Spectacle Frame Induced Irritant Contact Dermatitis
Allergic contact dermatitis due to spectacle frames is not common. But, irritant contact dermatitis is not very common. We report such a case.
20-year-old young female patient, a spectacle wearer complained of irritation and itching over the cheeks of the two weeks duration. Examination of the face showed bilateral skin lesions just above the cheeks where the spectacle frame rested. The lesion was crescentic in shape, measuring 3.8 cms x 1.2 cms in its widest part [Figure 1a and 1b]. There was erythema, oedema, oozing of serous discharge along with scaling. She has been wearing the same spectacle frame for the past 8 years. The spectacle frame was plastic in nature (cellulose acetate). She was advised to discontinue the spectacle and was prescribed corticosteriod antibiotic ointment (betamethosone dipropionate 0.025% and neomycin sulphate 0.5%) twice a day over the lesion.
Spectacle frames are broadly classified into two groups1- metallic and plastic. Allergic contact dermatitis (ACD) represent an immunological interaction between a chemical allergen and the skin being a sensitized host.1 Pruritis is the hallmark of ACD. Diagnosis is made by patch test. Review of literature shows among the metals, nickel is the most common agent causing ACD.2 Irritant type of contact dermatitis (ICD) is a non immunological reaction by excessive moisture or by acid, alkali or chemicals capable of injuring the skin if persistent contact is allowed. Pruritus develops along with hyperkeratosis and fissuring of the skin. The diagnosis is made clinically on history and negative patch test.3
Our case was unique. Heavy spectacles due to thick glasses, sub-tropical climate and facial features of high cheek bones were the contributing factors. The fact that the frame was 8 years old ruled out the possibility of ACD. However, the patch test was not done as the patient was reluctant to undergo the test.
1. Dahl MV. Chronic irritant contact dermatitis: Mechanisms, variables and differentiation from other forms of contact dermatitis Adv Dermatol. 1988;3:261
2. Grimali F, Romaguera C. Nickel allergy and spectacle frame contact aene Contact Dermatitis. 1978;4:377
© 2005 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow
3. Friedlander MH. Eczematoid reactions of the skin Ophthalmol Clin North Am. 1992;5:195–202