The patient is an 9-year-old boy with a >2 year history of an eyelid dermatitis. It seems to be somewhat seasonal in severity, athough it is present throughout the year. He is from Iceland, but his family has moved to Albania ~ 2 years ago.
His parents had doctor look at it few times when they lived in Scandinavia and he was prescribed an ointment (they think it may have been a corticosteroid). They stopped using it over a year ago. Nothing they have tried has been helpful (Vaseline, an Aquaphor stick, or wiping it with a warm wet cloth.)
After wiping with warm water for a couple of minutes most of the buildup is removed, butt it comes back within some hours. Occasionally, there is a small amount of blood, but that does not bother the child.
His parents have not noticed him rubbing the area and the child does not complain of symptoms.
He does not have an atopic history, but his maternal grandmother has had a chronic forehead and eyelid dermatitis possibly related to a mild, patch-test proven PPD hair dye history. In her case, rubbing and scratching has exacerbated her dermatitis.
Assuming that this is either lichen simplex chronicles or a contact dermatitis, what is the simplest way to handle this? Patch testing is not possible where they are living.
Your thoughts will he helpful and are appreciated!
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