What is the treatment for periorbital dermatitis?

Treatment of Periorbital Dermatitis

Chemical peeling is the most effective treatment for periorbital dermatitis, particularly for periorbital hyperpigmentation, showing superior results compared to other modalities including PRP. 1

Understanding Periorbital Dermatitis

Periorbital dermatitis is a common condition affecting the skin around the eyes that can manifest as:

• Allergic contact dermatitis (most common cause - 44% of cases) 2
• Atopic dermatitis (25% of cases) 2
• Airborne contact dermatitis (10% of cases) 2
• Irritant contact dermatitis (9% of cases) 2
• Other causes: periorbital rosacea, allergic conjunctivitis, or psoriasis vulgaris 2

Risk factors include:

• Female gender 2, 3
• Age ≥40 years 2, 3
• Atopic skin diathesis 2, 3

Treatment Algorithm

First-Line Treatments

1. Chemical Peeling

   • TCA 3.75% and lactic acid 15% combination shows excellent improvement in 38% of cases 1
   • More effective, tolerable, and satisfying than PRP injections 1
   • Typically requires multiple sessions at 2-4 week intervals 1

2. Topical Calcineurin Inhibitors

   • Tacrolimus ointment is first-line for facial atopic eczema and effective for other forms 2
   • Apply 0.1% ointment once daily to external eyelids including lid margins for 2-4 weeks 1
   • For children, start with 0.03% ointment 1

3. Topical Corticosteroids (short-term use only)

   • Triamcinolone cream shows lower rates of refractory disease (<30%) 4
   • Avoid hydrocortisone (>80% refractory rate) 4
   • Caution: prolonged use may cause or worsen periorbital dermatitis 2, 5

Second-Line Treatments

1. Autologous Platelet Concentrates (APCs)

   • PRP (Platelet-Rich Plasma) treatments:
     • Effective for periorbital hyperpigmentation with 80% achieving fair to good improvements 1
     • Typically requires 3-4 sessions at 2-4 week intervals 1
     • Improves periorbital dark circles (47.8-60.9%) and wrinkles (73.9-78.3%) 1

2. Plasma Gel

   • More effective than conventional PRP for periorbital rejuvenation 1
   • Requires two sessions one month apart 1

3. PRF (Platelet-Rich Fibrin)

   • Effective for skin rejuvenation in the periorbital area 1
   • Improves deep and fine wrinkles, periocular hyperpigmentation 1
   • Typically requires four sessions one month apart 1

4. Carboxytherapy

   • Slightly more effective and better tolerated than PRP 1
   • Weekly sessions for optimal results 1

For Refractory Cases

1. Combination Therapy

   • Chemical peeling + PRP shows better results than either treatment alone 1
   • PRF + microneedling combination for enhanced results 1

2. Systemic Antibiotics

   • Oral tetracyclines (if patient is over 8 years old) 6
   • Use subantimicrobial doses until complete remission 5

3. Systemic Isotretinoin

   • Consider for patients refractory to all standard therapies 5

Allergen Identification and Avoidance

• Perform patch testing to identify relevant allergens 2, 3
• Common allergens include:
  • Fragrances (19% of cases) 3
  • Preservatives in cosmetics 2, 3
  • Balsam of Peru (10%) 3
  • Thiomersal (10%) 3
  • Neomycin sulfate (8%) 3
• Test patient's own products (12.5% of allergic cases are exclusively identified this way) 3

Treatment Pitfalls to Avoid

• Avoid long-term topical corticosteroid use - can cause or exacerbate periorbital dermatitis 2, 5
• Beware of rebound phenomenon after stopping topical corticosteroids 5
• Don't overlook patient's own products as potential allergen sources 3
• Avoid hydrocortisone due to high refractory rate (>80%) 4
• Don't expect immediate results - most treatments require multiple sessions over weeks to months 1

Special Considerations

• For children under 8 years, avoid tetracyclines and use topical treatments 6
• For periorbital dermatitis with atopic features, prioritize calcineurin inhibitors 2
• For allergic contact dermatitis, allergen identification and elimination are essential 2, 3
• For periorbital hyperpigmentation, chemical peeling shows superior results to PRP 1