Eyelid Dermatitis: The REAL Cause (It's Often Not Your Eye Cream)

[00:00:00]Well, hey guys. Welcome back. If you're new here, I'm Dr. Dre. I'm a board certified dermatologist and today we are talking about eyelid dermatitis. Now, if you've ever dealt with red, flaky, dry, itchy eyelids, you know how incredibly frustrating and miserable it can be to cope with. The skin of your eyelids is very delicate. So, even the mildest inflammation can creep up and become unbearable. I think one of the things that makes eyelid dermatitis so frustrating is that the underlying root cause is not always obvious. For example, many people will just assume that they're reacting to an eye cream or an eye shadow, but there are a lot of things that come in contact with your eyelids that can be driving the eyelid dermatitis. Today, we're going to talk about what eyelid dermatitis is exactly.

[00:00:41]I'll go over the common causes, and importantly, we're going to talk about how to deal with it and get rid of it.

[00:00:47]The eyelids contain some of the thinnest skin on the entire body. Think of the skin on your eyelids like tissue paper, whereas the skin on the palms of your hands, the soles of your feet, that's a lot more like leather. Because eyelid skin is so thin, it's a lot easier for irritating substances to penetrate this delicate area and cause irritation and inflammation. Furthermore, your eyelids are constantly moving. Every time you blink, you create a little bit of friction around the eyelids. Throw on top of that, if your eyelids are itchy, you're rubbing them, you're trying to scratch them, that's even more friction.

[00:01:16]Tears, wind, dry air, environmental exposures. All of these things also can definitely influence the integrity and health of the skin barrier on your eyelids and contribute to eyelid dermatitis. Eyelid dermatitis isn't actually a specific disease, but rather an umbrella term for a variety of different inflammatory skin conditions of the eyelids. The three most common reasons are irritant contact dermatitis, allergic contact dermatitis, and attopic dermatitis. I want to start with irritant contact dermatitis. This happens when something directly damages the skin barrier. It's not an allergy.

[00:01:50]In other words, your immune system doesn't have some sort of memory to the particular thing coming in contact with it. Your immune system is not directly attacking it out of a pattern recognition, but rather the product exposure, the ingredient exposure overwhelms what your skin barrier can reasonably handle. And as you can imagine, like we already explained, eyelid skin is very, very thin. What are some common examples? Well, using topical retinoids or cosmetic retinol or retinaldahhide, we already know those ingredients can cause dryness, peeling, and irritation of facial skin. But when they get on the eyelids, that dryness, irritation, and peeling obviously is going to be a lot more common, in many cases more severe. That's not to say that these ingredients can never be used there, but rather it's something to understand about the side effect profile. Other examples include alpha hydroxy acids, salicylic acid, benzol peroxide. Excessively washing your eyelids, rubbing them very harshly also can contribute to an irritant contact dermatitis. Sometimes it's not even the ingredient itself, but rather leaving behind that ingredient as a residue. For example, if you wash your eyelids and you don't properly rinse the cleanser residue off, which is actually a lot easier than one might expect to fall into, well, that right there will dry out your eyelids. Sometimes people simply don't understand that certain topicals should really not be put on the eyelids. And in fact, you'd be better off to before applying them to other areas of your face, actually protect your eyelid skin first from those ingredients by applying a thin film of plain petroleum jelly, which is very safe to use around the eyes and protects delicate eyelid skin from these otherwise irritating ingredients which might migrate there even if you don't put them there directly. The second major category is a little bit different. It's allergic contact dermatitis. So what exactly is going on here? Well, in contrast to an irritant contact dermatitis, here your immune system is getting involved. There's something about a particular ingredient that your immune system has decided it does not like and it actually remembers that particular pattern within that ingredient so that every time it comes in contact with it, your immune system will say, "Hey everybody, gather the troops. She's here again." And will come into the skin and mount a reaction. But here's the thing, it's not an immediate reaction. meaning you apply the ingredient or the ingredient comes in contact and there is a delay before you start to have side effects of dryness, peeling and eyelid dermatitis. It is known as a delayed type hypersensitivity reaction for [snorts] that reason as opposed to an immediate type hypersensitivity reaction like what one might encounter with say anaphilaxis which is a very serious allergic reaction. This is not anaphilaxis. You are not going to end up unable to breathe, unable to take in air and full-on cardiac arrest because you came in contact with something you're allergic to on the skin. But it can lead to a pretty debilitating dermatitis. And here's the other sneaky thing about allergic contact dermatitis that throws people for a loop. Your immune system can decide at any time in your life that it no longer likes a particular ingredient. And this comes as a surprise because often times you will develop at some point in life an allergy to an ingredient in something you have been using for years. So the patient never suspects that that's actually the problem cuz they're like, "I've been using this for 15 or 20 years and I only just started having these eyelid rashes." Exactly. Exactly. Your immune system just decided that it no longer likes a particular ingredient in, for example, that eye cream you've been using for years. Once the immune system becomes sensitized to a particular allergen, well, you have to completely avoid that allergen. Not just in the product that you've been using to your eyelids, but in general. The third major cause is attopic dermatitis. Commonly referred to as eczema, though it's actually a type of eczema. But people who have eczema, we'll just say, in general, they have a skin barrier that is a little less hearty, a little less robust at baseline. So overlay that onto already delicate, fragile eyelid skin.

[00:05:58]You definitely have a recipe for repeat dermatitis. A greater tendency to lose water from the skin when the skin is super delicate and exposed to a lot of things. That just makes the area all the more inclined to develop dryness, peeling, and irritation. And it may have nothing to do with a particular product that you are using. Although irritating products certainly can trigger flare-ups and aggravated. Often times patients who have attopic dermatitis, they're going to have a background of other types of disorders, usually one or a couple of the following. Seasonal allergies. They might have food allergies. They may often have asthma, reactive airways. In other words, they get wheezy and they will deal with bouts that come and go of flare ups of itchy rashes that often are oozy in the beginning and then over time can become scale crusted and even thickened, coarse, dry and discolored in appearance. That's known as lyanification. And all of these changes can also occur as part of the pattern of eyelid dermatitis that attopic dermatitis patients experience.

[00:07:02]Initially they may have oozy, weepy red rashes. Over time those become flaky and dry. The skin of course is swollen in the area. And then if they chronically rub the skin because it's super itchy.

[00:07:14]Well, the rubbing makes the itch even more stubborn and persistent and the skin starts thickening in a response to that. You can get lyanification around the eyelids. A lot of patients might experience this under the eyes in particular and think, "Oh my gosh, I have dark circles now. Let me go buy another eye cream out there." And spoiler alert, the eye cream is not going to correct those types of dark circles. You've got to address the underlying inflammation. Although honestly, eye creams are mostly just moisturizers, which will actually end up helping the skin barrier a bit. So, could actually end up being helpful.

[00:07:48]But, uh, you don't need a dedicated eye cream, in other words, in order to address that. But, if you've developed an allergy to an ingredient, you got to avoid eye creams with that ingredient.

[00:07:57]Your eyelids are actually often innocent bystanders. The trigger for the eyelid dermatitis often times isn't even something that you're putting on your eyelids. I'm going to walk you through some very common surprising examples.

[00:08:10]Number one, hair products. These are actually a big one. Shampoo, conditioner, leave-in conditioner, styling sprays, mouses, dry shampoo, and especially hair dye. All of these things can run onto the face as you're showering and make their way onto your eyelids. This often manifests as a eyelid dermatitis and then later progresses to involve more of what we describe as a rinse off pattern involving the sides of the face, behind the ears, the back of the neck, and last but not least, your scalp finally does end up developing irritation, but long after you have already had an eyelid dermatitis. Do you see how the timing of appearance can really throw people off?

[00:08:51]And as a result, they won't actually suspect that, oh, maybe I've developed an allergy to something in my shampoo.

[00:08:57]Here's another common culprit that people never even think of. Stuff that you are putting on your fingernails.

[00:09:04]Yes, nail products like nail polish, artificial nails, the glues that you use for the artificial nails, the shellax, etc. all contain ingredients that are relatively common allergens. And you transfer those allergens to eyelid skin.

[00:09:19]Anytime you touch your face, which try as you might, you will inevitably touch your face. It is just the nature of being human. As I touch my face right now, now fragrances are another common culprit. Fragrance is sort of an umbrella term for many different ingredients and they can cause well allergic contact dermatitis. For example, certain ingredients in fragrance that are common allergens are lemonine, linolu, cinnamol, but you can become allergic to really anything in fragrance. And don't be fooled, there's no such thing as an allergenfree fragrance that you can become allergic to anything. Eye makeup, mascara, eyeliner, these are also relatively common. I mean, anything you're putting on the eyelid, if you're allergic to something in it, it's definitely not going to be a good thing for your eyelid dermatitis. even contact lens solution, prescription eye drops. You can become allergic to the preservatives in these and that can lead to a pretty intense eyelid dermatitis. Topical antibiotic ointments that might be used around the eyes are another common culprit.

[00:10:24]Something to think about is that if you have touched something with your hand, your eyelids are likely going to see it and they're going to react to it way more quickly, way more intensely than your hands. Cuz again, remember leather tissue paper. When dermatologists evaluate an eyelid dermatitis, we're not really thinking about the eye cream itself per se or the brand or you know whether or not it's a good eye cream, but rather what are the ingredients in this product and other products that the patient is using that are common [snorts] allergens. Like I said, fragrance is one of the most common causes of allergic contact dermatitis, but you also have to factor in botanical extracts which overlap with fragrance, essential oils. Just because something is natural doesn't mean your immune system discriminates. It's definitely can and often does rebel with allergic contact dermatitis. In fact, one of the most natural things out there is one of the most common causes of allergic contact dermatitis which can lead to an eyelid dermatitis and that is poison ivy.

[00:11:26]Yeah, that's a delay type hypersensitivity reaction to uhol resins in poison ivy. Preservatives are another category. Now, preservatives are great.

[00:11:36]Okay, we don't want microbial contamination and stuff. However, some preservatives your immune system is a lot more inclined to decide are unsavory. Namely, those in the category tholones like methylchloroisothioone, methyl isothioenone. Parabens on the other hand are a lot safer despite what marketing propaganda might have one believe about them. I was just at a conference and a bunch of skincare entrepreneurs were presenting their new products that they're hoping to become famous for and make a lot of money selling to people and all of them were boasting paraben free paraben free and I'm like why do we care about that anymore? Okay. Uh what are they tholone free? I would much rather see that because tholenones while not the devil are just a lot more likely and make more sense to avoid. But with the widespread demonization of parabens, they started substituting these more problematic preservatives and things that cause allergic contact dermatitis for people.

[00:12:36]Propulolis aderived we'll say ingredient which I have videos on. Very moisturizing. Love it. But man, people do develop allergies to that stuff.

[00:12:45]Topical antibiotics. We already said particularly those that you buy over the counter that contain neomyiain aka neosporin or baset tracin stay away from those in general they are well-known causes of contact dermatitis and they're not very good antibiotics to be putting on the skin so stay away from them one of the biggest parts about diagnosing an eyelid dermatitis simply boils down to asking the right questions. When did the rash start? Do you have rashes anywhere else? Is it on one eyelid, both eyelids?

[00:13:16]Is it constant? Does it come or go? Do you color your hair? Do you paint your nails or get artificial nails put on? A lot of times if you go to a non- dermatologist, like say those friendly folks in the urgent care, the emergency room, they often fixate on a recent change in laundry detergent and honestly that's usually irrelevant. Okay. I've never really had somebody who like changed their laundry detergent and developed contact dermatitis and that was the end of the story. Like it's in my experience, changing laundry detergent is just this kind of like historical point that always gets mentioned and is for the most part uh usually irrelevant. Not to say that you can't develop irritation from laundry detergent. I'm just saying like it tends to be something that a lot of novice history takers in dermatology report and it's usually irrelevant. Once it becomes clear that it seems like there could be some underlying contact dermatitis going on, that's when the dermatologist really needs to pursue patch testing. Patch testing is a very involved testing. So, it's not a simple, oh, just order this test. It takes a lot to prepare for, to have on hand as far as reagents. And you, the person going through it, has to commit some time because to come in and have these patches put on your back with all of these different allergens of concern on your back. And then you come back to the dermatologist, usually at 48 hours, sometimes 72 hours, and we take a look at the back where all those little wells were and determine if your body reacts to any particular allergen.

[00:14:46]Interpreting those things is not as straightforward as one might uh might assume. So expertise in patch testing uh is incredibly helpful in interpreting the test. And then once you determine the allergen, well then the patient has to aggressively avoid it. And the patients are often caught off guard by how many things they never would have thought actually contain that. I mean like household cleaning products, stuff that you're not necessarily directly putting on your skin, but you've got to avoid and it can be very burdensome actually to avoid allergens. How do we treat eyelid dermatitis? while removing the underlying root cause in the case of contact dermatitis. Uh whether it be allergic or irritant and also simple barrier repair. Eyelid skin is very delicate. So a bland fragrance-free moisturizer to the eyelids is recommended. I recommend plain petroleum jelly. Why isn't that bad for you? No, quite the opposite. Plain petroleum jelly is the closest to a zero allergen product that you will ever find. doesn't require any preservatives. There's no fragrance in plain petroleum jelly. You got to be careful though because they try and jazz it up sometimes and add scents. But as long as it's plain petroleum jelly, the only ingredient is 100% prolotum, you are good. Not to mention, it's the most olusive. So, it's the best thing to put on the eyelid skin to reduce transepidermal water loss. And it really restricts access of irritants and aerero allergens, allergens in general to eyelid skin by creating a watertight barrier. And it also has pretty good longevity on the eyelids in comparison to a cream or a lotion and that it stays on the skin for longer.

[00:16:32]And so it's really the best choice.

[00:16:34]Lowest risk of contact dermatitis, fastest repair with it, best reduction in transepidermal water loss. It's really what is necessary here. And um it will also just moisturize the skin as well. You want to keep your routine very simple. Fewer products less likelihood that you will develop allergic contact dermatitis. The more stuff you use, the greater the likelihood for either irritant or allergic contact dermatitis to develop. But if you have attopic dermatitis, you want to stay consistent with moisturizing as is mandated by your basic regimen for controlling flare-ups.

[00:17:07]and you want to stay consistent with topical medications as prescribed by your dermatologist. If you have any questions about them, please ask the dermatologist rather than just abandoning the uh medication because you came across a Reddit thread that has you convinced it's going to kill you. Please talk to them. Scary blackbox warnings come with things, but oftent times they're very different when we're talking about a cream versus taking the medication by mouth. But the black box warning doesn't necessarily distinguish the differences in routes and so it can scare the daylights out of you if you read it and are not expecting that. Now speaking of blackbox warnings, what prescription treatments are utilized to address this? Well, very short brief courses of low potency corticosteroids can be used, but eyelid skin is really not the best location to be putting topical steroids. there's a risk of glaucoma with use of steroids around the eyes. So, we really try and be super super restrictive with that. Also, concern about glaucoma, cataracts, with inappropriate long-term use, thinning of already thin eyelid skin. So, for that reason alone, most dermatologists will consider a topical medication known as a calcinurine inhibitor. Tacrymus, pimprolamus are two very common ones.

[00:18:25]They have brand names like Protopic and Eladil. These are a lot more precise and specific as to how they reduce inflammation to heal the skin in comparison to steroids and are considered steroid sparing without those concerning side effects that one can develop with topical steroids, especially to the eyelid area. There are several common mistakes though that can delay your eyelid dermatitis healing.

[00:18:48]rubbing or scratching the eyelids, the repeat friction, using multiple active ingredients all over the face, trying DIY homemade remedies, continuing to wear eye makeup. I do suggest taking a break because eye makeup can contain some of the allergens if it's allergic contact dermatitis and can make things worse. Don't just keep applying a product cuz you spent money on it and you want to get your money's worth. If you have an eyelid dermatitis, oh, you will pay for that. Trust me. Now, here's the last thing that I really want to emphasize to you guys and why, you know, you got to be careful with educational videos. They're meant for well, educational, not diagnostic purposes.

[00:19:25]Not all eyelid rashes are eyelid dermatitis. You could have seigic dermatitis, psoriasis, dermatomyioitis, bllepheritis, could be related to demadeex. Uh, speaking of topical steroids, you may have developed perorificial dermatitis. We've even seen cases of herpes simplex virus infection around the islands. activation of vericella. Check out my video on warning signs of shingles. Not to miss cellulitis, a bacterial skin infection.

[00:19:52]In other words, there are other things that can be affecting the eyelids. Even skin cancers, yes, even skin cancers can kind of sneak on up there and look like an eyelid dermatitis. So, when should you see the old dermatologist? Uh well, if your eyelid rash keeps coming back despite uh your efforts to avoid things and every time it's more severe, it's very debilitating, you're getting pus, oozing, swelling, see a derm. Please do not try and DIY this. Biggest take-home point from this video. Eyelid dermatitis is not usually a matter of finding the perfect best cream. I'll get these questions. What's a good cream for eyelid dermatitis? That's not the right question to ask. The right question to ask is actually what should I be avoiding? Well, the only way to answer that is to see a dermatologist to know what the problem is. It's more about finding the perfect trigger rather than the perfect cream. Eyelid skin is very sensitive, very thin barrier there.

[00:20:48]Thin, delicate tissue paper skin. Stuff that comes in contact with your hands will more likely cause an eyelid dermatitis than it will a hand dermatitis. But once the trigger is identified and avoided, eyelids they can get back to their usual schedule programming and the eyelid dermatitis can resolve. I really hope you guys found today's video helpful and informative. Now, if you want to learn all about treating dark circles, you're going to want to watch the video on the ends. We do a deep dive there. All of your dark circles questions addressed. I hope you all enjoyed today's video. If so, give it a thumbs up, share it with your friends, and as always, don't forget sunscreen and subscribe. I'll talk to you guys tomorrow. Bye.

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