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Dermatology/Dry skin on eyelids and directly under eyes.

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Question
Hi Dr. Fisher,

I have extremely dry skin on my eyelids and directly under my eyes.  I have tried (separately) olive oil, walnut oil, vitamin E, Avocado oil, as well as Neutrogena hand creme.  All, to no avail. However, I read that Avocado oil is really suppose to be very good for the skin.

I think the cooler weather is causing my problem.  Additionally, my eyelids are itchy.  I like to wear a little eye shadow, but due to my acute dryness on my lids, even putting a little eye shadow on, looks as if I have caked on my makeup - when, in fact, I have not.  

I'll try anything.  Please, if you could suggest a product (price does not matter at this point, because I am so desperate) I might try, I would be so grateful! I have to use fragrance free products on my skin.  My eyelids are SO dry, that when they are wet (in the shower) they are dry!!!!  That's bad!

Thank you in advance for any suggestions or advice.  I appreciate your help and time, more than you know.  

P.S.:  I am not allergic to my makeup or soap ~ becuase I've been using the same for many, many years now.  I know it's simply the cooler temps, causing my problem.

Beth

Answer
Eyelids dermatitis is the skin inflammation of the eyelids and in most cases it is difficult to cure even though upper eyelid dermatitis treatment is available. Before treating eyelid dermatitis is necessary to establish the cause of the disease because if the cause is not taken care of it is most likely to lead to recurrent episodes. Dermatitis of eyelid can be caused by different types of allergies and most frequently by eyelid contact dermatitis. Other causes include topical medication or even nail enamel or shampoo. The most difficult to diagnose is the eyelid dermatitis caused by contact dermatitis of the eyelid even though it is the most common cause of the disease, in over 70% of the cases. Cases of eyelid dermatitis caused by cosmetics, hair dye, nails or metals have been reported over time.

Dermatitis of eyelid symptoms generally consist in dry, flaky skin of the eyelids and the inflammation becomes swollen and itchy. Symptoms may vary depending on the specific cause of the disease. Sometimes, the eyelids become so swollen that can affect the sight of the patient. Eyelid dermatitis can only be diagnosed by a specialist after a proper physical examination and depending on the results of the laboratory tests. The doctor will also establish a detailed patient history in order to find out if there are any allergies that the patient is aware of.

Since the most common cause of eyelid dermatitis is eyelid contact dermatitis hygiene becomes very important. Avoiding touching the ayes until having the hands washed is the first step in preventing this skin disease. Preventing is always easier than treating especially when the area affected is as sensitive as the eyelids. Being so close to the eyes makes eyelid dermatitis treatment difficult because most of the creams that could cure the condition can affect the eyes.

However, different types of treatment are available. The key in curing the disease is avoiding the factor that causes the condition in the first place. This is the reason why the underlying cause must be first established. The symptoms are usually relieved with cool compresses. Although corticosteroids may be used, they require extra caution because they have been associated with skin atrophy and cataracts when used in the periocular area most doctors recommend topical immunomodulators as eyelid dermatitis treatment. Topical immunomodulators can include tacrolimus (Protopic) or pimecrolimus (Elidel). They must be administrated twice a day until the rash clears and there were no side effects reported so they are safe to be used on the eyelids. But in some cases, the topical immunomodulators can be ineffective so mild topical steroid ointment can be used for short periods of time, no longer than seven days. However, they are recommended up to a class V (such as Synalar) and stronger steroids are considered too dangerous and should be avoided.

Thus, upper eyelid dermatitis treatment may vary depending on the agent that is causing the disease and with the right treatment and approach the condition can be cured with no complications.

Dermatology

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Michael S. Fisher, <B>Ph.D., M.D.</B>

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