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Description
An otherwise healthy male infant presented to our hospital with persistent jaundice. He was exclusively breast fed, with adequate weight gain for his age. He was diagnosed with breast milk jaundice and was initiated on phototherapy due to a marked elevation of his total bilirubin level (total bilirubin of 25.7 mg/dL and direct bilirubin of 1.4 mg/dL). An eye shield was provided for eye protection. Phototherapy was discontinued the next day since his total bilirubin level decreased to 16.0 mg/dL. On removing his eye shield, rectangularly distributed rashes were observed in the area previously covered by the eye shield (figure 1). Because his rashes spontaneously disappeared after 2 days, he was diagnosed with contact dermatitis caused by an eye shield. No family history of atopic dermatitis was identified. Although we considered the use of dermatological tests, such as a patch test, to determine the causative agent of the rashes, we opted to avoid these tests to mitigate the risk of creating a new sensitisation. The patient’s parents also declined the use of such tests. We explained the need to reconsider dermatological tests to the parents in the case of reoccurring dermatitis.
Frontal (A) and lateral (B) views of rectangular-shaped rashes coincided with the area previously covered by the eye shield.
Phototherapy is a key treatment for unconjugated hyperbilirubinemia. During phototherapy, an eye shield is used to prevent retinal damage. Although several minor eye problems, such as conjunctivitis or purulent eye discharges,1 have been reported as adverse effects of eye shield use, contact dermatitis has never been reported as a complication.
The immature immunological system of infants makes allergic contact dermatitis a rare entity. In the majority of cases, contact dermatitis in infants develops due to external irritation, of which diaper dermatitis is the most common form.2 In our case, the material of the eye shield was a non-woven fabric composed of polyester, acrylic adhesive containing fatty acid polyester and gauze made of polyolefin, rayon and soft aluminium foil. We suspect that the rectangular-shaped gauze on the central part of the eye shield served as an irritant. Daily check-up of the ocular area should be performed for early detection of contact dermatitis during phototherapy.
The differential diagnosis of this case includes seborrhoeic dermatitis, erythema toxicum neonatorum, miliaria rubra and neonatal lupus.3 Although all these rashes can be treated conservatively, in neonatal lupus an underlying congenital heart block should be sought, which in severe cases may require cardiac pacing.4
Learning points
Eye shield used in phototherapy could cause contact dermatitis around the eyes.
Daily check-up of the ocular area should be performed for early detection of contact dermatitis during phototherapy.
Ethics statements
Patient consent for publication
Footnotes
Contributors YW and KI drafted the initial manuscript, and reviewed and revised the manuscript. YI and GY critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.