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Klin Monbl Augenheilkd 2018; 235(04): 445-447
DOI: 10.1055/s-0044-101011
Kasuistik
Georg Thieme Verlag KG Stuttgart · New York

Skin Ulceration of Eyelids in Atopic Dermatitis

Hautulzerationen der Augenlider bei atopischer Dermatitis
Kim David Plattner
1   Department of Ophthalmology, University of Basel, Basel, Switzerland
,
Markus Tschopp
2   Department of Ophthalmology, Cantonal Hospital Aarau, Aarau, Switzerland
,
Margarita G. Todorova
1   Department of Ophthalmology, University of Basel, Basel, Switzerland
› Author Affiliations
Further Information

Publication History

received 20 September 2017

accepted 03 January 2018

Publication Date:
28 March 2018 (online)

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Abstract

Background Superinfection of atopic dermatitis due to a disturbed skin barrier is well known. Still, affected eyelids with ulceration are rarely described. We present a case series of three patients in different stages of upper eyelid superinfection.

History and Signs Three males aged 58, 37, and 52 years with clinical symptomatology of gradual expansion of eyelid ulcerations, crusts, and pus were evaluated. In all cases a standard ophthalmologic examination, including a detailed neuro-ophthalmological status, was performed. Consequently, a skin swab was obtained.

Therapy and Outcome The completed neuro-ophthalmological status and posterior segment findings were unremarkable in all patients. The skin swab results confirmed the presence of Streptococcus pyogenes, Staphylococcus epidermidis, and Staphylococcus aureus, thus necessitating antibiotic therapy.

Conclusions Superinfected atopic dermatitis can develop massive ulcerations, indicating a swap and empiric therapy. A complete neuro-ophthalmological status is mandatory to exclude the possibility of orbital involvement. Nevertheless, any paradoxical worsening of symptomatology indicates further referral to a dermatologist.

Zusammenfassung

Hintergrund Superinfektionen der atopischen Dermatitis aufgrund einer gestörten Hautbarriere sind bekannt. Betroffene Augenlider mit Ulzerationen sind jedoch selten beschrieben. Wir präsentieren 3 Patienten in unterschiedlichen Infektionsstadien der Augenlider.

Anamnese Drei Männer im Alter von 58, 37 und 52 Jahren mit unterschiedlich ausgeprägten Ulzerationen, Krusten und Eiter an den Augenlidern wurden evaluiert. In allen Fällen wurde eine standardisierte ophthalmologische Untersuchung inklusive eines neuroophthalmologischen Status sowie eines Hautabstrichs durchgeführt.

Therapie und Verlauf Der neuroophthalmologische Status und die hinteren Augenabschnitte waren bei allen Patienten unauffällig. Der Hautabstrich zeigte eine Infektion mit S. pyogenes, S. epidermidis respektive S. aureus, weshalb eine lokale und teils systemische Therapie gestartet wurde.

Schlussfolgerungen Superinfizierte atopische Dermatitis kann massive Ulzerationen entwickeln, weshalb ein Hautabstrich sowie eine empirische Therapie wichtig sind. Ein neuroophthalmologischer Status ist obligatorisch, um eine orbitale Mitbeteiligung auszuschließen. Paradoxe Verschlechterungen sollten dem Dermatologen vorgestellt werden.

Key words

lids - infectious diseases - atopic dermatitis - ulceration

Schlüsselwörter

Lider - Infektiologie - atopische Dermatitis - Ulzeration
 

  • References

  • 1 Williams H, Flohr C. How epidemiology has challenged 3 prevailing concepts about atopic dermatitis. J Allergy Clin Immunol 2006; 118: 209-213
    CrossrefPubMedGoogle Scholar
  • 2 Gupta J, Grube E, Ericksen MB. et al. Intrinsically defective skin barrier function in children with atopic dermatitis correlates with disease severity. J Allergy Clin Immunol 2008; 121: 725-730
    CrossrefPubMedGoogle Scholar
  • 3 Sun D, Ong PY. Infectious complications in atopic dermatitis. Immunol Allergy Clin North Am 2017; 37: 75-93
    CrossrefPubMedGoogle Scholar
  • 4 Ozkan J, Zhu H, Gabriel M. et al. Effect of prophylactic antibiotic drops on ocular microbiota and physiology during silicone hydrogel lens wear. Optom Vis Sci 2012; 89: 326-335
    CrossrefPubMedGoogle Scholar
  • 5 Sankaridurg PR, Markoulli M, de la Jara PL. et al. Lid and conjunctival micro biota during contact lens wear in children. Optom Vis Sci 2009; 86: 312-317
    CrossrefPubMedGoogle Scholar
  • 6 Huber-Spitzy V, Böhler-Sommeregger K, Arocker-Mettinger E. et al. Ulcerative blepharitis in atopic patients – is Candida species the causative agent?. Br J Ophthalmol 1992; 76: 272-274
    CrossrefPubMedGoogle Scholar
  • 7 Nakata K, Inoue Y, Harada J. et al. A high incidence of Staphylococcus aureus colonization in the external eyes of patients with atopic dermatitis. Ophthalmology 2000; 107: 2167-2171
    CrossrefPubMedGoogle Scholar
  • 8 Wollenberg A, Oranje A, Deleuran M. et al. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. J Eur Acad Dermatol Venereol 2016; 30: 729-747
    CrossrefPubMedGoogle Scholar
  • 9 Thyssen JP, Toft PB, Halling-Overgaard AS. et al. Incidence, prevalence, and risk of selected ocular disease in adults with atopic dermatitis. J Am Acad Dermatol 2017; 77: 280-286
    CrossrefPubMedGoogle Scholar
  • 10 Kothari N, Young RC, Read SP. et al. Retinal detachment associated with atopic dermatitis. Ophthalmic Surg Lasers Imaging Retina 2017; 48: 513-517
    CrossrefPubMedGoogle Scholar