Skip to main content
SpringerLink
Log in

Diagnostik und Therapie des Lidekzems

Eine interdisziplinäre Herausforderung

Diagnosis and treatment of eyelid eczema

An interdisciplinary challenge

  • Weiterbildung · Zertifizierte Fortbildung
  • Published:
Der Hautarzt Aims and scope Submit manuscript

Zusammenfassung

Lidekzeme sind eine klinisch-therapeutisch klar geschnittene, jedoch pathogenetisch heterogene Entität. Die anatomischen und funktionellen Gegebenheiten der Periorbitalregion erschweren ihre Behandlung. Dies macht sie—neben ihrer häufigen Therapieresistenz und Rezidivneigung—zu einer großen diagnostischen und therapeutischen Herausforderung für Haut- und Augenärzte. Auch ein vergleichsweise kleinflächiges Lidekzem kann aufgrund der belastenden Symptomatik und der hohen ästhetischen Bedeutung dieser Körperregion einen hohen Leidensdruck verursachen. Diese interdisziplinäre Übersichtsarbeit behandelt vor allem aktuelle pathogenetische und therapeutische Aspekte der Lidekzeme.

Abstract

Eyelid eczemas are clinically and therapeutically clearly delineated, but remain a pathogenetically heterogeneous entity. The anatomic and functional conditions in the periorbital region make treatment difficult. Thus, in addition to frequent resistance to therapy and a tendency to recur, they pose a considerable diagnostic and therapeutic challenge to dermatologists and ophthalmologists. Even a comparatively small area of eyelid eczema can cause substantial suffering because of the burdensome symptoms and high aesthetic significance of this body region. This interdisciplinary overview deals in particular with current pathogenetic and therapeutic aspects of eyelid eczemas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. Abelson MB, Gomes P, Crampton HJ et al. (2004) Efficacy and tolerability of ophthalmic epinastine assessed using the conjunctival antigen challenge model in patients with a history of allergic conjunctivitis. Clin Ther 26:35–47

    Article  PubMed  Google Scholar 

  2. Ayala F, Fabbrocini G, Bacchilega R et al. (2003) Eyelid dermatitis: an evaluation of 447 patients. Am J Contact Dermat 14:69–74

    PubMed  Google Scholar 

  3. Beetham WP (1940) Atopic cataracts. Arch Ophthalmol 24:21–37

    Google Scholar 

  4. Bornhövd E, Burgdorf WHC, Wollenberg A (2001) Macrolactam immunomodulators for topical treatment of inflammatory skin diseases. J Am Acad Dermatol 45:736–743

    Article  PubMed  Google Scholar 

  5. Bornhövd E, Wollenberg A (2003) Topische Immunmodulatoren zur Ekzembehandlung. Allergo J 12:456–462

    Google Scholar 

  6. Breuer K, Häussler S, Kapp A, Werfel T (2002) Staphylococcus aureus: colonizing features and influence of an antibacterial treatment in adults with atopic dermatitis. Br J Dermatol 147:55–61

    Article  CAS  PubMed  Google Scholar 

  7. Brewitt H (2001) Therapie der Keratokonjunktivitis sicca. In: Messmer EM (Hrsg) Diagnose und Therapie der Keratokonjunktivitis sicca. UNI-MED, Bremen, S 93–96

  8. Burton JL, Harrad RA (1998) The skin and the eyes. In: Champion RH, Burton JL, Burns DA, Breathnach SM (eds) Rook Wilkinson Ebling Textbook of Dermatology. Blackwell Science, Oxford, pp 2984

  9. Daecke CM, Schaller J, Goos M (1994) Der Stellenwert patienteneigener Testsubstanzen bei der Epikutantestung. Hautarzt 45:292–298

    Article  CAS  PubMed  Google Scholar 

  10. Darsow U, Ring J (2000) Airborne and dietary allergens in atopic eczema: a comprehensive review of diagnostic tests. Clin Exp Dermatol 25:544–551

    Article  CAS  PubMed  Google Scholar 

  11. Darsow U, Ring J (2003) Atopie-Patch-Test. Atopisches Ekzem und Allergie. Hautarzt 54:930–936

    Article  CAS  PubMed  Google Scholar 

  12. Darsow U, Vieluf D, Ring J (1999) Evaluating the relevance of aeroallergen sensitization in atopic eczema with the atopy patch test: a randomized, double-blind multicenter study. J Am Acad Dermatol 40:187–193

    CAS  PubMed  Google Scholar 

  13. Dogru M, Katakami C, Nakagawa N et al. (1998) Impression cytology in atopic dermatitis. Ophthalmology 105:1478–1484

    CAS  PubMed  Google Scholar 

  14. Dogru M, Nakagawa N, Tetsumoto K et al. (1999) Ocular surface disease in atopic dermatitis. Jpn J Ophthalmol 43:53–57

    Article  CAS  PubMed  Google Scholar 

  15. Foster CS, Calonge M (1990) Atopic keratoconjunctivitis. Ophthalmology 97:992–1000

    CAS  PubMed  Google Scholar 

  16. Frosch PJ, Weickel R, Schmitt T, Krastel H (1988) Nebenwirkungen von ophthalmologischen Externa. Z Hautkr 63:126,129–132,135–136

    CAS  PubMed  Google Scholar 

  17. Ganz M, Koll E, Gausche J et al. (2003) Ketotifen fumarate and olopatadine hydrochloride in the treatment of allergic conjunctivitis: a real-world comparison of efficacy and ocular comfort. Adv Ther 20:79–91

    CAS  PubMed  Google Scholar 

  18. Goh CL (1989) Eczema of the face, scalp and neck: an epidemiological comparison by site. J Dermatol 16:223–226

    CAS  PubMed  Google Scholar 

  19. Guin JD (2002) Eyelid dermatitis: experience in 203 cases. J Am Acad Dermatol 47:755–765

    Article  PubMed  Google Scholar 

  20. Guzmann A, Hernandez A, Climent A et al. (1996) Non-steroid antiinflammatory solutions as alternative on allergic conjunctivitis treatment. Invest Ophthalmol Vis Sci 37:S311

    Google Scholar 

  21. Hoang-Xuan T, Prisant O, Hannouche D, Robin H (1997) Systemic cyclosporine A in severe atopic keratoconjunctivitis. Ophthalmology 104:1300–1305

    CAS  PubMed  Google Scholar 

  22. Holsclaw DS, Whitcher JP, Wong IG, Margolis TP (1996) Supratarsal injektion of corticosteroid in the treatment of refractory vernal keratokonjunktivitis. Ophthalmology 121:243–249

    CAS  Google Scholar 

  23. Hutnik CM, Nichols BD (1998) Cataracts in systemic diseases and syndromes. Curr Opinion Ophthalmol 9:14–19

    CAS  Google Scholar 

  24. Katoh N, Murakami M, Yasuno H (1999) Eyelid dermatitis caused by delayed-type hypersensitivity to natural rubber latex. Contact Dermatitis 40:336–337

    CAS  PubMed  Google Scholar 

  25. Kerschenlohr K, Darsow U, Burgdorf WHC, Ring J, Wollenberg A (2004) Lessons of atopy patch testing in atopic dermatitis. Curr Allergy Asthma Rep, in press

  26. Kerschenlohr K, Decard S, Darsow U, Ollert M, Wollenberg A (2003) Clinical and immunologic reactivity to aeroallergens in „intrinsic“ atopic dermatitis patients. J Allergy Clin Immunol 111:195–197

    PubMed  Google Scholar 

  27. Kerschenlohr K, Schaller UC, Messmer EM, Wollenberg A (2003) Das Lidekzem—eine therapeutische Herausforderung. Ophthalmologe 100:240–251

    Article  CAS  PubMed  Google Scholar 

  28. Leiferman KM, Schroeter A, Kirschner M, Spelsberg TC (1983) Characterization of the glucocorticoid receptor in human skin. J Invest Dermatol 81:355–360

    CAS  PubMed  Google Scholar 

  29. Leonardi A, Abelson MB (2003) Double-masked, randomized, placebo-controlled clinical study of the mast cell-stabilizing effects of treatment with olopatadine in the conjunctival allergen challenge model in humans. Clin Ther 25:2539–2552

    Article  CAS  PubMed  Google Scholar 

  30. Mayer K, Reinhard T, Reis A, Böhringer D, Sundmacher R (2001) 0,1% FK 506-Salbe—Eine neue therapeutische Option bei der atopischen Blepharitis. Klinische Studie an 14 Patienten. Klin Monatsbl Augenheilkd 218:733–736

    Article  CAS  PubMed  Google Scholar 

  31. Messmer EM (1998) Steroid- und immunsuppressive Therapie in der Ophthalmologie. Nutzen und Risiko. In: Kampik A, Grehn F (Hrsg) Nutzen und Risiken augenärztlicher Therapie. Enke, Stuttgart, S 59–74

  32. Messmer EM, May CA, Stefani FH et al. (2002) Toxic eosinophil granule protein deposition in corneal ulcerations and scars associated with atopic keratoconjunctivitis. Am J Ophthalmol 134:816–821

    Article  CAS  PubMed  Google Scholar 

  33. Nethercott JR, Nield G, Holness DL (1989) A review of 79 cases of eyelid dermatitis. J Am Acad Dermatol 21:223–230

    CAS  PubMed  Google Scholar 

  34. Ockenfels HM, Seemann U, Goos M (1997) Contact allergy in patients with periorbital eczema: an analysis of allergens. Dermatology 195:119–124

    CAS  PubMed  Google Scholar 

  35. Queille-Roussel C, Paul C, Duteil L et al. (2001) The new topical ascomycin derivative SDZ ASM 981 does not induce skin atrophy when applied to normal skin for 4 weeks: a randomized, double-blind controlled study. Br J Dermatol 144:507–513

    Article  CAS  PubMed  Google Scholar 

  36. Reinhard T, Ruzicka T, Sundmacher R (1999) Pathogenese, Klinik und Therapie der Augenbeteiligung bei Atopie. Ophthalmologe 96:473–488

    Article  CAS  PubMed  Google Scholar 

  37. Reitamo S, Rissanen J, Remitz A et al. (1998) Tacrolimus ointment does not affect collagen synthesis: results of a single-center randomized trial. J Invest Dermatol 111:396–398

    Google Scholar 

  38. Rikkers SM, Holland GN, Drayton GE et al. (2003) Topical tacrolimus treatment of atopic eyelid disease. Am J Ophthalmol 135:297–302

    Article  CAS  PubMed  Google Scholar 

  39. Ring J (1988) Angewandte Allergologie. MMV Medizin, München

  40. Roat MI, Ohji M, Hunt LE, Thoft RA (1993) Conjunctival epithelial cell hypermitosis and goblet cell hyperplasia in atopic keratoconjunctivitis. Am J Ophthalmol 116:456–463

    CAS  PubMed  Google Scholar 

  41. Sall K, Stevenson OD, Mundorf TK, Reis BL (2000) Two multicenter, randomized studies of the effficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3 Study Group. Ophthalmology 107:631–639

    CAS  PubMed  Google Scholar 

  42. Schlotmann K, Goerz G, Straube AM, Schürer NY (1996) In-loco-Epikutantestung bei Verdacht auf allergisches Lidekzem. Allergologie 19:103

    Google Scholar 

  43. Sher MA (1979) Contact dermatitis of the eyelids. S Afr Med J 55:511–513

    CAS  PubMed  Google Scholar 

  44. Sowden JM, Berth-Jones J, Ross JS et al. (1991) Double-blind, controlled, crossover study of cyclosporin in adults with severe refractory atopic dermatitis. Lancet 338:137–140

    Article  CAS  PubMed  Google Scholar 

  45. Svensson A, Moller H (1986) Eyelid dermatitis: the role of atopy and contact allergy. Contact Dermatitis 15:178–182

    CAS  PubMed  Google Scholar 

  46. Trocme SD, Kephart GM, Bourne WM et al. (1993) Eosinophil granule major basic protein deposition in corneal ulcers associated with vernal keratoconjunctivitis. Am J Ophthalmol 115:640–643

    CAS  PubMed  Google Scholar 

  47. Turjanmaa K, Alenius H, Reunala T, Palosuo T (2002) Recent developments in latex allergy. Curr Opin Allergy Clin Immunol 2:407–412

    Article  PubMed  Google Scholar 

  48. Valsecchi R, Imberti G, Martino D, Cainelli T (1992) Eyelid dermatitis: an evaluation of 150 patients. Contact Dermatitis 27:143–147

    CAS  PubMed  Google Scholar 

  49. Wilkinson JD, Shaw S (1998) Contact dermatitis: allergic. In: Champion RH, Burton JL, Burns DA, Breathnach SM (eds) Rook Wilkinson Ebling Textbook of Dermatology. Blackwell Science, Oxford, pp 756–757

  50. Wollenberg A, Bieber T (2000) Atopic dermatitis: from the genes to skin lesions. Allergy 55:205–213

    Article  CAS  PubMed  Google Scholar 

  51. Wollenberg A, Wagner M, Günther S et al. (2002) Plasmacytoid dendritic cells: a new cutaneous dendritic cell subset with distinct role in inflammatory skin diseases. J Invest Dermatol 119:1096–1102

    Google Scholar 

  52. Wollenberg A, Wetzel S, Burgdorf WHC, Haas J (2003) Viral infections in atopic dermatitis: pathogenic aspects and clinical management. J Allergy Clin Immunol 112:667–674

    Article  PubMed  Google Scholar 

  53. Wollenberg A, Zoch C, Wetzel S et al. (2003) Predisposing factors and clinical features of eczema herpeticum—a retrospective analysis of 100 cases. J Am Acad Dermatol 49:198–205

    Article  PubMed  Google Scholar 

  54. Yokoi K, Yokoi N, Kinoshita S (1998) Impairment of ocular surface epithelium barrier function in patients with atopic dermatitis. Br J Ophthalmol 82:797–800

    CAS  PubMed  Google Scholar 

Download references

Danksagung

Frau Dr. med. Elke C. Bornhövd sei für die kritische Durchsicht des Manuskripts gedankt.

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München

    A. Wollenberg, K. Kerschenlohr & T. Pavicic

  2. Augenklinik, Klinikum der Ludwig-Maximilians-Universität, München

    E. M. Messmer

  3. Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, Frauenlobstraße 9–11, 80337 , München

    A. Wollenberg

Authors
  1. A. Wollenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Kerschenlohr
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Pavicic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. M. Messmer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Wollenberg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wollenberg, A., Kerschenlohr, K., Pavicic, T. et al. Diagnostik und Therapie des Lidekzems. Hautarzt 55, 677–688 (2004). https://doi.org/10.1007/s00105-004-0759-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00105-004-0759-7

Schlüsselwörter

Keywords

Search

Navigation