Your eyelid skin is a ‘canary in the mine shaft’ when it comes to allergic and irritant reactions.
Eyelid skin is so thin that it will break-out in an allergic reaction while the rest of your face sits by quietly unfazed. I see a lot of people with eyelid dermatitis in my dermatology office, and I just had a conversation about it on the web too. It’s always fun for me to sleuth-out the cause, sort of a Sherlock Holmes meets dermatology moment. My patients seem to like the detective adventure too since they’re frustrated by their eyelid dermatitis and eager for help.
When the thin skin of your eyelids get a rash it’s pretty dramatic. People with eyelid dermatitis usually describe their eyelids as wrinkled, swollen, red and itching or burning. They’re also pretty disturbed by the appearance because the rash is so striking and hard to hide. Most of the home remedies they’ve tried sting and the problem gets steadily worse.
The real detective work comes because of the seemingly unrelated allergen exposures that cause allergic eyelid reactions. For example, the number one cause of eyelid dermatitis in North America is nail polish! Yes, nail polish. It contains chemicals (most notably formaldehyde and it’s relatives) and when your polished fingernails touch your fragile eyelids the chemicals can cause eyelid dermatitis. The thick skin of your fingers remains rash-free because it’s so thick that the chemicals don’t easily get through it. Your eyelid skin, on the other hand, is thin and readily absorbs the chemicals; if you’re allergic to formaldehyde that means a rash.
Common ways that your eyelids are exposed to allergens:
Chemicals are carried to your eyelids from your hands such as the fragrances or ingredients in hand soaps and hand lotions. Actually everything that you get your hands into can be carried to your eyelids. I’ve seen hand-to-eyelid dermatitis in musicians allergic to the metal on their musical instruments, gardeners allergic to specific plants, artists working with glues, paints and lacquers, cooks allergic to foods, hair dressers allergic to hair dye or perm solutions etc. Most of the time though, it’s nail polish! When the allergen is brought to the eyelids from the hands the rash is usually worse on one side than the other because we touch our faces more with one hand than the other.
Airborne droplets of any spray products bring allergens to your eyelids. I’ve seen eyelid dermatitis due to air fresheners (sprays, plug-ins, potpourri, scented candles etc), spray perfumes, hair spray, spray household cleaners etc. If you can smell it, it’s in the air and it settles out on your eyelids too. Allergens include the fragrance itself, chemicals in products etc.
Airborne pollen can cause eyelid dermatitis too. That includes the usual pollens that also cause sneezing in allergic folks, but also includes indoor flower arrangements with flowers like chrysanthemums and others. Wood burning smoke, inadvertently burned poison oak or ivy smoke, new carpet off-gassing, and sawdust have all had their turn as culprits in eyelid dermatitis in my office.
Chemicals washing over your eyelids bring allergens. I usually see this from hair care products which are very taunting to delicate eyelid skin. Hair care products are some of the most chemically complex hygiene products that we have, and their ingredients can be more than your delicate eyelids can handle. These products are loaded with fragrance, foaming agents that dry out delicate skin to make it more porous, and strong preservative chemicals. As mentioned above, fragrances are common allergens. Preservatives are too, especially the formaldehyde releasing preservatives commonly found in hair care products such as:
- Quaternium 15,
- Imidiazolidynil urea,
- Methylchloroisothiazolinone and its relatives, among others
It’s best to completely wash these products off your skin before stepping out of the shower just to be safe.
Lastly, allergens can be those things that you directly apply to your eyelid skin. Most commonly these are your facial soaps or creams. Again, fragrances and preservatives in these products are often the cause. Interestingly, eye cosmetics are formulated carefully to minimize potential allergens and I rarely find them the culprit of an allergic eyelid dermatitis. The one exception is metal sensitive patients who can mount an allergic reaction to metal pigments in eye makeup.
Not every eyelid rash in allergic. It’s also possible that the skin has broken down due to simple irritation without allergy. Examples include ingredients in many of the best anti-aging or acne treatment products such as tretinoin, glycolic acid, benzoyl peroxide and salicylic acid. Typically with an irritant reaction on the eyelids, I see more of a skin redness and less scale, usually starting in the upper eyelid fold. The skin may split in the crease and the skin sensation is more likely described as a burn than an itch by patients.
Treatment of eyelid dermatitis:
Treatment starts with identifying the cause and avoiding it. I usually also recommend that patients wash their face with only the most non-irritating cleanser until the skin heals; skin with a rash is more porous, and thus easily irritated – and irritated skin just won’t heal. My favorite cleanser for the job is Tolariane Cleanser. I usually also recommend a thin film of a safe, bland emollient applied after washing such as pure jojoba oil. For my eyelid dermatitis patients I may also prescribe a very short course of a non-halogenated, hypoallergenic cortisone ointment. This treatment must be supervised by a treating physician because cortisone topical medicines can be absorbed through the eyelid skin and can damage the eyes.
It’s difficult to confirm the allergen that causes eyelid dermatitis because we usually do this type of allergy testing on the back skin. Eyelids are so much more sensitive than the back, or any other area on the body and we usually can’t recreate the same reaction elsewhere. Figuring out the allergen pretty much depends on good detective work.
Eyelid dermatitis is dramatic and frustrating, AND, it’s also fascinating because the cause is almost always such a surprise. Find the allergen and you fix the problem.
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Photo Attribution: Thanks and Gratitude to Ali Smiles