Ocular Microbiology and Immunology Group
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2012 OMIG Abstract 12

Chronic Eyelid Dermatis Secondary to Cocamidopropyl Betaine Allergy in a Patient Using Baby Shampoo Lid Scrubs
J.D. Welling, T.F. Mauger, A.J. Hendershot
Havener Eye Institute, The Ohio State University Medical Center, Columbus, OH

Purpose: The purpose of this report is to highlight the allergenicity of cocamidopropyl betaine (CAPB), its presence in many products which may contact the eye - including a commonly prescribed baby shampoo lid scrub - and to suggest diagnostic and management strategies which may be helpful when eyelid contact allergy is suspected.

Methods:  Case report with systematic review of the literature

Results:  A 52 y/o female was referred to our department with ten years of recalcitrant blepharitis, conjunctivitis and periorbital dermatitis despite multiple topical and oral therapeutic regimens, including multiple oral steroid tapers. Conjunctival cultures were negative and conjunctival biopsies showed only non-specific inflammation and keratinization. The patient was referred to dermatology for patch testing, which revealed an allergic response to amidoamine (AA) and 3-(dimethylamino)propylamine (DMAPA), two impurities related to CAPB, a common surfactant used in many cosmetic and personal care products. The patient was found to be using two products which contain cocamidopropyl betaine: her hair shampoo and the Johnson & Johnson’s baby shampoo which she had used as a daily eyelid scrub for years. In fact, CAPB was found to be the second leading ingredient in this particular baby shampoo product. The patient discontinued all products containing cocamidopropyl betaine (and was started on topical tacrolimus 2% to eyelids twice daily) and experienced rapid, significant improvement. Our review found that CAPB-related contact dermatitis, including eyelid dermatitis, is well-documented in the dermatology literature. However, despite widespread use of this surfactant in many cosmetic and self-care products, including some commonly prescribed by ophthalmologists for eyelid hygiene, we found no mention of this allergen in the ophthalmic literature. To our knowledge this is the first reported case of CAPB-related eyelid dermatitis in a patient using Johnson & Johnson’s baby shampoo lid scrubs and the first case of CAPB-related eyelid dermatitis in the ophthalmic literature.

Conclusions: Clinicians should be aware of the allergenic potential of CAPB-containing products, including a baby shampoo commonly prescribed lid scrubs. Patients suspected of contact allergy-related eyelid dermatitis should undergo patch testing for CAPB-related allergens. Positive patch tests should be followed by a comprehensive review of the patient’s cosmetic and self-care products, with discontinuation of all which contain identified allergens. Co-management with dermatology may be helpful.

Disclosure: N

2012 Agenda and Abstracts | < Previous | Next >