A 48-year-old white man routinely develops a reddish, bilateral, slightly papular rash on his lower eyelids. The rash resolves with OTC hydrocortisone but reappears. This has been happening for the past three months. Do you have any suggestions as to what it could be?—SHARI HEATHCOTT, FNP, Dyersburg, Tenn.
Recurrent skin lesions involving the periocular skin, including the eyelids, may represent a contact dermatitis (either allergic or irritant). The patient’s fingers are likely to be nonintentionally presenting the causative culprit to his eyelids. Nail polish, even in men, is a distinct possibility. Patch testing may be helpful to identify the etiologic allergen. Alternatively, if contact dermatitis is excluded, a punch biopsy of the skin lesion might be indicated to aid in establishing the diagnosis. —Philip R. Cohen, MD (133-6)