Monday, February 27, 2012

Periocular Dermatitis in a Child

Melanie Austin, a pediatrician asks:
"This is a 4 y/o with 10 day history of this rash around only her right eye. No eye discharge. The rash is not bothersome - mother describes at times it looks worse. H/o eczema, keratosis pilaris
I don't recognize the rash and I didn't want to start and topical steroids due to proximity to eye. Mom denies any make up or topical treatments at home...
What are your thought?


  1. From Fran Storrs: "Sure looks like cont derm to me.  Bitsy vesicles.  Could be on a parent and transfer to child or in a nose drop?? or on kids hands??  May soon be bilateral.  Koh neg I assume.  If those are pustules could even be candida."

  2. from Lili Mann (pediatric dermatology resident: "Interesting - looks like there might be some upper lid involvement too - hard to tell from the photo. If yes, I'd wonder about atopic dermatitis. I'd expect AD and allergic contact dermatitis to both be itchy though, which is odd. The periocular derm that I've seen is usually more discrete papules. Hmm.

    We use HC 2.5% ointment around the eye BID x 2-3 days without worrying at all about ocular effects, so they could try that. Or tincture of time if it's not bothering the child."

  3. from pediatric PA, Brian Maurer: "This could be a mild contact dermatitis, exacerbated by rubbing--but there doesn't seem to be a history of the hallmark of pruritis.
    I've seen peri-ocular herpes present in this distribution. Admittedly, this photo was taken ten days out--any history of initial vessicular eruption or crusting? If so, it would be important to perform a fluorescein staining of the cornea to look for dendritic signs.
    I also thought about a mild dacryostenosis/dacryocystitis, although again there is no history of ocular discharge. Interesting that the area of inflammation is more medial than lateral in the photograph.
    If there is no ocular involvement, you could always treat with an oral antihistamine such as Benadryl or hydroxyzine and observe--somewhat less effective, but safer than topical steroid creams."


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