Periorbital Dermatitis: The Role of Type 1 and Type 4 Hypersensitivity as Contributing Factors

Research Article

Austin J Allergy. 2017; 4(2): 1028.

Periorbital Dermatitis: The Role of Type 1 and Type 4 Hypersensitivity as Contributing Factors

Ornek SA*, Kuteyla Can P, Degirmentepe EN, Kiziltac K, Gungor S, Oguz Topal I and Kocaturk E

Department of Dermatology, Okmeydani Training and Research Hospital, Istanbul, Turkey

*Correspoing author: Ornek Sinem Ayse, Department of Dermatology, Okmeydani Training and Research Hospital, Istanbul, Turkey

Received: May 26, 2017; Accepted: July 04, 2017; Published: July 11, 2017

Abstract

Background: Periorbital dermatitis is common and may be a manifestation of either allergic or non-allergic diseases.

Objectives: In this study, we investigated the role of type 1 and type 4 hypersensivity as etiologic factors on periorbital dermatitis and we explored whether the prognosis was associated with the etiology.

Methods: Data of sixty patients who had referred with eyelid dermatitis and had undergone patch testing between January 2014 and January 2017 were retrospectively analyzed.

Results: Patients have been diagnosed as Allergic Contact Dermatitis (ACD) (28,3%), Irritant Contact Dermatitis (ICD) (51,6%), atopic dermatitis (8,3%), Seborrheic Dermatitis (8,3%), Periocular Rosacea (3,3%), and Discoid Lupus Erythematosus (DLE) (1,6%). Atopy history was present in 21,7% of patients. Positive prick test reactions were found in 9 patients (15%). The most prevalent allergens were house dust mites, grass mix, and cat dander. Patch test positivity for at least one allergen was found in 27 patients (45%). The most common clinically relevant allergens were detected as isothiazolinone (methylchloroisothiazolinone and methylisothiazolinone), thiomersal, formaldehyde, p-phenylenediamine and dispers blue.

Conclusion: Physicians should take into account the patients’ use of cosmetics and hygiene products as well as atopy history and should perform a general skin examination not to miss other dermatological conditions that may present as periorbital dermatitis.

Keywords: Periorbital dermatitis; Eyelid eczema; Periocular dermatitis; Patch test; Prick test

Introduction

Periorbital dermatitis is common and may be a manifestation of either allergic or non-allergic diseases. The differential diagnosis includes endogenous causes like seborrheic and atopic dermatitis and exogenous causes like contact dermatitis [1]. Contact dermatitis may be irritant or allergic; the former develops secondary to the contact of an irritating substance and occurs by a direct local toxic effect. The personal and environmental factors such as atopy, age, sweat and heat may exacerbate this process. However, allergic contact dermatitis is a reaction of delayed hypersensitivity and occurs after previous sensitization [2]. Important sources of eyelid contact allergy include cosmetics, fragrances, topical medications, cleaning products and metals. In addition, the thin skin of the eyelids is susceptible to air borne allergens such as pollen, dust mites, animal dander and volatile chemicals [3].

In this study, we investigated the role of type 1 and type 4 hypersensivity as etiologic factors on periorbital dermatitis and we explored whether the prognosis was associated with the etiology.

Materials and Methods

We performed a retrospective analysis of 60 patients who had a complaint of eyelid dermatitis and had undergone patch testing at Okmeydani Training and Research Hospital between January 2014 and January 2017. All patients’ important demographic and clinical information’s like age, sex, profession, presence or history of atopy (atopic dermatitis, allergic rhinitis and asthma), duration of complaints, localization, the results of prick and patch tests and diagnosis had been recorded. Patch tests with standard series were performed with all the patients. After 48 hours, the patches were removed and assessed and readings were repeated 96 hours after tests began. For all the positive test results, the clinical relevance was investigated regarding the association between exposure and dermatitis. Prick tests included inhalant and food allergen panel and latex. Histamine was used as a positive control and saline was used as a negative control. The skin was evaluated after 20 min, and any wheal =3mm than the negative control was considered to indicate positivity. For the long term follow up, the patients were given a telephone call visit and evaluated for the regression of symptoms. Statistical analyses were performed with IBM SPSS version 22. Non parametric tests were used for the analysis of data, and the chi-square test and fisher exact test were used for the comparison of the data. A p-value <0,05 was considered to be statistically significant.

Results

During the 3-year period from January 2014 to 2017, of all 715 patch-tested patients, 60 (8,3%) had a complaint of periorbital dermatitis. There were 44 (73,3%) female and 16 (26,7%) male patients. The patients’ ages ranged from 9 to 72 with a mean age of 34 years. In terms of professions, housewives predominated among patients with periorbital dermatitis (41,7%), followed by office workers (20%), high risk jobs for occupational contact dermatitis (18,3%), students (15%), and healthcare workers (5%).

In most of the patients, periorbital dermatitis was the only clinical manifestation (83,3%) (Figure 1,2). The remaining 16,7% had also hand dermatitis. The duration of symptoms ranged from 1 to 180 months with mean time of 29 months. Atopy history was found in 21, 7% of patients with periorbital dermatitis. For demographic data, see Table 1.