Causative allergens of eyelid dermatitis in Greece

There remains a scarcity of available data concerning allergic contact eyelid dermatitis (ED) in Greece, warranting further investigation in this field. Our primary aim was to evaluate the frequency and significance of positive patch test results in individuals with ED. To address this knowledge gap, a retrospective study was conducted at the Dermatology Department of the University Hospital of Heraklion, located in Heraklion, Crete, Greece, involving patients suffering from ED who underwent patch testing between June 2018 and August 2023. The patch testing followed the guidelines of the International Contact Dermatitis Research Group. All patients were patch-tested using the European baseline series, utilizing allergEAZE Allergens from SmartPractice, Canada, applied with aluminium Finn Chambers on the patients' upper back for 48 h. Results were assessed on days 2, 4, and 7, and reactions were scored according to guidelines.1, 2 Descriptive analysis was employed to present information in frequencies and percentages for categorical data, while the mean and standard deviation were used for normally distributed data. A total of twenty-three patients exhibiting symptoms of ED participated in patch testing conducted at the Dermatology Department of the University Hospital in Crete, Greece, from 2018 to 2023. Among these individuals, 21 out of 23 (91.30%) were female, with the remaining 2 out of 23 (8.70%) being male. The median age of the patients was 47 years (SD ± 15.79), with an interquartile range (IQR) of 25 (Q1 36, Q3 61), ranging from 22 to 82 years. The median duration of ED was 7 months, with an IQR of 19 (Q1 5, Q3 24). Positive patch test results were observed in 73.90% (17/23) of the patients, while 26.10% (6/23) yielded negative results. Among the participants, 39.13% (9/23) experienced solely ED, while 60.87% (14/23) presented with ED alongside generalized facial eczema. In total, 12 out of 23 (52.2%) patients with eyelid dermatitis had a past medical history (PMH) of atopy. Among these, 6 out of 23 (26.10%) had a PMH of atopic dermatitis (AD), 7 out of 23 (30.4%) had a PMH of allergic rhinitis, and 2 out of 23 (8.7%) had a PMH of asthma. Common allergens contributing to allergic ED included nickel (30.43%—7/23), followed by fragrance mix 1 (17.39%—4/23), textile dye mix (17.39%—4/23), fragrance mix 2 (8.69%—2/23), and methyl dibromo glutaronitrile (MDBGN) (8.69%—2/23) (see Table 1). This study highlights the importance of considering allergic contact dermatitis (ACD) in patients with ED.3 Notably, nickel, textile dye mix, metals, fragrances, and MDBGN have emerged as the primary allergens associated with ED linked to ACD within the Greek population. Metals ranked highest among allergens in our patients with ED, likely because eye cosmetics like eye shadow, eyeliner, eyebrow pencils, and mascara may contain significant amounts of nickel, cobalt, colophonium, or chromium, eliciting allergic reactions.4-7 Fragrances play a significant role in causing ED, whether applied directly through cosmetics or encountered through air fresheners like those used in essential oil diffusers.8 MDBGN serves as a biocide found in various consumer goods, particularly in cosmetics and skincare items. It gained popularity as a preservative for European cosmetic manufacturers due to its lower sensitizing potential in animal studies, especially when compared to isothiazolinones. However, there has been a noticeable increase in ACD cases associated with MDBGN in Europe. Consequently, the EU Commission has imposed a ban on the use of MDBGN in leave-on cosmetic products such as creams and lotions,9 and subsequently was also banned in rinse-off products, like liquid soaps and shampoos, based on the SCCP/0863/05 regulation.10 While not all instances of positive responses to metal allergens necessarily correlate with clinical significance in ED, it's advisable and rational to inquire whether the application of eye makeup exacerbates their symptoms. It's also sensible to assume that nearly all pigmented makeup items might contain traces of metal allergens. Our data are in accordance with previous studies on ED conducted in other countries.9 It will be interesting to observe whether rates of sensitization to metals and MDBGN in ED increase in Greece across various regions. Dimitra Koumaki: Conceptualization; methodology; supervision; data curation; writing – review and editing; writing – original draft; investigation. Stamatios Gregoriou: Formal analysis; supervision; validation; writing – review and editing; conceptualization; methodology. Alexander Katoulis: Conceptualization; software; supervision; validation; writing – review and editing. Konstantinos Krasagakis: Supervision; data curation; resources; formal analysis; methodology; writing – review and editing. No funding has supported this work. The authors declare no conflict of interest. This study was approved by the Ethical Committee of the University Hospital of Heraklion, Heraklion, Greece (Reference number 56/26-02-2020). The study followed the Helsinki Declaration of 1964 and its later amendments. All subjects provided informed consent to participate in the study. The patients in this manuscript have given written informed consent to the publication of their case details.

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