Someone help

[SamK7]

Hello. My seven-year-old brother has an eczema around his eye and I can't figure out what it is specifically it is nor I can find a cause. Other than that, he doesn't have eczema elsewhere (except mild dyshidrosis on his hands). Here are the photos, so I'd appreciate if someone could suggest what type of eczema this can be:

http://img98.imageshack.us/img98/5325/dsc06549c.jpg
http://img692.imageshack.us/img692/866/dsc06550.jpg

We used steroids to treat this (Triderm, specifically, though really carefully, since it's the eye area and I'm afraid of side effects) - it does vanish but after some time, it returns again. Visited a few dermatologists so far but they said nothing useful - or, well, to be more precise, they said it was atopic dermatitis but it just doesn't seem like one to me, and to be frank, I don't have much confidence in local dermatologists since I myself have been misdiagnozed twice by them. Though, we surely will visit another one as soon as we get the chance.

Thanks.

  



This discussion is related to Red Bumps on the penis glans.

[Bhupinder Kaur, MD]

Hello,
Some of the factors that are known to affect or aggravate eczema are air-borne allergens, certain foods, skin irritants, and stress. Any fever does not necessarily aggravate eczema directly but can indirectly aggravate it being a stressful condition for the body. Moreover for eczema, one type of treatment is not sufficient. A combination os treatments has to be followed to control the symptoms. Take care and regards.

[SamK7]

Here's another info that may be of some use. He got ill last night and had a fever - and the eczema around his eye worsen drastically. It's totally red and he didn't scratch even once. I can take a photo if needed.

Moreover, I remember that the first time this eczema appeared, he was also ill with a fever (I think it was flu back then, not sure). It just never crossed my mind that these two things could be linked in the first place. Is there any sense in this?

[Simpleman74]

This doctor is a very good one. I been reading his replies on other dermatology issues and posts as well. And he is very good. There is one on here "no names mentioned" that isn't so good. Actually he can't even hold a candle to this one here. We are all lucky to have this Doctor here.  Thanks for being here Doc! Hats off to you!

[SamK7]

I thought of it too. I was looking for some images of seborrhea and it looked somewhat similar (but then again, all eczema are similar), so we'll definitely have to do those medical tests to differ this type. Thanks a lot.

[Bhupinder Kaur, MD]

Hello,
The other possibility that I has thought of was seborrheic dermatitis since the site involved is common for both eczema and seborrheic dermatitis and they closely resemble each other in physical appearance but the lesions of seborrheic dermatitis usually presents as yellow, flaky lesions. A biopsy skin and allergy tests can differentiate between the two and confirm the diagnosis.

It is very difficult to comment precisely beyond this stage. Do let me know if there are any additional doubts. Kind regards.

[SamK7]

Thanks for the reply, both of you.

I've thought before about this being a delayed reaction to an allergen and it honestly seems the most plausible to me, so yes, an allergy test is the way to go.

Like I said, the only other skin issue he's recently had was a mild dyshidrosis on his had which is gone by now. However, skin problems, especially atopic dermatitis, do run in our family but he doesn't have it - though, a few years ago, he had a typical eczema on his hands and legs but it didn't last for too long, and ever since then, it never appeared again. But now, this stuff around his eye is the only skin issue he has. Also, sometimes it will expand to his other eye (milder though) and under his ear but it's lesser there.

It doesn't itch anywhere else and he says that the area around his eye doesn't itch either. Or rather, rarely.  

Could this be Seborrheic Dermatitis?

[Bhupinder Kaur, MD]

Hello,
I completely agree with the dermatologists as it indeed looks like atopic dermatitis to me. Eczema is a type of atopic dermatitis and causes red, itchy, dry lesions. What you can do is consult an allergist and get skin allergy tests and patch tests/ blood tests like RAST done to confirm the allergens which are causing this atopic dermatitis. Prevention of these allergens is the best treatment then. In addition, you can apply calamine lotion and a mild steroid cream on the rash. Eczema is aggravated by dryness. So please keep the area moisturized.
If the symptoms are severe then more patent steroids may be needed. I sincerely hope it helps. Take care and please do keep me posted in case you have any additional doubts. Kind regards.

[Simpleman74]

That is not eczema.
eczema does not start or remain just on the eye. Especially one eye.
Two things that can are herpes of the eye.
And More likely because of no big swelling, Allergic reaction. ACD Allergic contact dermatitis. A delayed reaction to an allergen.
or maybe something else. I need to know more. Does he get skin issues any place else. If yes describe.
Does he ever itch a lot anyplace? Or at certain times. More at night?  And for now
Check this link.   Copy and paste it in your browser and hit enter. Then scroll down and flip through pages after. And remember. As the skin dies, it flakes. And he could have eczema AND this! And is why it is so dry.
http://www.dermnet.com/Allergic-Contact-Dermatitis/photos/14