Eczema on the face and lips

What does facial and lip eczema look like?

Eczema, also called dermatitis, describes several types of skin inflammation. Atopic dermatitis is the most common type and affects adults as well as children. Facial eczema is particularly common in babies and toddlers. Affected skin can be dry, itchy, cracked, scaly or thickened. Depending on skin tone, patches can look red, purple, grey, white, or lighter or darker than surrounding skin. Redness is not the only sign to watch for.13

Lip eczema is called eczematous cheilitis, meaning inflammation of the lips. It can affect either lip or both and extend onto the surrounding skin. Dryness, itching, scaling, soreness and painful cracks are common. Eczema is not contagious. However, not every lip rash is eczema: irritation at the mouth corners can be angular cheilitis, often linked to yeast or fungal infection, and some infectious forms of lip inflammation are contagious.23

What causes it to flare?

Eczema is likely linked to both genetic and environmental factors. A personal or family history of eczema, asthma or hay fever increases the likelihood of atopic eczema. Some people have an impaired skin barrier, the outer layer that helps retain water and resist irritants. Excessive washing can dry skin and trigger flares. Perfumed cosmetics, soap, temperature changes and stress can also aggravate eczema. Hormonal changes during pregnancy can make it worse.134

On the lips, triggers include licking, biting or sucking, along with irritants or allergens in lipstick, lip balm, toothpaste and mouthwash. Contact allergy and atopic eczema can both cause lip dermatitis. A clinician can review the products you use and arrange allergy testing, including patch testing, when a particular substance is suspected. A rash around the mouth can also develop from frequent lip licking, especially in children.25

How to care for your face each day

An emollient is a moisturizing treatment, not a separate ritual that needs its own shelf. Regular use helps control itching and reduces the need for topical steroids, which are medicines applied to the skin to reduce inflammation.167

1. 1Wash with an emollient soap substitute rather than ordinary soap. Avoid excessive washing.
2. 2Apply moisturizer after washing while the skin is still moist. Repeat at least twice daily and more often as needed; adult eczema care can involve three to four applications a day.
3. 3Use any prescribed flare treatment as directed for the face. Moisturizer can go before or after a topical steroid; there is no established best order or waiting interval.
4. 4Continue moisturizing when the rash improves. Use a pump or clean spoon to remove product from a pot, rather than your fingers, and do not share emollients.

Lotions, creams and ointments are different formats, not three ranks in a skincare promotion ladder. Ointments suit very dry, thick or scaly areas but can feel greasy. Light emollients are an option for adolescent and adult facial eczema because heavier products can provoke acne or dermatitis around the mouth. Some creams and lotions irritate because of added preservatives or fragrances.46

Avoid aqueous cream because it can aggravate eczema. Keep cool and keep nails short to limit damage from scratching. Emollient residue on clothing, bedding or dressings makes those fabrics catch fire more easily, so avoid smoking and naked flames. Do not remove foods from your diet without medical advice, including when breastfeeding a baby with eczema.1

What should you put on your lips?

Petroleum jelly or an unscented, hypoallergenic moisturizer can soothe dry, cracked lips. Leave out cosmetics containing fragrances or dyes, and stop licking, biting, sucking or picking. Choose toothpaste and mouthwash without alcohol or harsh antiseptics. Very salty or spicy foods can aggravate sore lips.2

Lip care belongs in the daily routine, rather than being a seasonal department. Apply balm or ointment on waking, whenever the lips feel dry, after eating or drinking, and before bed. A thicker ointment helps retain moisture overnight. Outdoors, use a lip product with SPF 30 or higher and reapply about every two hours. A humidifier can help when indoor air is dry.5

Avoid chapped lip products containing menthol, eucalyptus, camphor, lanolin, fragrances or flavorings. Stop using a balm if it stings, burns or tingles. Lips have no oil glands and are more sensitive than much of the rest of the skin, so a product intended for lips still needs to be tolerable on sore lips.5

Can you use steroid cream on your face or lips?

When moisturizers alone do not control eczema, a clinician can choose a topical steroid matched to the affected area and severity. Facial treatment generally uses lower potency steroids, such as hydrocortisone. Lip eczema can also need a prescribed steroid ointment. Tacrolimus or pimecrolimus are prescription alternatives for facial or eyelid eczema that does not respond to lower potency steroids. They do not cause skin thinning, but can cause warmth, burning or itching, especially during the first week.246

Do not use mometasone, also called Elocon, on your face unless a doctor specifically tells you to. If prescribed for the face, use it for no more than five days and keep it away from the eyes and eyelids. Prolonged use can thin the skin. If you have used mometasone for a long time, ask your doctor how to reduce it rather than changing treatment yourself. Tell your doctor if symptoms worsen during use.7

How long does it take to improve?

Ordinary chapped lips usually recover in two to three weeks with regular care, although severe chapping takes longer. Lip eczema is different: it tends to be chronic, with clear periods followed by flares. Atopic eczema has no cure, but treatment can reduce symptoms and flare frequency. Children often improve as they get older. If facial eczema remains uncontrolled, treatment needs reassessment rather than simply more moisturizer.1256

When should you get medical help?

Arrange an appointment for suspected eczema or treatment that is not helping. For persistent lip irritation, seek assessment if it does not settle within a few days, particularly with severe open or bleeding sores. Ordinary chapping that worsens or remains unimproved after a few weeks also needs checking. A clinician can distinguish eczema from contact allergy, infection or another cause.125

• Get urgent medical assessment if eczema develops blisters, crusting, leaking fluid or pus, becomes painful, swollen or warm, suddenly spreads, or comes with fever or feeling unwell. These can signal infection, including eczema herpeticum, a serious infection associated with herpes simplex.
• Contact a healthcare provider for hives or swelling around the face, lips or eyes.
• Call emergency services immediately for trouble breathing or swallowing, which can signal anaphylaxis, a life threatening allergic reaction.