What is the diagnosis and treatment for periorbital (around the eye) dermatitis?

From the Guidelines

Periorbital dermatitis should be managed by discontinuing all topical steroids and irritating skincare products around the eyes, and considering lid hygiene measures, such as warm compresses and eyelid massage, as recommended by the most recent expert consensus in 2024 1. The treatment approach should prioritize a gentle skincare routine using mild, fragrance-free cleansers and moisturizers.

• For asymptomatic patients and those with blepharitis or lid margin disease, the evaporative component of dry eye can be managed by encouraging healthy tears to lubricate the eyes, prevent premature evaporation of the tears, and reduce inflammation.
• The use of specially designed, battery-powered devices or microwaveable eyelid warming devices, followed by eyelid massage to soften the oils, and cleaning eyelid margins to unblock the oil glands and remove excess bacteria, can be beneficial.
• Homemade bicarbonate solution or commercially available lid wipes can be used for this purpose. It is essential to note that the aetiology of periorbital dermatitis is highly unlikely to adhere to the warm-compresses regimen in children, and therefore, this approach is not recommended in pediatric patients. In cases where dupilumab is being used, dose reduction may be a useful approach in selected patients, especially those with good skin control, as it may reduce the risk and severity of ocular adverse events, as suggested by a small study of 15 patients with DROSD 1. Patch testing patients with atopic dermatitis on dupilumab with persistent facial and eyelid eczema has been suggested previously, but the role of patch testing in the management of DROSD is unclear 1. Overall, the management of periorbital dermatitis requires a comprehensive approach, considering the potential causes and contributing factors, and tailoring the treatment to the individual patient's needs.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Causes of Periorbital Dermatitis

• Allergic contact dermatitis is a common cause of periorbital dermatitis, with leave-on cosmetic products and eye drops being frequent allergens 2
• Atopic eczema is another significant cause, with female gender, atopic skin diathesis, and age of 40 years and older being identified as risk factors 2, 3
• Airborne contact dermatitis, irritant contact dermatitis, periorbital rosacea, allergic conjunctivitis, and psoriasis are less frequent causes of periorbital dermatitis 2, 3

Treatment of Periorbital Dermatitis

• Calcineurin inhibitors are considered first-line therapy for facial atopic eczema and may be effective in periocular eczematous lesions of other origins 2
• Triamcinolone cream is commonly used to treat periorbital dermatitis, with less than 30% of patients being refractory to treatment 4
• Topical hydrocortisone is also used, but over 80% of patients may experience refractory episodes of persistent irritation and erythema 4

Demographic Data

• Periorbital dermatitis is more common in women, with 82.2% of patients being female 4
• The average age at first diagnosis is 60.3 years, with 84.4% of patients identifying as Caucasian 4

Differential Diagnoses

• Periorbital dermatitis can be difficult to diagnose due to its variety of clinical appearances, and differential diagnostic considerations are often challenging 2
• Patch testing of standard trays and consumers' products is necessary to elucidate the relevant contact sensitization 3