For several months, a 69-year-old woman has had a rash around her eyes. It is terribly symptomatic, burning and itching with or without treatment (attempts at which have encompassed moisturizers, petroleum jelly, topical vitamin E oil, and most recently, application of triple-antibiotic cream three times a day). She finally requests referral to dermatology from her primary care provider.
When the rash manifested, she reports, she made some alterations to her routine, eliminating or changing the type of makeup, soap, cleanser, and laundry detergent she used. None of these changes helped.
Even before the distressing symptoms started, a friend had suggested the patient might have an eye problem. She consulted an ophthalmologist, who prescribed eye drops (the patient doesn’t recall any details); these only produced more burning and itching around her eyes.
The patient’s history is significant for atopy, with a childhood history of seasonal allergies, asthma, and eczema.
EXAMINATION
There is marked erythema and scaling in the bilateral periocular areas that spills onto both upper and lower lids. Very little edema is seen. The eyes themselves are free of changes.
What is the diagnosis?