitis on their face feel ashamed or insecure. This article has given you some tips and explanations on how to deal with atopic dermatitis on the eyes. However, different treatments work differently for those affected. Give yourself some time to find the most suitable treatment for you. Ultimately, a skin condition does not define who you are. Not even if it appears on the most sensitive skin area of the body.
References:
- Beltrani VS. Eyelid dermatitis. Curr Allergy Asthma Rep. 2001 Jul;1(4):380-8. doi: 10.1007/s11882-001-0052-0. PMID: 11892062.
- Peralejo B, Beltrani V, Bielory L. Dermatologic and allergic conditions of the eyelid. Immunol Allergy Clin North Am. 2008 Feb;28(1):137-68, vii. doi: 10.1016/j.iac.2007.12.004. PMID: 18282550.
- Crouse L, Ziemer C, Ziemer C, Lugo-Somolinos A. Trends in Eyelid Dermatitis. Dermatitis. 2018 Mar/Apr;29(2):96-97. doi: 10.1097/DER.0000000000000338. Erratum in: Dermatitis. 2018 May/Jun;29(3):175. Ziemer, Caroline [corrected to Ziemer, Carolyn]. PMID: 29494383.
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- Zirwas, MJ. Pearls for the Diagnosis and Management of Eyelid and Lip Dermatitis. With sensitivity to diagnostic clues and initiation of appropriate therapeutic strategies, clinicians can eliminate irritant dermatitis of the lips and eyelids. 2008 Oct; practical dermatology
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