Which cream helps flaky skin from dermatitis on the face?

Which type of dermatitis are you treating?

Dermatitis means skin inflammation and includes several conditions, including atopic, contact and seborrheic dermatitis. The moisturizer advice here mainly covers atopic dermatitis, contact dermatitis and asteatotic eczema, a type caused by moisture loss. The treatment beyond moisturizer depends on the type.3

Atopic dermatitis causes itchy, dry, inflamed skin and can begin at any age. Contact dermatitis develops when skin reacts to an irritant or something you are allergic to. Asteatotic eczema causes dry, itchy, cracked patches and can affect the face. Flaking alone cannot tell you which condition you have: a clinician examines the skin and sometimes uses tests to distinguish dermatitis from other causes of a rash.1234

Should you choose a cream, ointment or lotion?

For very dry asteatotic eczema, choose a greasy cream or ointment with a high oil content rather than a watery lotion. The greasy texture helps retain moisture, although it is unlikely to win an award for disappearing politely.4

What should be in the cream?

Look for a short ingredient list that combines moisture attracting ingredients with ingredients that soften skin and reduce water loss. Ceramides help restore the skin barrier, the outer protection that keeps moisture in. Glycerin and hyaluronic acid attract water. Petrolatum, mineral oil and dimethicone help seal moisture in. Colloidal oatmeal can also soothe eczema.5

Choose a gentle product intended for sensitive skin, without fragrance or dyes. Lipids, meaning fats, and ceramides are useful ingredients for supporting the barrier. A moisturizing cream and a prescribed medicated cream have different jobs: the moisturizer supports dry skin, while the medicine treats symptoms such as inflammation. Keep using moisturizer alongside prescribed treatment rather than treating the two as interchangeable.34

Which ingredients should you avoid?

Avoid fragrance and essential oils in eczema products. Botanical ingredients can cause allergic contact dermatitis, and lanolin can become an allergen. Olive oil can damage the skin barrier and worsen eczema. Sodium lauryl sulfate can cause stinging, itching and redness. Moisture attracting ingredients used alone can sting, especially glycolic and lactic acids; a formulated eczema cream combines them with more soothing ingredients.5

How to apply cream to a flaky face

1. 1Wash with a gentle cleanser rather than harsh soap. Use warm water, not hot water.
2. 2Gently dry the face, leaving the skin slightly moist, and apply moisturizer immediately.
3. 3Smooth moisturizer onto the skin rather than rubbing it in. For contact dermatitis, smooth in the direction the hair grows.
4. 4For dry patches needing more protection, lightly apply petroleum jelly over the cream to hold moisture in. An ointment is already occlusive, meaning it seals moisture in.

For very dry contact dermatitis, apply moisturizer two to four times daily, or as your doctor directs. Morning and evening can anchor the routine, with another application when needed during the day. For asteatotic eczema, moisturize daily and reapply as needed. Continue moisturizing between flares rather than stopping as soon as the flakes disappear.24

Petroleum jelly holds existing moisture in rather than adding water by itself, so it works over moist skin or moisturizer. Its job is to keep moisture from leaving, not to give the bathroom shelf another complicated assignment.5

When do you need a medicated cream?

Persistent soreness, itching or inflammation deserves treatment advice rather than repeated moisturizer changes. For contact dermatitis, clinicians choose steroid strength according to severity and location; thinner skin on the face generally needs a weaker steroid. Use the prescribed amount and duration. Stronger steroids and larger amounts increase the risk of side effects, including skin thinning.2

For contact dermatitis treated with a topical corticosteroid, apply emollient first and wait around 30 minutes before the steroid, unless your clinician gives different instructions. Other prescribed creams can have different layering directions, so ask which goes first. Do not assume every treatment belongs under the same moisturizer.24

Adults with atopic dermatitis have several effective topical treatment options. Corticosteroids reduce itching and inflammation. Calcineurin inhibitors, medicines such as pimecrolimus cream and tacrolimus ointment, reduce inflammation, itching and flares. Crisaborole ointment and ruxolitinib cream are other options; ruxolitinib is used for short term treatment of mild to moderate atopic dermatitis.6

What improvement should you expect?

Moisturizers relieve dry, cracked skin in atopic dermatitis, decrease inflammation and help reduce flare severity and lengthen the time between flares. They are an ongoing part of treatment, not just something to use when the face looks flaky.6

Asteatotic eczema can take a couple of weeks to rehydrate and heal. A prescribed corticosteroid for contact dermatitis usually starts having an effect within a few days. Atopic dermatitis is a long lasting condition with no current cure, but treatment can ease symptoms and lead to clearer skin. Even after a rash clears, the skin can remain easily irritated.124

What if the cream keeps failing?

Look for an ongoing trigger as well as a better moisturizer. Makeup, skincare products, soaps and detergents can trigger eczema. Scratching can break the skin and create painful sores. Note what you applied before symptoms worsened, and bring that history to your appointment. Treatment can include medicines as well as skincare; a cream cannot replace avoiding a known irritant or allergen.37

If a moisturizer irritates your skin, stop using it and ask a pharmacist about an alternative. Arrange medical advice if home moisturizers are not helping or prescribed treatment is not improving symptoms. Seek prompt care for pain, swelling, fluid or pus leaking from sores, fever or chills, which can indicate infection.24