A red papular rash on the eyelids

Case history

A 28-year-old woman presented with a five-month history of a red papular rash on and around the eyelids of her left eye (Figure). She described a burning irritation rather than itch. She was not atopic. The rash did not settle by changing and then stopping using her facial cosmetics. Initially she had had partial relief from 1% hydrocortisone cream, but this soon stopped. For the next three months she had applied 0.1% mometasone furoate cream daily, which cleared the rash at first. Continued use of mometasone furoate helped partially, but the rash kept recurring whenever it was ceased.