Q A client of mine gets a persistent rash on her eyelids. She thinks it might be an allergy of some sort, but doesn’t know exactly what. I suggested it might be the makeup she uses, but she says several different brands have been tried and she hasn’t been able to pin down the product that causes the problem. Do you have any suggestions?

A As your client suspects, the rash on her eyelids is probably caused by an allergy to something that is getting on this sensitive skin area. Finding out what she is allergic to may be quite difficult. She may have become suddenly allergic to something she has used for years without any problem, or she could have become allergic to something new. The rash will not clear up unless the thing she is allergic to is completely eliminated.

If your client takes her problem to a dermatologist, she will be asked to avoid a long list of items for at least two weeks. Included in the list will be eye drops or ointments, eye makeup, mascara, liner, shadow, moisturizers, makeup removers, eyelash curlers, and artificial lashes.

Aerosol sprays, at home or at work — used by your client or by someone else in the room — may be the source of the trouble. These include garden sprays, bug sprays, room deodorizer spray, Lysol spray, cologne, underarm deodorant spray, depilatory spray, breath spray, hair spray, oven cleaner, and furniture polish.

Chemical substances that get on the hands and fingers and are then accidentally rubbed onto the eyelids might include nail polish, nail glue, polish remover, cuticle remover, household cleaning products, car polishes, cleaning solutions, oils and varnishes, glues and paints.

If the eyelid rash continues or returns after all the above have been eliminated, patients will be asked to stop all face cosmetics (makeup, liquids, powders, creams, blush, lipstick, etc.), all perfumes or colognes (used by the patient or their significant other, on any part of the body), all hair treatments (dyes, conditioners, setting lotions, etc.), and all detergents and fabric softeners used on pillowcases or towels (which should be washed only in Ivory, and rinsed well).

I would add to this list of no-noes anything else that the patient herself can possibly think of that might come into contact with the eyelids.

If, after the two week period, the rash on the eyelids is cleared up (and has remained clear without the use of medicine), patients have to start each discontinued item anew. They may restart them in any order, but may only go back to one discontinued product every three days. In this way, each product is tested individually (either by applying a small amount of the product on a small area inside one arm each day for a couple of days, or by just using the product in the normal way), to see whether it causes the rash to return.