Two types of contact allergies are likely to result on the face. The first is the result of an aerosolized allergen. The second is direct physical contact that is most prominent on the sensitive skin of the face.
Clinically, allergic contact dermatitis resulting from an aerosolized allergen presents as erythema or scale with or without vesiculation. The involvement is diffuse with upper and lower eyelids affected. This distribution is in contrast with photosensitive eruptions in which nonsun-exposed areas, such as the upper eyelids and the upper lip, are spared. Direct allergic contact dermatitis tends to be most prominent on the most sensitive skin, such as the eyelids. Examples of aerosolized contactants include rhus (poison ivy, oak) when the plant has been burned. Examples of common contactants affecting the face include nickel, nail polishes, toothpaste, preservatives in make-up, contact lens solutions, eyeglasses, and hair care products. Chemical-splash injuries are a common cause of facial-irritant contact dermatitis. A thorough history is necessary to uncover the offending agent. Referral to a dermatologist or allergist may be necessary if the history is unrevealing.
Avoiding the offending agent is the most crucial part of treatment. Medical treatment will be of little value if the offending agent is not removed from the patient's environment. Depending on the severity, topical or oral corticosteroids and oral antihistamines are used in medical management. Domeboro's compresses can be beneficial as well. Only low-potency topical corticosteroids should be used on the face. Hydrocortisone 2.5%; cream or ointment should be tried initially. Careful application around the eyes is important because topical corticosteroid use has been implicated in causing cataracts and glaucoma. Oftentimes, extensive and severe periocular involvement requires oral prednisone.
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