The Story of the Eye
Let’s talk eyelids! Itchy, irritated, dry, scaly, crepey ones in particular.
By Marie Leger, MD PhD
For some reason, this has been a theme in my practice over the last few months. A variety of conditions can make the skin around the eyes red, inflamed, and itchy. When dermatologists see itchy eyelids, we usually think of a few common things first—eczema, allergies, or irritants. I don’t so much mean allergies to pollen, dogs, cats—though these things can affect your eyes, too (usually making them red and watery). I mean allergies to things TOUCHING your eyelids. If a dermatologist suspects an allergy, we will recommend patch testing—which is a way to determine if something touching your skin is making it inflamed. This kind of allergy is also caused a “type IV hypersensitivity reaction” (like poison oak or poison ivy). If someone is allergic to something in this way, every time it touches their skin, memory T lymphocytes—a kid of white blood cell that “remembers” past products or chemicals it doesn’t like--freaks out, basically creating a barrage of inflammation on the skin.
When we do decide to look for allergies in people with rashes on their eyelids, we often find something useful. One recent study showed that 43% of eyelid rashes had a relevant allergy when tested, most commonly to nickel, fragrance, methylisothiazolinone (a preservative found in cosmetics and wet wipes) gold, and balsam of peru (a sticky fragrant liquid from tree bark, used for its fragrance, flavor and antiseptic properties). Why is this relevant? Because believe it or not, despite “using the same things you have always used” or your favorite expensive shampoo, conditioner, moisturizer, makeup, or sunscreen, some of these things may be affecting your eyelids! Notably, a lot of people sticking to clean beauty regimens and using natural products can have allergic responses to some of these very same entities.
Some recent eyelid/allergy identification wins for my patients:
A professional body builder allergic to methyl methacrylate, an adhesive used for her fabulous nails and her eyelash extensions.
Two athletic patients allergic to nickel, whose eyelids improved after ditching the metal water bottles they carried with them daily to the gym.
A designer allergic to cobalt, a metal commonly found in stainless steel, who had to part with two watches because they made both her wrists and eyelids itchy.
Two young women allergic to hydroperoxides of linalool, a natural fragrance extracted from citrus and such plants as jasmine, lavender, basil, and thyme and used in many shampoos, conditioners, and other personal care products.
Not all eyelid rashes are allergies. Eczema, seborrheic dermatitis, and periorificial dermatitis (stay tuned for a discussion of this next month) can also cause eyelid problems. Treatment for these kinds of issues varies—and there have been a lot of advances in the past year with respect to non-irritating, non-steroid products that are effective for these chronic eyelid problems, too. But when we can identify a cause in one of the products that you are using, it is often life-changing, and my medical assistants and I will exchange high-fives with you.
In our practice, we also see a lot of concerns about eyelid hydration, crepyness, wrinkling, pigment change, undereye hollowing, and lid laxity. In our armamentarium for our patients’ cosmetic eyelid concerns, we also offer a lot of low downtime procedural remedies that help with pigment, skin cell turnover, and collagen stimulation--including brow lifts via strategic neuromodulater placement, ultrasound treatments to lift and tighten brows, radiofrequency microneedling for textural improvement and collagen production, skin care products for eyes containing retinoids, antioxidents, caffeine, and many other fun things.
What eyelid issues do you have? DM Dr. Leger @marielegermd and we will answer questions this month as they come up.