Common Causes of Eyelid Rash (Dermatitis)

The redness, irritation, and swelling of an eyelid rash may be due to an irritation (e.g., from makeup), an allergy, or skin conditions like eczema, psoriasis, and some autoimmune or immune-related disorders. Such skin irritation, no matter the cause, is referred to as eyelid dermatitis.

This article describes several of these causes of an eyelid rash, including what they look like and how they are treated.

Common Signs and Symptoms of an Eyelid Rash

The symptoms of an eyelid rash can vary by the underlying cause. Even so, there are characteristics common to all of these skin conditions.

Eight common symptoms of eyelid dermatitis include:

• A red rash, often along the rim of the eyelashes or on the eyelid itself
• Swelling of one or both eyelids
• Itching
• Burning, stinging, or pain
• Scaly or crusty skin
  
• Tearing and/or eye redness
• A sensation of grit in the eye
• Blistering
  

Contact Eyelid Dermatitis

Contact dermatitis is an itchy, red rash. It occurs when your skin comes into contact with an irritant or an allergen. This can be a chemical or other substance, but it can also be be something physical like excessive rubbing of the eyes or extreme heat, cold, or humidity.

This kind of eyelid rash is common in people who apply makeup to their eyes. Many cosmetics contain allergens such as quaternium-15, which releases the chemical formaldehyde.

Eye makeup with a green or blue color often contains nickel or cobalt. These are also common allergy triggers. Even certain applicators, like those used for mascara, may contain nickel.

Some other potential external irritants include:

• Hair products like shampoos, conditioners, hair dyes, and hairsprays
• Soaps and detergents
• Chlorine 
• Perfumes and fragrances
• Wool
• Dust

Some potential allergens can be found in certain personal care products or other things you encounter every day, such as:

• Pollen and dust mites
• Poison ivy, poison oak, or poison sumac
• Topical antibiotics
• Certain metals, such as nickel or gold
• Eyedrops, topical antibiotics, or contact lens solution
• False eyelashes
• Sunblock
• Food
  

Contact dermatitis can affect the upper and lower lids. It can occur on one or both sides of the face. The rash will usually be itchy, often with a dull burning sensation.

The rash itself will be red and scaly. In addition, it may cause the skin to become thick and leathery (referred to as lichenification).

Eczema (Atopic Eyelid Dermatitis)

Atopic dermatitis (eczema) is a common skin condition that leads to an itchy, scaly rash. It is commonly associated with asthma, hay fever (allergic rhinitis), and food allergies.

Allergens are not thought to cause atopic dermatitis, but they may worsen it. Some people notice that their eczema flares when exposed to environmental allergens like dust mites and pollen.

While eczema most often affects skin creases under the arms or behind the knees, it can develop anywhere on the body. Sometimes it develops on the eyelids alone.

Itchiness (pruritus) often accompanies the red, scaly rash. The itch can be very intense and is often described as maddening.

Due to the relentless itching and scratching, the skin of the eyelids will often look raw. There may even be visible hair loss from the eyelashes or eyebrows.

Seborrheic Eyelid Dermatitis

Seborrheic dermatitis (dandruff) causes the skin to become flaky and inflamed. It is most common on the scalp but can also affect other oily parts of the body. These might include the face, upper back, chest, and eyelids.

The cause is not entirely known, but this type of eyelid dermatitis is believed to be the result of either a fungus found in skin oil called Malassezia or an autoimmune disorder.

Autoimmune Causes

Other autoimmune diseases such as dermatomyositis and lupus can also cause an eyelid rash. These rashes have more symptoms than an allergy. They include weight loss, fever, fatigue, night sweats, muscle aches, and joint pains.

Diagnosing Eyelid Dermatitis

Your healthcare provider can diagnose eyelid dermatitis based on your symptoms and a physical examination of your eyes. A patch test can help determine if your symptoms are caused by an allergen.

A patch test involves having a suspected allergen placed on your skin and covered by a patch. This is to be left on for 48 hours to see if your skin reacts.

Healthcare providers that can diagnose and treat eyelid dermatitis include a primary healthcare provider or a specialist such as an allergist or dermatologist. 

Treating Eyelid Rash

Contact or atopic dermatitis are both commonly treated with topical creams or ointments. In addition, low-dose steroids are sometimes used for short periods of time.

A low-potency, over-the-counter hydrocortisone cream, such as Cortaid, may be used. However, you should only use this under the supervision of a doctor and for no longer than 10 days.

Two non-steroidal eczema creams, known as Elidel and Protopic, are safe on the eyelids. These can be applied twice daily until the rash is fully resolved.

Severe cases may require a low-dose oral corticosteroid, such as prednisone. This medication is usually prescribed for no longer than one to three weeks to help relieve symptoms.

Prevention

If your eyelid dermatitis has physical or external causes, you can prevent it by taking precautions to avoid them. For example:

• Avoid touching, scratching, or rubbing your eyes.
• Wear protective glasses or goggles if you're going to work in dusty conditions or outdoors in extreme temperatures.
• Avoid cosmetics and other personal care products with ingredients you're sensitive to.

Summary

Eyelid rashes are fairly common. They may be caused by an allergic reaction, eczema, fungus, or an autoimmune disease.

Since the skin on the eyelid is sensitive, you should always see a doctor for guidance on treating rashes on the eyelid. Treatments may include topical ointments and short-term corticosteroids.