One or more creases along the lower eyelid that start at the medial canthus and progress outwards and slightly further down from the eyelid margin. There may be one or more of such lines and when they are occur in the presence of atopic dermatitis, they are called Dennie-Morgan lines. 

Dennie-Morgan lines are usually seen in children when they develop atopic dermatitis and can be seen soon after birth. Dr Charles C. Dennie used to teach that these lines are usually retained throughout life. They become more prominent when patients have active atopic dermatitis. 

Dennie-Morgan lines are seen in patients with atopic dermatitis which may present as eczema, allergic rhinitis or chronic sinusitis. The lines are often associated with lower eyelid skin thickening due to chronic oedema. They are also often associated with "allergic shiners" which are dark circles under the eyes which are caused by venous stasis. "Allergic shiners" are seen in about 60% of atopic patients. 

Dr Charles Clayton Dennie (1883 - 1971) was a prominent dermatologist who practiced in Kansas City, Mo. He was an accomplished raconteur, who was popularly known as "Uncle Charlie" to sudents and colleagues alike. His special interest was congenital syphilis about which he published extensively. He used to teach his students that the lines one sees below the eyelids were typically seen in patients with atopic dermatitis. Although he never published this himself, one of his colleagues, Dr. David B. Morgan (1911 - 2001), also a Kansas City dermatologist, published this teaching in a brief report in 1948, entitled "A suggestive sign of Allergy" and explained that this was the teaching of Dr. Charles C. Dennie. Thereafter, these lines have been called either "Dennie lines", or "Dennie-Morgan lines or folds".

Dennie's Solution used for the treatment of keratoses
Dennie-Morgan lines
Dennie-Mafan syndrome: spastic paraplegia of the lower limbs and mental retardation in children with congenital syphilis which he described in 1929. The same syndrome was described by the French doctor, Antoine Marfan in 1936 and is therefore known as the Dennie-Marfan syndrome.
Syphilis acquired and heredosyphilis published in 1928
A History of Syphilis published in 1962

Chronic allergic changes or eczema result in collagen breakdown secondary to inflammation and chronic irritation, resulting in localized edema and folds or grooves. These are different from the normal aging changes which produce lower eyelid wrinkles, usually after mid-30s. Patients who have flare-ups into adulthood will have the thickening and folds and grooves affecting the lower eyelids as adults. These patients have skin that is sensitive and will be easily irritated and react to external chemicals. 

Treatment of the underlying atopic dermatitis is vital. As the skin is sensitive to many products, dermatologists will order patch testing to determine the products that should be avoided. The aim is to reduce the inflammation and the irritation. It is best to avoid all products when the inflammation is active. Most dermatologists suggest the use of emollients like CeraVe moisterizing cream. Ceramides are often incorporated in such moisterizers and help to replenish the lack of the natural ceramides (oils) that our skin produces normally. The second important component is hyaluronic acid (HA), which also occurs naturally in human skin cells. HA hydrates and plumps skin. The addition of ceramides and HA allows the skin to "plump" and hydrate. CeraVe does not contain paraffins, parabens and oils. 

It is best to avoid all makeup and other lotions and potions when the dermatitis is active. Even ingredients that one is not allergic to can cause an increase in the inflammation because of the defective skin barrier in the presence of inflammation. We always take the "cold turkey" approach by stopping all topical creams, lotions and ointments and only introducing emollients gradually. 

​Vaseline and Aquaphor are also useful as they allow retention of hydration. Aveeno parabens lotion and cetaphil lotion are also hypoallergenic and useful for atopic dermatitis. Eucerin Urea Repair Rich Replenishing face cream is is also useful for dry, scaly skin.    

A weak topical anti-inflammatory like a weak steroid like Desonide or Desowen 0.05% cream may be needed to reduce the inflammation. 

A number of treatments may help improve the texture and tone of the skin with the use of chemical peels, fractionated resurfacing lasers, and hyaluronic acid fillers. It is important to ensure that the inflammation is controlled before instituting these treatments. For finer lines laterally, botulinum toxin (Botox, Dysport, etc) can be useful. 

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​Botox has become one of the most popular cosmetics treatments sought in the USA. Although the term "Botox" is widely used, the products used are varied and include Botox, Dysport, Myobloc, Xeomin, Jeuveua and others. Cosmetically, any of these products are used for one or more of the following reasons:

• frown lines between brows ("elevenses")
• frown line across the bridge of the nose
• smile lines
• forehead lines
• crow's feet
• bunny lines
• raise the corner of the mouth (improve the "frowny" mouth)
• improve the jawline (the vampire lift)
• improve neck platysma bands
• make subtle changes in the position of the upper and lower eyelids
• improving the fullness caused by the masseter muscles (round face to oval face change)

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​Common questions we are asked are:

• "what is the right age to start?"
• "am I too young to start with botox?"
• "should I have started earlier?"
• "am I too far gone with my wrinkles to benefit from botox?"
• "will the botox get rid of all my lines?"
• "why do I have to keep on repeating the injections of botox?"

A more recent development is the use of Botox as a preventative measure to decrease the development of wrinkles and lines. Here are all the answers to all your questions about botox and preventative botox in Salt Lake City and St. George, Utah.