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Background: Periorbital allergic contact dermatitis is a rare disease and the main differential diagnoses are atopic and seborrhoeic dermatitis. The diagnosis is based on clinical appearance, patient history and patch testing. Current systematic overviews on contact allergens involved are lacking and with changes in medical preparations, new relevant antigens may emerge., Patients and Methods: Based on the systematic data of the information network of dermatological clinics (IVDK), patch test reactions in 48,969 patients tested between 1996 and 2000 were evaluated. A total of 763 patients suffered from periorbital dermatitis which was suspected to be due to the use of topical medication., Results: The most common epidermal sensitizations in the general population were observed against nickel and fragrances. In the periorbital dermatitis group, sensitization against local anaesthetics and antibiotics was more frequent than in the general population., Conclusions: In three patients, oxybuprocain was identified as the causative agent, which has not yet been recognized as a common allergen.

Background: Phenylephrine and pseudoephedrine are sympathomimetic drugs belonging to the phenylamine family. Adverse cutaneous effects associated with these drugs have been reported but, in view of their frequent use, appear to be rare. The very close chemical structures of these drugs could explain potential cross-reactions among them but the results reported in the literature are controversial., Case Report: An 18-year-old woman developed blepharoconjunctivitis after application of phenylephrine and tropicamide eye drops. Four years after this reaction, she took 1 tablet of Narine (pseudoephedrine and loratadine) and 3-4 hours later developed a generalized erythrodermic reaction. Cutaneous biopsy revealed hydropic changes in the basal layer and, in the dermis, moderate edema with slight perivascular lymphocyte and eosinophil infiltrates. Patch tests with European standard series, commercial eye drops, tropicamide, phenylephrine, pseudoephedrine and other sympathomimetic agents were applied to the patient's back. After 47 and 96 hours, only the patches with pseudoephedrine and phenylephrine were positive., Conclusions: We believe that our patient has presented two different reactions with different clinical outcome and histopathology, which are unlikely to be due to cross-reactivity between the drugs involved. We have found no similar coincidences reported int the literature.

A 64-year-old female patient developed periorbital eczema after eye treatment with a corticoid ointment. Epicutaneous tests with the effective component as well as with other ingredients of the ointment and suspected substances revealed a delayed hypersensitivity to prednisolone-21-trimethyl acetate, neomycin, cobalt, and cetyl alcohol. We did not observe any cross-reactions to other corticoids, not even to the closely related prednisolone-21-monoacetate. To the best of our knowledge, allergic contact dermatitis to prednisolone-21-trimethyl acetate has not been described in the literature so far.

A case is described in which, following local application of glaucoma eye drops containing Levobunolol, a recurring allergic contact eczema with periocular localisation occurred. In the course of the epicutaneous allergy testing a positive reaction (crescendo-type) could be clearly demonstrated experimentally against both the eye drops and their active ingredient, levobunolol-hydrochloride, a beta-blocker (beta-sympatholyticum) out of the class of the aryloxypropylamines.