Allergic contact dermatitis is a common cause of eyelid dermatitis.
Objective:
To identify the most common clinically relevant allergens and characterize personal product exposures in patients with eyelid dermatitis presenting for patch testing.
Methods:
Retrospective study of 245 patients with eyelid dermatitis patch tested over a 5-year period. Reported data include demographics, history of atopy, and patch test reaction prevalence and relevance, including reactions to personal care products.
Results:
8.83% of patch-tested patients in our clinic presented with primary eyelid dermatitis (+/− head/neck involvement). Carmine, cetrimonium chloride, cocamidopropyl betaine-related surfactants (dimethylaminopropylamine, oleamidopropyl dimethylamine, and amidoamine), preservatives (methylisothiazolinone and formaldehyde), fragrances (Balsam of Peru and linalool), and nickel were the top 10 clinically relevant allergens. Shampoos and make-up were the most common personal products demonstrating reactions. Topical and ocular medicaments, acrylates, hairdressing chemicals, salicylates, and ultraviolet light filters were rare but relevant allergens.
Conclusions:
Patch testing continues to play an essential role in the diagnosis and management of eyelid dermatitis. Testing supplemental series as well as direct testing of patients’ products is critical for the detection of clinically relevant allergens.
HuangCX, YianniasJA, KillianJM, et al.Seven common allergen groups causing eyelid dermatitis: Education and avoidance strategies. Clin Ophthalmol. 2021;15:1477–1490; doi: 10.2147/OPTH.S297754
3.
LandeckL, SchalockPC, BadenLA, et al.Periorbital contact sensitization. Am J Ophthalmol. 2010;150(3):366–370.e2; doi: 10.1016/j.ajo.2010.03.026
4.
WarshawEM, BuonomoM, DeKovenJG, et al.Importance of supplemental patch testing beyond a screening series for patients with dermatitis: The North American Contact Dermatitis Group experience. JAMA Dermatol. 2021;157(12):1456–1465; doi: 10.1001/jamadermatol.2021.4314
5.
GlassLRD, AakaluVK, FosterJA, et al.Patch testing for eyelid dermatitis: A report by the American Academy of Ophthalmology. Ophthalmology. 2025;132(7):842–847; doi: 10.1016/j.ophtha.2025.01.019
6.
StingeniL, FotiC, GuarneriF, SIDAPA Study Group. et al.Contact allergy to SIDAPA baseline series allergens in patients with eyelid dermatitis: An Italian multicentre study. Contact Dermatitis. 2024;90(5):479–485; doi: 10.1111/cod.14507
7.
LandeckL, JohnSM, GeierJ. Periorbital dermatitis in 4779 patients—patch test results during a 10-year period. Contact Dermatitis. 2014;70(4):205–212; doi: 10.1111/cod.12157
8.
VeverkaKK, DavisMDP. Dubiously doubtful: An exploration of the literature concerning doubtful, macular erythema, “?+,” and “+/−” patch test reactions. Dermatitis. 2020;31(1):36–41; doi: 10.1097/DER.0000000000000533
9.
WarshawEM, VollerLM, MaibachHI, et al.Eyelid dermatitis in patients referred for patch testing: Retrospective analysis of North American Contact Dermatitis Group data, 1994-2016. J Am Acad Dermatol. 2021;84(4):953–964; doi: 10.1016/j.jaad.2020.07.020
10.
MoreauL, SassevilleD. Allergic contact dermatitis from cocamidopropyl betaine, cocamidoamine, 3-(Dimethylamino)propylamine, and oleamidopropyl dimethylamine: Co-reactions or cross-reactions? Dermatitis. 2004;15(3):146–149; doi: 10.2310/derm.1.2004.2020
11.
KimD, SeokJK, KimM, et al.Safety assessment of cocamidopropyl betaine, a cosmetic ingredient. Toxicol Res. 2024;40(3):361–375; doi: 10.1007/s43188-024-00243-2
12.
OkekeCAV, KhannaR, EhrlichA. Quaternary ammonium compounds and contact dermatitis: A review and considerations during the COVID-19 pandemic. Clin Cosmet Investig Dermatol. 2023;16:1721–1728; doi: 10.2147/CCID.S410910
13.
ReederMJ, NihalA, AravamuthanSR, et al.Allergic or not: Final interpretation of doubtful patch test reactions from the North American Contact Dermatitis Group, 2019–2020. Dermatitis. 2024;35(2):138–143; doi: 10.1089/derm.2023.0285
14.
GoldsteinMH, SilvaFQ, BlenderN, et al.Ocular benzalkonium chloride exposure: Problems and solutions. Eye (Lond). 2022;36(2):361–368; doi: 10.1038/s41433-021-01668-x
15.
ShawDW. Allergic contact dermatitis from carmine. Dermatitis. 2009;20(5):292–295; doi: 10.2310/6620.2009.09025
16.
SuzukiK, FutamuraK, SatoN, et al.Contact urticaria caused by carmine-containing eyeshadows; the causative allergen is carminic acid rather than CC38K. Contact Dermatitis. 2021;84(6):468–469; doi: 10.1111/cod.13769
17.
ShawT, OostmanH, RaineyD, et al.A rare eyelid dermatitis allergen: Shellac in a popular mascara. DERM. 2009;20(6):341–345; doi: 10.2310/6620.2009.09009
18.
Le CozCJ, LeclereJM, ArnoultE, Members of Revidal-Gerda. et al.Allergic contact dermatitis from shellac in mascara. Contact Dermatitis. 2002;46(3):149–152; doi: 10.1034/j.1600-0536.2002.460304.x
19.
GalloR, MarroI, PavesiA. Allergic contact dermatitis from shellac in mascara. Contact Dermatitis. 2005;53(4):238; doi: 10.1111/j.0105-1873.2005.0670f.x
20.
HanJ, WarshawEM. Allergic contact cheilitis due to candelilla wax. Dermatitis. ®2023;34(6):548–550; doi: 10.1089/derm.2023.0062
21.
ChowdhuryMMU. Allergic contact dermatitis from prime yellow carnauba wax and coathylene in mascara. Contact Dermatitis. 2002;46(4):244; doi: 10.1034/j.1600-0536.2002.460414.x
22.
SchwensenJF, UterW, BruzeM, European Environmental Contact Dermatitis Research Group. et al.The epidemic of methylisothiazolinone: A European prospective study. Contact Dermatitis. 2017;76(5):272–279; doi: 10.1111/cod.12733
23.
GoossensA. Contact allergic reactions on the eyes and eyelids. Bull Société Belge Ophtalmol. 2004;292:11–17.
24.
SainioEL, Henriks-EckermanML, KanervaL. Colophony, formaldehyde and mercury in mascaras. Contact Dermatitis. 1996;34(5):364–365; doi: 10.1111/j.1600-0536.1996.tb02225.x
25.
AertsO, SmeetsJ, AdriaenssensK, et al.Contact allergy to biguanides might explain cases of unresolved eyelid dermatitis. J Eur Acad Dermatol Venereol. 2015;29(10):2064–2065; doi: 10.1111/jdv.12598
26.
WeberB, KarelsS, OphaugS. Micellar water mayhem: A new source of biguanide-related allergic contact dermatitis. Dermatitis. 2025; doi: 10.1177/17103568251379880
27.
Pastor-NietoMA, González-MuñozP, Pérez-MesoneroR, et al.Allergic contact dermatitis caused by poly(hexamethylene) biguanide hydrochloride in contact lens care solutions. Contact Dermatitis. 2017;76(6):373–376; doi: 10.1111/cod.12730
28.
LeysenJ, GoossensA, LambertJ, et al.Polyhexamethylene biguanide is a relevant sensitizer in wet wipes. Contact Dermatitis. 2014;70(5):323–325; doi: 10.1111/cod.12208
HettiaratchiCB, KennedyH. Allergens in ophthalmic medicaments in New Zealand. Australas J Dermatol. 2025;66(1):14–20; doi: 10.1111/ajd.14395
31.
EllisFA. Allergic contact dermatitis due to wool fat and cholesterol. Arch Derm Syphilol. 1947;56(6):801–806; doi: 10.1001/archderm.1947.01520120089009
32.
HigginsCL, NixonRL. Periorbital allergic contact dermatitis caused by lanolin in a lubricating eye ointment. Australas J Dermatol. 2016;57(1):68–69; doi: 10.1111/ajd.12426
33.
EiermannHJ, LarsenW, MaibachHI, et al.Prospective study of cosmetic reactions: 1977–1980. J Am Acad Dermatol. 1982;6(5):909–917; doi: 10.1016/S0190-9622(82)70080-5
34.
FlemingCJ, BurdenAD, ForsythA. The genetics of allergic contact hypersensitivity to nickel. Contact Dermatitis. 1999;41(5):251–253; doi: 10.1111/j.1600-0536.1999.tb06155.x
35.
RigaliS, LiszewskiW. Allergic contact dermatitis to nickel in Japanese eyeglasses. Dermatitis. 2025;36(1):81–82; doi: 10.1089/derm.2024.0023
36.
OhJE, LeeHJ, ChoiYW, et al.Metal allergy in eyelid dermatitis and the evaluation of metal contents in eye shadows. J Eur Acad Dermatol Venereol. 2016;30(9):1518–1521; doi: 10.1111/jdv.13646
37.
TravassosAR, BruzeM, DahlinJ, et al.Allergic contact dermatitis caused by nickel in a green eye pencil. Contact Dermatitis. 2011;65(5):307–308; doi: 10.1111/j.1600-0536.2011.01960.x
38.
WangX, HedbergYS, OdnevallI. Presence of impurities of nickel and cobalt in facial cosmetic pigments and their dissolution into artificial sweat. Contact Dermatitis. 2022;87(6):550–553; doi: 10.1111/cod.14212
39.
LodénM, NilssonG, ParvardehM, et al.No skin reactions to mineral powders in nickel-sensitive subjects. Contact Dermatitis. 2012;66(4):210–214; doi: 10.1111/j.1600-0536.2012.02040.x
40.
NedorostS, WagmanA. Positive patch-test reactions to gold: Patients’ perception of relevance and the role of titanium dioxide in cosmetics. Dermat Contact Atopic Occup Drug. 2005;16(2):67–70.
41.
HouleMC, DeKovenJG, AtwaterAR, et al.North American Contact Dermatitis Group patch test results: 2021–2022. Dermatitis. 2025;36(5):464–476; doi: 10.1089/derm.2024.0474
YangB, SundquistB, PashaM. OR111 Determining the clinical relevance of positive patch testing to gold. Ann Allergy Asthma Immunol. 2017;119(5):S14; doi: 10.1016/j.anai.2017.08.028
44.
AndersenKE, JensenCD. Long-lasting patch reactions to gold sodium thiosulfate occurs frequently in healthy volunteers. Contact Dermatitis. 2007;56(4):214–217.
45.
QureshiAA, AwosikaO, NelsonK, et al.Retrospective review of insurance coverage for patch testing. Ann Allergy Asthma Immunol. 2019;122(5):508–512; doi: 10.1016/j.anai.2019.02.012
46.
De GrootA. Allergic contact dermatitis from topical drugs: An overview. Dermatitis. 2021;32(4):197–213; doi: 10.1097/DER.0000000000000737
47.
OkerekeUR, CohenDE. The utility of chamber scarification in the detection of allergic contact dermatitis to ophthalmic solutions. Dermatitis. 2014;25(6):373–374; doi: 10.1097/DER.0000000000000076
48.
SandlerM, RodriguezI, AdlerBL, et al.Eyelid dermatitis: Common patterns and contact allergens. Cutis. 2024;114(4):104–108.
49.
LeeK, KrausC, SmithJ. What lengths for a lash? Int J Dermatol. 2018;57(12):1538–1539; doi: 10.1111/ijd.14226
50.
MoreiraJ, GonçalvesR, CoelhoP, et al.Eyelid dermatitis caused by allergic contact to acrylates in artificial nails. Dermatol Reports. 2017;9(1):7198; doi: 10.4081/dr.2017.7198
MenanteauM, Bensefa-ColasL, CrepyMN. First case of pustular eyelid allergic contact dermatitis to methacrylates in artificial nails. Contact Dermatitis. 2025;92(3):241–243; doi: 10.1111/cod.14717
53.
KarimM, KleinEJ, NohriaA, et al.Potential for allergic contact dermatitis in popular hair care practices and ingredients. Dermatitis. 2023;34(6):484–491; doi: 10.1089/derm.2023.0045
54.
D’ErmeAM, AgnolettiAF, MilanesiN, et al.Eyelid contact dermatitis caused by unusual allergens in hair dye: The importance of testing with additional series. Int J Dermatology. 2014;53(2):e108–e109; doi: 10.1111/j.1365-4632.2012.05613.x
55.
TeixeiraM, De WachterL, RonsynE, et al.Contact allergy to para-phenylenediamine in a permanent eyelash dye. Contact Dermatitis.2006;55(2):92–94; doi: 10.1111/j.0105-1873.2006.00883.x
56.
LapczynskiA, McGintyD, JonesL, et al.Fragrance material review on benzyl salicylate. Food Chem Toxicol. 2007;45(Suppl 1):S362–S380; doi: 10.1016/j.fct.2007.09.036
57.
ShawDW. Allergic contact dermatitis from octisalate and cis-3-hexenyl salicylate. Dermatitis. 2006;17(3):152–155; doi: 10.2310/6620.2006.05046
58.
BrumleyC, AroraP, NeeleyA, et al.Allergic contact dermatitis to salicylic acid: A case series of relevant sensitization. Contact Dermatitis. 2024;91(2):133–138; doi: 10.1111/cod.14573
59.
WarshawEM, WangMZ, MaibachHI, et al.Patch test reactions associated with sunscreen products and the importance of testing to an expanded series: Retrospective analysis of North American Contact Dermatitis Group data, 2001 to 2010. Dermatitis. 2013;24(4):176–182; doi: 10.1097/DER.0b013e3182983845
60.
NedorostST. Facial erythema as a result of benzophenone allergy. J Am Acad Dermatol.2003;49(5 Suppl):S259–S261.
61.
KimSY, KimMH, ChoiHY, et al.A case of photoallergic contact dermatitis due to benzophenone-3. Korean J Dermatol. 2004;42(3):328–331.
