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Skin Ulceration of Eyelids in Atopic Dermatitis
Kim David Plattner1, Markus Tschopp2, Margarita G Todorova1
1Department of Ophthalmology, University of Basel, Basel, Switzerland.
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.
Insights
Superinfected atopic dermatitis can cause severe eyelid ulcerations. Prompt antibiotic therapy and ophthalmologic evaluation are crucial for managing this condition and preventing complications.
Area of Science:
- Ophthalmology
- Dermatology
- Infectious Diseases
Background:
- Atopic dermatitis (AD) commonly involves skin barrier dysfunction leading to superinfections.
- Eyelid involvement with ulceration in AD superinfection is infrequently documented.
Observation:
- A case series of three male patients presenting with progressive eyelid ulcerations, crusting, and purulent discharge.
- Standard ophthalmologic examinations, including neuro-ophthalmological assessment, were performed.
- Skin swabs were collected for microbiological analysis.
Findings:
- Neuro-ophthalmological and posterior segment examinations were normal in all cases.
- Microbiological analysis identified Streptococcus pyogenes, Staphylococcus epidermidis, and Staphylococcus aureus.
- Antibiotic therapy was initiated based on culture results.
Implications:
- Superinfected AD can manifest as extensive eyelid ulcerations requiring prompt intervention.
- Comprehensive ophthalmologic and neuro-ophthalmological evaluation is essential to rule out orbital involvement.
- Worsening symptoms necessitate dermatological referral for optimal management.
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