眼睑湿疹？请考虑化学物质过敏

拉斯维加斯——新泽西州西奥兰治市的美容外科医生Janet M. Neigel在美国整容外科学会(AACS)2013年会上建议，如果患者表现为眼睑湿疹或眼睑肿胀，且对外用皮质类固醇激素治疗无应答，应考虑进行化学检测。



Neigel表示，在过去5年间，她看到越来越多的患者表现为局限于眼睑或眼球区域的湿疹，并像杂草一样反复复发，难以根治。“我给予他们外用皮质类固醇激素治疗，情况会有所好转，但总是难以避免复发。其中一些是季节性的，可能仅发生于冬季，即空气和皮肤倾向于较为干燥的时候。而另一些患者可以在一年中的任何时间复发。似乎在女性中更为常见，但在男性中也可发现这种情况。在男性中，倾向表现为眼睛发红和皮肤皲裂。”

Janet Neigel医生

多数患者的病因为化学物质过敏，包括金、镍、锡、橡胶、洗发水中的防腐剂和衣物洗涤剂，以及指甲油中的甲醛树脂等。“有一名患者对滴眼液中的防腐剂过敏，”Neigel医生回忆：“她接受了多种不同的滴眼液治疗，试图消除眼部区域肿胀，结果却使情况更加恶化。另一名患者在摘掉结婚戒指后眼部湿疹消失，因此该患者不能再佩戴任何黄金首饰。还有一名患者对锡和镍过敏，所以不能再佩戴任何廉价首饰。”

美容操作中经常使用的药膏也可能造成麻烦。“新霉素、妥布霉素和新孢霉素之间具有交叉反应性。有一名患者在身体不同部位受到创伤的时候，每次都使用新孢霉素治疗，而眼睑是唯一反复受累的区域。”

Neigel推测，这些病例的反应局限于眼睑的原因为，“这是身体皮肤最薄、也是最敏感的区域”。因此她建议，对于过敏性结膜炎或因表现为眼球或眼睑周围类型的接触性皮炎而发生皮肤皲裂的患者，应进行化学检测。“这一措施很有可能确定患者对哪些物质过敏，从而找到真实病因并加以根治，而非一味给予对症治疗。”

Neigel医生披露无相关利益冲突。

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By: DOUG BRUNK, Internal Medicine News Digital Network

LAS VEGAS – If a patient presents with eczema of the eyelids, or swollen eyelids that don’t respond to topical steroids, think about sending them for chemical testing, advised Dr. Janet M. Neigel.

"The eyelids are red and scaly, a little swollen, and it just never goes away," she said in an interview at the annual meeting of the American Academy of Cosmetic Surgery.

If a patient presents with eczema of the eyelids, or swollen eyelids that don\'t respond to topical steroids, think about sending them for chemical testing, advised Dr. Janet M. Neigel.
 
Dr. Neigel, a cosmetic surgeon in West Orange, N.J., said that over the past 5 years, she has seen increasing numbers of patients present with eczema localized to the eyelids or eyeball area that recurs like pesky crabgrass.

"I treat them with topical steroids," Dr. Neigel said. "It will get better, but it always comes back. Some of this is seasonal. It may only happen in the winter, when the air is drier and their skin tends to get drier. In others it can be all year long," she said. "It seems to be more common in women, but I see men with this condition, too. In men, it tends to present as a reddish eye and tearing," she noted.

In the majority of cases, the culprit turns out to be an allergy to chemicals including gold, nickel, tin, rubber, preservatives in shampoos and laundry detergent, and formaldehyde resin, which is used in nail polish. "There was one patient who was allergic to the preservative in eyedrops," Dr. Neigel recalled. "She was on several different eyedrops trying to treat the swollen eye area, and it was just making the condition worse."

Another patient’s eczema cleared only after she removed her wedding ring, Dr. Neigel said. "So she couldn’t wear any gold jewelry. In somebody else it was tin and nickel, so she couldn’t wear any cheap jewelry."

Ointments commonly used for cosmetic procedures also can cause trouble. "There is cross-reactivity between neomycin, tobramycin, and Neosporin," Dr. Neigel said. "One patient was applying Neosporin every time she bumped herself on different parts of her body, and her eyelids were the only things flaring up."

Dr. Neigel speculated that the reaction in such cases is localized to the eyelid because "it’s the thinnest skin in the body. It’s the most sensitive, and for some reason, the patients I’m seeing only have reactions there," she noted. So, for patients with allergic conjunctivitis or tearing for a contact dermatitis–type presentation around the eyeball or the eyelids, send them for chemical testing, she advised. "There’s a good chance you might clear things up and figure out what they’re truly reacting to – get to the source instead of just treating the problem symptomatically," she said.

Dr. Neigel said she had no relevant financial disclosures.