Caroline, 42 years old, Watch out for the eyelids
Related topics
- Dryness / Atopy / Eczema
- Young woman with a history of eczema
- Recent inflammatory erythematosquamous dermatosis on both eyelids.
- Used new make-up
- Pruritus with dry skin elsewhere
- Family and friends: NTR
- No animals
- No family history of atopy
Quiz
40 respondents
Question of 1
What is your diagnosis? (only one correct response)
Allergic contact eczema
Allergic contact eczema
It is indeed allergic contact eczema.
Let’s rule out differential diagnoses:
- Atopic dermatitis:
Flare-ups with periods of remission, history of atopy, pruritus, xerosis.
Location of the lesions: face, skin folds, limbs.
Jagged eczema lesions.
No infectious contact or animals.
- Psoriasis:
Found in typical locations: elbows, knees, lumbar region, scalp, +- nails with a context or history of psoriasis, without the atopic context or animal contact.
Histology if necessary.
Atopic dermatitis
Wrong answer!
It was allergic contact eczema.
Let’s rule out differential diagnoses:
- Atopic dermatitis:
Flare-ups with periods of remission, history of atopy, pruritus, xerosis.
Location of the lesions: face, skin folds, limbs.
Jagged eczema lesions.
No infectious contact or animals.
- Psoriasis:
Found in typical locations: elbows, knees, lumbar region, scalp, +- nails with a context or history of psoriasis, without the atopic context or animal contact.
Histology if necessary.
Psoriasis
Wrong answer!
It was allergic contact eczema.
Let’s rule out differential diagnoses:
- Atopic dermatitis:
Flare-ups with periods of remission, history of atopy, pruritus, xerosis.
Location of the lesions: face, skin folds, limbs.
Jagged eczema lesions.
No infectious contact or animals.
- Psoriasis:
Found in typical locations: elbows, knees, lumbar region, scalp, +- nails with a context or history of psoriasis, without the atopic context or animal contact.
Histology if necessary.
- Presence of pruritus: Yes
- Onset: Recent
- Lesions:The patient has jagged inflammatory eczema lesions.Bilateral on both eyelids, nothing else elsewhere
- History: The patient does not have a family history of atopy
- Other elements: Contact/make-up
- No additional examinations to be performed in general. The diagnosis is clinical.
- Allergy tests may be indicated in the event of recurrence or resistance to treatment or to specify the allergen(s).
Dermatological treatment:
Topical corticosteroids can be prescribed as first line therapy. What is dangerous is steroid phobia!
In short: low-potency class such as desonide.
- Initial treatment: A small amount once a day (½ fingertip unit). Should be started early and continued until clearing.
- Spray with water: using a shower head or spray bottle.
- Eliminate the allergen.
Dermo-cosmetic support:
Specific “eyelid” moisturising cream.
Patient education:
- Eczema does not appear immediately after contact (usually after 48 to 72 hours),
- and contact just once a week is sufficient to cause chronic eczema.
- Treatment depends on eliminating the allergen or irritant products, not just applying topical corticosteroids daily.
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