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Recent Onset of Eyelid Dermatitis

Q.A 55 year-old woman came to my office complaining of dry, scaly skin involving both her upper and lower eyelids, as well as the periorbital areas for the last 4 months.  The skin on her eyelids appears eczematous, erythematous and she complains of pruritus. She has been self-medicating with over the counter 1% hydrocortisone cream. She denies wearing facial or eye makeup, or applying any other cosmetic product to her facial skin, and washes her face only with special non-allergenic products free of fragrances and preservatives. She does wear fingernail polish regularly. What workup is recommended for her recent findings, and what are likely causes?

A. The geographic location of the rash suggests that this eruption could be related to contact sensitivity and allergic contact dermatitis. However, this case is puzzling because the patient denies directly applying cosmetic products to her eyelids. The history of nail polish use is important. Allergic contact dermatitis may be caused by chemical allergens applied to other skin sites that are inadvertently transferred to the affected geographic site. This is referred to as ectopic allergic contact dermatitis. Patch testing to relevant contact allergens in nail polish is recommended in this case, in particular.

Clinical follow-up: Patch testing in this woman revealed a 2 + reaction to toluene sulfonamide formaldehyde resin at 48 hours. In this case, the patient has likely transferred the chemical sensitizer, toluene sulfonamide formaldehyde resin, a common constituent of nail polish, from casual touching of her eyelids. The rash has not recurred since she discontinued use of nail polish.

 
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