Dennie–Morgan fold

Dennie–Morgan fold is a distinctive physical sign often associated with atopic dermatitis (AD), also known as eczema. It manifests as a prominent crease or fold under the lower eyelid. The presence of Dennie–Morgan folds is considered a minor diagnostic criterion for atopic dermatitis, particularly in children. This feature is named after Charles Clayton Dennie and Douglas Morgan, who first described it in the mid-20th century.

Etiology and Pathogenesis

The exact cause of Dennie–Morgan folds is not fully understood, but they are closely linked to the chronic inflammatory process of atopic dermatitis. Inflammation and edema in the tissues around the eyes, as part of the allergic response, are thought to contribute to the development of these folds. Genetic predisposition and environmental factors that exacerbate atopic dermatitis may also play a role in the formation of Dennie–Morgan folds.

Clinical Presentation

Dennie–Morgan folds appear as an additional crease or line below the lower eyelid, parallel to and slightly below the eyelid margin. These folds may be unilateral or bilateral and vary in prominence among individuals. While Dennie–Morgan folds are most commonly associated with atopic dermatitis, they can also be seen in individuals with other atopic conditions, such as allergic rhinitis and asthma.

Diagnosis

The diagnosis of Dennie–Morgan fold is primarily clinical, based on physical examination. Its presence supports the diagnosis of atopic dermatitis, especially in ambiguous cases. However, Dennie–Morgan folds alone are not diagnostic of atopic dermatitis, as they can occur in other atopic conditions. A comprehensive medical history and examination are necessary to differentiate between these conditions.

Management

Management of Dennie–Morgan folds involves treating the underlying atopic dermatitis. This may include the use of moisturizers, topical corticosteroids, and other anti-inflammatory medications to reduce skin inflammation and edema. Addressing environmental factors and allergens that trigger atopic dermatitis flare-ups is also crucial. In some cases, specific treatment for eye-related symptoms, such as mild topical steroids or calcineurin inhibitors, may be recommended under close medical supervision.

Prognosis

The prognosis for individuals with Dennie–Morgan folds is generally good, especially with effective management of atopic dermatitis. While the folds themselves do not cause harm, they can be a cosmetic concern for some individuals. With appropriate treatment of the underlying condition, the prominence of Dennie–Morgan folds may decrease.

See Also

• Atopic dermatitis
• Allergic rhinitis
• Asthma