What are Dennie-Morgan lines and how do you treat them?

definition of dennie-morgan lines

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. 

At what age are dennie-morgan lines seen?

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. 

Photographs from the original 1948 paper in the Archives of Dermatology and Syphilology by Dr. David B Morgan showing the Dennie-Morgan lines in a young child and in an adult, both with atopic dermatitis

What are dennie-morgan lines associated with?

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. 

Dennie-Morgan lines present together with an "allergic shiner" which is the dark circle affecting the lower eyelid caused by venous stasis and chronic inflammation with hyperpigmentation and thickening of the skin

why are these lines called "dennie-morgan" lines?

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".

Charles Clayton Dennie photographed in his office at the Kansas University School of Medicine where he served as head of dermatology from 1939 - 1949

Other contributions of Charles C Dennie

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

A history of Syphilis by Charles Clayton Dennie published in 1962

How are Dennie-Morgan lines different from normal aging lines?

Dennie-Morgan lines with surrounding thickening of the skin, edema and discoloration in a young adult

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. 

Dennie Morgan lines in an adult together with thickening of the surrounding skin and darkening of the skin by chronic inflammation and venous stasis

How do you treat Dennie-Morgan lines in adults?

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. 

Dennie-Morgan lines in adolescence with skin thickening and parallel creases and folds

What can be done to my wrinkles once the inflammation causing the Dennie-Morgan lines is controlled?

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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