Eczema Complications series – Eye and Eyelid

Eczema eyelid complications eyeThis is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!

Eyelid Functions and Skin

The eyelid very often present a very tricky and difficult to treat skin area for eczema sufferers. Moreover, the constant rubbing and scratching of the eczema at the eyelid can also lead to complications. Before we go into the complications, let’s first understand the basics of eyelid functions and the skin at this delicate area.

Functions of the Eyelid

  1. Protection from injury
  2. Regulation of light
  3. Maintenance and distribution of tear film/ flow

Eyelid Skin

The skin of the eyelid is characterized by:

  1. Thinnest skin are of our body – total less than 1mm, with both the epidermis and dermis being the thinnest
  2. Smoother skin due to finer hairs
  3. Oilier skin due to more oil glands

Common Eyelid Conditions

Being thinner oilier skin and on the face predispose the eyelid to various health conditions, such as:

  1. Atopic dermatitis (eczema), more common from adolescent age (read more from dermatologist Dr Lynn Chiam)
  2. Contact dermatitis, due to contact with chemicals used on the face/eyes and hair
  3. Seborrheic dermatitis, typically on the eyelid and eyebrow (read here for more on seborrheic dermatitis)
  4. Blepharitis, also known as eyelid inflammation
  5. Conjunctivitis – this refers to inflammation of the eyelid lining, accompanied by itching and eye watering
  6. Ptosis, known as droopy eyelids from prolonged contact lens use or aging
  7. Dermatochalasis, baggy eyes from aging
  8. Ectropion, eyelids that roll outwards usually from ageing or sun-damaged facial skin
  9. Entropion, eyelids that roll inwards, may also be complication of blepharitis
  10. Malignant eyelid tumors
  11. Chalazion, eyelid cyst swelling from obstruction of the meibomian (tear) gland, may also be complication of blepharitis
  12. Hordeolum, also known as a stye, lump from infection of the meibomian gland, may also be complication of blepharitis

Eczema and Eyelid Complications

Apart from atopic, contact and seborrheic dermatitis of the eyelid, there are also complications from having eczema at the eyelid. Complications usually occur in patients with severe atopic dermatitis where repeated scratching and rubbing, inflammation and infection of the eyelid cause other conditions. Let’s take a closer look at some of these eczema eyelid complications:

Blepharitis

This refers to inflammation of the eyelid, being accompanied by redness, sore eyes, itch, flakiness, burning, swelling, eye watering and mucous discharge. The eyelid margin may appear crusty, waxy or greasy. Blepharitis can be due to many reasons, including allergy, irritation and bacteria infection that causes the eyelids to become itchy. Blepharitis is associated with eczema, rosacea and acne patients.

Relation of Blepharitis to eczema as follow:

a)     Staphylococcal blepharitis – patients with eczema have higher chance of staphylococcus bacteria colonization, leading to staph bacteria infection

b)    Seborrheic blepharitis – due to the malfunction of oil glands at the eyelid, affecting patients with seborrheic dermatitis. The excess oil production may be due to stress, hormonal changes or diet. A characteristic of seborrhea blepharitis is redness at the eyelid throughout the day and crusting at eyelid in the morning.

c)     Other eczema complications – Complications of eczema such as from herpes simplex or varicella zoster virus or molluscum contagiosum can also cause blepharitis.

Dennie-Morgan fold

This refers to a fold under the lower eyelid, typically due to excessive scratching/rubbing of the eye. The eyelid may also hyper-pigment or become red and swollen.

Allergic Contact Dermatitis

Ophthalmic corticosteroids may also product allergic contact dermatitis, due to allergy from certain ingredients of the corticosteroids.

Eyelid Erythema

This refers to redness of the eyelids and can be caused by eczema, contact dermatitis and blepharitis.

Cellulitis

This refers to bacterial infection of the eyelid and can also be caused by insect bite/ other skin injury. Preseptal cellulitis affects the eyelid and skin around the eye, but not the eye socket. Orbital Cellulitis is much more severe and affects the back of the eye, causing eye protrusion and double vision. The common bacteria causing cellulitis are Haemophilus influenzae, Staphylococcus and Streptococcus.

Neurodermatitis

Also known as lichen simplex chronicus, this refers to skin thickening, lichenification of the skin of the eyelid from habitual scratching.

Eczema and Eye Complications

There are also complications involving the eye, typically for prolonged eczema at the eyelid.

Keratoconus – This refers to the degeneration of cornea which pushes the eye outward, resulting in a cone shaped eyeball. There will be visual disturbance with this condition. This may be due to hard rubbing of the eye from the itch.

Scarring – This refers to scarring of the eye, mostly due to scratching or excessive rubbing.

Cataract – There is association between cataract and severe and chronic atopic dermatitis of more than 10 years, possibly due to overtime absorption of steroid cream applied on thin eyelid. One feature of cataracts associated with eczema is that the cataract affects both eyes.

Retinal detachment – This is very rare and associated with severe atopic dermatitis.

Complications from prescription creams seeping into the eyes, resulting in glaucoma

Certain eye-related conditions are not directly related to eczema, but related to allergy. For instance, conjunctival irritation

General Care for the Eyelid (Hygiene)

Top tips for general care of the eyelid:
1. Refrain from eye make-up
2. If wearing contact lens, always clean with disinfectant solution; in certain cases, refrain from using contact lens.
3. Apply warm (not hot) compress 4 times a day to clean and reduce discomfort (for blepharitis)
4. Clean eyelid with cotton swab with mild diluted baby shampoo/wash (read dermatologist Dr Jessica Krant’s tips for baby’s eyelid here)
5. Use artificial tears as blepharitis commonly occurs alongside dry eyes
6. An omega-3 supplement may be recommended to patients with blepharitis as small-scale study suggested anti-inflammatory effect of omega 3 benefit blepharitis patients. More on omega 3 and eczema here.

As you can see, there are quite a lot of health conditions affecting the eyelid and a few relating to eczema. Most of it has to do with bacteria and scratching, thus it is important to practice eyelid hygiene and treating conditions that create itch at the eye promptly.

note: if you’ve reached this far to the post, thank you! Took me a long time to do up a comprehensive post on eyelid complications from eczema and if you have any to share, kindly comment, will make my day!

AAD Skincare Video Series: Face Washing

Face Washing 101 by American Academy of Dermatology

Face Washing 101 by American Academy of Dermatology

I’m inspired by the efforts of like-minded individuals and organizations around the world to help eczema families via social media platforms. I came across American Academy of Dermatology (AAD) on Pinterest and they had pinned a Dermatology A: Z Video Series. I asked to feature their videos here, and their team of public relations is helpful and responsive, and made the special effort of introducing me to dermatologists who assisted with my questions and together, we made this series available to you.

Today’s video is “Face Washing 101“. For this video, I’ve interviewed Dr Jessica Krant MD MPH, who is a board-certified dermatologist, member of the American Academy of Dermatology, Assistant Clinical Professor of Dermatology at SUNY Downstate in New York City, and founder of ArtofDermatology.com.

MarcieMom: Thank you Dr Jessica for kickstarting this AAD video series! Today’s video sounds pretty basic, but I’ve some questions that still puzzle me, particular for those with sensitive skin. How should the face of a toddler be washed? Should the cleanser or bath oil for the body be used for the face? or is it not necessary to specifically wash the face except a quick rinse during shower?

Dr Jessica: Just like every adult has different skin, every toddler does too. Some might also be a little messier. It’s safe to wipe your toddler’s face clean with a towel soaked in warm water. Soap is really not needed, except on rare occasion, or if your own dermatologist has suggested something specific for certain medical conditions like seborrhea, eczema, or baby acne. Cleansing bath oils or lotions that are soap-free are safe to use during bath time, as long as they are kept away from the baby’s eyes.

MarcieMom: If the child has facial eczema, say weepy cheeks, how should the face be washed? Is that a sign of infection, and if so, what different measures ought to be taken?

Dr Jessica: Facial eczema with weepy cheeks can either be a sign of moderate to severe eczema with a broken down skin barrier but no infection, or a sign of skin infection in some cases. If unclear, it’s best to take the child to see a dermatologist so any risk of scarring is minimized, since babies and toddlers will definitely scratch itchy face skin and it’s hard to prevent that. No change should be made in the facial washing routine except to be extra gentle so as not to further irritate the rashy areas. Make sure any moisturizers aren’t stinging the skin and making it more itchy, and use ointment-based topical medicines rather than creams where possible.

MarcieMom: In the video it is mentioned that the skin around the eyelid is delicate, and I would assume that for a child it is even more so. Would wiping with lukewarm soaked cotton pad be sufficient to clean the skin and remove the oil on the eyelid?

Dr Jessica: When necessary, wiping with warm water is a good way to clean a baby’s or toddler’s eyelids, but just make sure that any item used like a cotton pad, won’t come apart and leave small cotton fibers behind on the lids or lashes which could irritate the baby’s eyes.

MarcieMom: It is recommended in the video to wash the face twice and after sweating. Is this recommendation the same for a child?

Dr Jessica: No, I think it would be best to wash a baby or toddler’s face as little as possible with anything other than warm water. A gentle soft cloth with warm water would be fine if there is any food or mucus at any time, but cleansing with anything else should be once per day or less often. And babies don’t really sweat, so there should be no extra cleaning unless there is actual dirt or mud present.

MarcieMom: Thank you so much Dr Jessica, indeed, I’ve to be careful of the cotton pads leaving residue on the eyes, particularly as my toddler tries to do it herself!

Facial Eczema with Dr Lynn Chiam: Rashes on the Eyelids

Dr Lynn Chiam, a consultant dermatologist who subspecializes in paediatric skin conditions

This is a series focused on facial eczema, with the privilege of having Dr Lynn Chiam, of of Children & Adult Skin Hair Laser Clinic, to help explain further the type of facial rashes, its treatment options and daily facial care. Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Singapore. Apart from paediatric dermatology, her other subspecialty interests include adult pigmentary conditions and laser dermatology. More on Dr Lynn can be found here.

What can I apply to treat the rashes on my eyelids?

For the past four posts, we’ve explored the various types of rashes that can occur on one’s face and various treatment options. This week’s focus is on the eyelids – a particularly tricky part of the face because the eyelid skin is very thin and steroids can be absorbed more readily, leading to problems such as cataract and glaucoma. Dr Lynn’s advice on treatment options include:

1. Do consult a doctor if you have rashes around the eyelid. It is important to determine what is causing the rash. Common causes include eczema and contact dermatitis secondary to eye make-up. In general, mild to mid potency steroids can be applied to the face. It should be applied twice a day and for not longer than 1-2 weeks. A mid potency steroid can be used initially then tailing down to a low potency steroid once the rash is better. Alternatively, a steroid-spring cream such as Tacrolimus or Pimicrolimus can used . In a minority of patients,Tacrolimus can cause a stinging sensation. At night, apply the cream just before you go to sleep. To prevent the steroid from dripping into the eyes, you can use a cream or ointment based steroid rather than a lotion based one which is more ‘watery’. Allow 20-30 minutes after application of the cream to the eyelids before doing activities that may cause sweating.

2. Clean the eyelid area, with lukewarm water, including cleaning the ‘mascara’ area of the eyelid. Avoid using water that is too hot. Use a gentle soap and do not rub this area excessively. Avoid using products with ingredients you’re allergic to. A patch test can be taken at the dermatologist, and ingredients that you’re tested sensitive to should be avoided for your face and eyelids as well.

3. Moisturize the eyelid, taking care again to use products that you are not allergic or sensitive to. If you feel that the moisturizing lotion you are using is too “watery“ and runs into your eyes, you can change the moisturizer to a cream or ointment form which is thicker.

4. For those who are using makeup, it is important to wash your brushes  and change them regularly. Do not use make-up past their expiry dates as bacteria will accumulate in make-up which can irritate and infect your skin. Avoid mascara and choose products from large cosmetics and skincare companies that clinically test their products. Also avoid products that are shimmery or glitters as these contain metal particles, mica, which can irritate the skin.

A final note is to avoid rubbing the eyes, as this can lead to neurodermatitis, a thickening (lichenification) of the eyelids due to prolonged scratching. The appearance of the eyelids will be darker and in some instance, lead to skin folds on the eyelid.

Friday Dr Q&A with Prof Hugo – Scratching Eyes

Prof Hugo Van Bever

Prof. Hugo Van Bever is the Head of National University Hospital’s Pediatric Allergy, Immunology & Rheumatology Department. He is also an active member of the board APAPARI (Asian Pacific Association of Paediatric Allergy, Respirology and Immunology) and has published more than 250 papers in national and international journals. His main research interest areas are paediatric allergy and paediatric respiratory infections.

Marcie Mom: Good day Prof Hugo, thanks for joining me for today’s Dr Q&A.

Babies tend to scratch their eyes when tired. Also, I notice that my baby’s eyelids (where eyeliner is applied) look oily. To soothe the discomfort, I would wet a cotton pad with lukewarm boiled water and clean outwards. This is sometimes followed by moisturizing sparingly when her eyelid is dry.

How would you recommend a parent to reduce their child scratching eyes?

Prof Hugo: Keep eczema under control and apply a preventive approach.

Marcie Mom: Short and sweet! Parents can also read Dr Verallo-Rowell’s answer in this post: Quoted below:

Marcie Mom: Lastly, the eyelid. Eyelid eczema is not uncommon for children and furthermore, children tend to scratch their eyes when sleepy or tired. I normally wipe my baby’s eyes with cotton pad soaked in slightly warm cooled boiled water followed by a thin layer of moisturizer. What would be your advice on treating rash on the child’s eyelid? Is there any ingredient that is a no-no for the eyelid?

Dr. Verallo-Rowell: Wet with a little water the way you do it above, then apply the VCO alone or with pure plain petroleum jelly to lock in the water.  The oils “melt” in a few minutes. Gently pat into the skin and if necessary (not usual) wipe off any excess to avoid their getting into the eye.

Sensitive Skin Product Series – How to Use on Sensitive Skin?

Sensitive skin of child includes the eyelid

This is a 13-part series focused on understanding and using products for sensitive skin, an important topic given the generous amount of moisturizers that go onto the skin of a child with eczema. Marcie Mom met Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity. VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist. Dr. Vermén created the VH Rating System which is the only validated hypoallergenic rating system in the world and is used across all the products at VMV. In this interview, Dr. Verallo-Rowell and Laura answer Marcie Mom’s questions on using a product on the sensitive part of child’s skin.

Sensitive Parts of Sensitive Skin Child

In our previous interviews, we have learnt what to look out for in the product packaging, including understanding the list of ingredients. In this interview, we wish to focus on the use of sensitive skin products on the parts of the child which are more delicate.

Marcie Mom: Thanks Laura for taking time to help us learn more about managing the delicate parts of our child’s skin. First, let’s all be on the same page relating to what defines delicate skin? Is it where the skin is thinner, like eyelid, face, neck, underarm and groin area?

Dr. Verallo-Rowell: Yes, where the skin is thinner: eyelids, neck, groin because of the easier absorption of chemicals. Plus, often wet areas such as cheeks, around the mouth from milk and food, neck and maybe the chest, and of course the diaper areas where maceration and heat “thins” the skin. Also from trauma and sweating of physical activities in school and at play with the use of play devices or clothing and shoe wear — hence the need sometimes for milder laundry soaps.

PLUS the following conditions:

–  Those diagnosed with an atopic problem: asthma, hay fever, and of course atopic dermatitis/ including a family history especially when (+) in both sides of the family. To treat and to prevent barrier loss because barrier dysfunction is a basic problem in those with atopic skin.

–  Those with medical conditions that make them “sensitive” Example: being off and on antibiotics a lot which disturbs the balance of naturally opposing bacteria and fungi in skin and the natural, healthy dominance of one over the other; those on maintenance drugs which make them prone to drug allergies or even photosensitivity; those who are obese and prone to sweatiness (or who are otherwise prone to sweatiness).

Marcie Mom: I also read that rinsing the product immediately is stated in many of your products’ instruction. For eczema children, they may need to soak in bath oil (my baby soaks in colloidal oatmeal bath oil). How long would you advise parents to let their child soak?

Dr. Verallo-Rowell: I generally like colloidal oatmeal bath oil but am careful to read the ingredients list for any additional ingredients as listed above and elsewhere. For the more sensitive I prefer the pure virgin coconut oil in water for 5 to 15-minute soaks.

Marcie Mom: And can they do so if they have a rash at the groin area?

Dr. Verallo-Rowell: Yes with the virgin coconut oil. I have seen extremely irritated skin, however, where even water makes them sting. In these cases, I prescribe the total removal of all products with just a bit of the VCO applied very lightly and gingerly, section by section — which I’ve found to be soothing until the oil can be applied all over. Once less sensitive, soaking in it can be done.

Laura: In case you’re reading instructions of “rinse immediately” for things like shampoo…this is important for ALL wash-off products. Wash-off products contain ingredients that are, as the name implies, meant to be washed off (such as surfactants or soaping/bubbling ingredients). Their action is cleansing, and they are not meant to stay on the skin for more than a few seconds at a time in the shower or bath. But oils and moisturizers? Or oils in a soak? These are usually fine to “marinate” in for a while 🙂 Again, with the caveats above of hypoallergenicity.

Marcie Mom: When I’m showering my 2 year old, I apply shampoo on her hair and bath oil on her tummy, back and legs. For her face, neck, underarm and groin, I don’t apply any bath oil on them but just rinse with water (I assume some of the bath oil would inadvertently flow to these areas when I’m rinsing). Is this the correct technique and clean enough?

Dr. Verallo-Rowell: Wise and smart. Another technique I use is the pure VCO as the cleansing oil on any irritated/irritable/potentially irritable skin.  It’s all in one: functions as a mild cleanser, barrier and for healing.

Marcie Mom: Lastly, the eyelid. Eyelid eczema is not uncommon for children and furthermore, children tend to scratch their eyes when sleepy or tired. I normally wipe my baby’s eyes with cotton pad soaked in slightly warm cooled boiled water followed by a thin layer of moisturizer. What would be your advice on treating rash on the child’s eyelid? Is there any ingredient that is a no-no for the eyelid?

 

Dr. Verallo-Rowell: Wet with a little water the way you do it above, then apply the VCO alone or with pure plain petroleum jelly to lock in the water.  The oils “melt” in a few minutes. Gently pat into the skin and if necessary (not usual) wipe off any excess to avoid their getting into the eye.

Laura: A nice alternative to the plain petroleum jelly can be our popular Big, Brave Boo-Boo Balm, which is petroleum jelly but with the coconut-derived monolaurin.

Marcie Mom: Thanks so much again, it sure gives me some peace on what I can do for the sensitive part of my baby’s skin. For our next and last interview, we’ll learn about the diaper area!

Skin Advice I’ve Learnt from Cosmopolitan (Singapore)

Cosmopolitan Singapore January 2012 Issue

Yes, I’ve actually learnt some new skin-related information from reading Cosmo. In case you’re wondering whether their advice for couples is useful, yes, I think it’s well-written too. I’m just going to list down the skin advice I’ve learnt from this issue, do get a copy and read if you’re interested to know more.

#1 Skin around the eye is very thin, thus more prone to fine lines which becomes more obvious with age. Blinking also increases the fine lines. No wonder, my baby’s eyelid already has lines from scratching eczema!

#2 Skin around the eye does not produce enough sebum, thus a moisturizing yet non-irritating product is needed.

#3 Astaxanthin, a carotenoid found in carrots, helps fight skin aging.

#4 Bluish dark circles are more common in younger women and due to stress and late nights. I’ve hardly slept since my baby is born, no wonder I’m turning into blue panda!

#5 Skin is 90% water and up to a litre of water can be lost through it. Another reminder to moisturize your child, see this link to learn how much to moisturize and this link on selecting moisturizer. Plus keep posted on the new 13-part Sensitive Skin Product Series.

#6 Skin repairs itself most actively from 10pm to 2am. That’s bad news for my baby who sleep around midnight sometimes or wakes up from 12.30-2am to scratch!

#7 Skin temperature increases at night, thus more prone to moisture loss. No wonder my baby keeps scratching at night (her eczema is triggered by heat) versus little scratching in the day.

So, above are 7 advice I’ve learnt which I’m sharing as somewhat applicable for eczema children.

Does Your Child Keep Scratching his Eyes?

Eczema on your child’s eyelid

Frequent scratching or rubbing of eyes can be due to itchiness caused by eye allergy or infection; but for a child with eczema, it is possible that he or she has eczema on the eyelid. Though eyelid eczema is more common in adults wearing cosmetics, children can also suffer from dry, sensitive and itchy eyelid. The skin around the eye is thin and sensitive, and also vulnerable to irritants and allergens just as other parts of the body of an eczema child. My baby Marcie sometimes scratches her eyes, and the eyelids look red, dry and sometimes a little swollen. Here’s a little bit more of how you can identify eyelid eczema in your child:

–          Eyelid is itchy, looks inflamed or scaly.

–          Eyelid is red or swollen.

–          If scratching is vigorous and prolonged, it may cause a change in the appearance of the eyelid, e.g. extra fold of skin under the eye or darker eyelid.

–          Extreme rubbing can even lead to deformed cornea (keratoconus)

I haven’t asked for any medical advice regarding eyelid eczema, but I usually wipe Marcie’s eyelid with cooled boiled water on cotton pad. If her eyelid looks oily (at the place where mascara is applied, not that I apply eye makeup on her), I will use slightly warm cooled boiled water that can remove the oil better. I will then sparingly apply Physiogel AI cream on her eyelids, and usually, she stopped scratching after a few days since her eyelid eczema is not severe. Do do see a specialist and seek appropriate treatment as you can read below, it’s a little trickier to treat the eyelid eczema.

–          Certain irritant/allergen in moisturizers may worsen the eyelid eczema, see this post and the comment section for some of these irritants.

–          Eyelid can be moisturized, but avoid doing it too generously that it flows into the eye and irritate the eye.

–          Check with the doctor if the steroid lotion/cream that you have can be applied on the eyelid. There’s some research that shows increased risk of cataract and glaucoma with steroid use. (Also read that the risk of cataract is higher for people with severe eczema for more than ten years…but let’s not scare ourselves too much now and just focus on managing our children’s eczema for now)

–          As the eyelid is already thinner than other skin, and extensive steroid use causes skin thinning, do consult your baby’s doctor on the frequency you can apply the steroid. (note: don’t get put off steroid use, as there’s research that there’s no long term adverse effect if used as doctor prescribed)

–          For cleaning the eyelid (if need to), ask your baby’s doctor first if you want to use eye lid cleanser as most of these are for adults only.

Anyone has any other tips on managing your child’s eyelid eczema? Do share in the comments, thanks!

Related Posts Plugin for WordPress, Blogger...