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Allergic contact dermatitis - External and Internal Eye
See also in: Overview,Anogenital,Hair and Scalp,Nail and Distal Digit,Oral Mucosal Lesion
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Allergic contact dermatitis - External and Internal Eye

See also in: Overview,Anogenital,Hair and Scalp,Nail and Distal Digit,Oral Mucosal Lesion
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Contributors: Priyanka Vedak MD, Susan Burgin MD
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Synopsis

This summary discusses adult patients. Allergic contact dermatitis in children is addressed separately.

Contact dermatitis presents as either allergic or irritant in etiology. While irritant contact dermatitis represents the direct toxic effect of an offending agent on the skin, allergic contact dermatitis (ACD) represents a delayed-type (type IV) hypersensitivity reaction that occurs when allergens activate antigen-specific T cells in a sensitized individual. Consequently, whereas irritant contact dermatitis can occur after one exposure to the offending agent, ACD typically requires repeat exposures before an allergic response is noted. Allergic contact dermatitis can occur 24-48 hours after exposure to the offending agent.

Ocular involvement in ACD can occur in the setting of topical agents (medications or cosmetics), airborne agents, or innocuous transfer of the culprit agent via the fingertips.

With regards to topically applied agents, ACD reactions to medicated drops have been reported, including latanoprost, dorzolamide, and phenylephrine. ACD has also been reported in response to cosmetic products such as acrylate-containing glue used as a false-eyelash adhesive. Many eye shadow products include metals, which are top-ranking allergens in patients with eyelid dermatitis.

Nickel sulfate and gold are top-ranking allergens in periorbital dermatitis. Accidental transfer may occur when hands are contaminated by prior contact with metal products including jewelry. Similarly, fragrances can be transferred from the hands to the face. Eyelid dermatitis can also be seen due to allergens in artificial fingernails.

Airborne exposures have been implicated in occupational ACD, such as a reported case of persistent periorbital ACD in a dental technician due to rubber accelerator found in a colleague's protective gloves. These airborne exposures can sometimes be associated with respiratory difficulty, as described in cases of airborne ACD reactions to methylisothiazolinone.

Codes

ICD10CM:
L23.9 – Allergic contact dermatitis, unspecified cause

SNOMEDCT:
40275004 – Contact dermatitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 10/03/2017
Last Updated: 10/03/2017
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Allergic contact dermatitis - External and Internal Eye
See also in: Overview,Anogenital,Hair and Scalp,Nail and Distal Digit,Oral Mucosal Lesion
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Allergic contact dermatitis : Erythema, Scaly plaque, Vesicle, Pruritus
Clinical image of Allergic contact dermatitis
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