Eczema on the face and neck

What does face and neck eczema look like?

Atopic eczema, also called atopic dermatitis, causes itchy, dry skin that can crack, scale or thicken. Depending on skin tone, patches can look red, purple, grey, white, lighter or darker than surrounding skin. Symptoms come and go in flares. Facial eczema is especially common in babies and toddlers.3

Eczema can affect the cheeks, chin, eyelids and neck. Longstanding facial or neck eczema can develop lichenification, meaning thickened skin with more obvious creases, and hyperpigmentation, meaning darker patches. Neck folds can show particularly noticeable redness.4

A new facial rash needs a diagnosis, not just an eczema cream. Contact dermatitis is another type of eczema. A clinician examines the skin and asks when symptoms began, where they appear, what improves or worsens them, and whether relatives have eczema, asthma or hay fever. Write these details down before your appointment. Occasionally, a small skin sample is needed to confirm the diagnosis.15

How should you care for it each day?

1. 1Wash with an emollient, a moisturizing treatment, instead of soap.
2. 2Apply moisturizer at least twice daily and continue when the skin improves. Morning and evening are practical ways to fit this in.
3. 3Apply prescribed flare treatment to affected patches, following your treatment plan.
4. 4Use a pump or clean spoon for moisturizer pots, rather than your fingers. Do not share emollients.

Moisturizers help protect skin from irritants. Ointments stay on the surface and are generally preferred for dry eczema; creams contain more substances that can irritate. Choice also depends on preference and cost, not which jar looks most qualified to run a spa. Avoid aqueous cream, which can irritate eczema.56

Ointments moisturize more effectively, but creams are often preferred during the day. A cream can win the daytime popularity contest without being the better moisturizer. In children, regular emollient use reduces the amount of topical steroid needed, but emollients do not replace prescribed treatment for inflammation.7

What should you avoid?

Common triggers include skincare products, fragrance, perfume, harsh detergents, wool, hot or cold weather and stress. Notice what repeatedly worsens your eczema and avoid identified triggers; some people never find a specific one. Keep cool, keep nails short and avoid scratching. Do not cut foods out of your diet unless a doctor advises it, including when breastfeeding a baby with eczema.13

Emollient residue on clothing, bedding and dressings makes those fabrics catch fire more easily. Avoid smoking and naked flames when using emollients.3

Can you use steroid cream on your face or neck?

Yes, when the strength and course are appropriate. Topical corticosteroids reduce inflammation and itch. Adults generally use mild or moderate steroids on the face; stronger treatments need specific medical direction. For children's face and neck eczema, do not choose moderate or potent steroids yourself. Hydrocortisone 1% ointment is a common mild option for childhood eczema.26

1. 1Wash your hands before applying the steroid.
2. 2Measure the prescribed amount. One fingertip unit is a line from the last finger crease to the fingertip, about 0.5 grams.
3. 3Apply a thin, glistening layer to affected skin in the direction of hair growth, without rubbing it in.
4. 4Wash your hands afterwards. Keep moisturizer and steroid applications separate; where practical, apply moisturizer 30 minutes before the steroid.

These fingertip amounts cover the entire face and neck, not a small patch. Children's quantities are measured on an adult finger. Use the amount specified in the child's treatment plan.27

Children's treatment plans can use steroids once daily during flares, then two or three times weekly for maintenance. Facial treatment can require a reduction in strength as directed. Frequency differs between prescriptions, so follow your own plan rather than copying another person's schedule. A child's maintenance plan can continue until skin has been completely clear for 14 days, with treatment restarted if eczema returns, as directed.7

What should you expect from treatment?

Atopic eczema cannot currently be cured, but treatment can control symptoms, reduce flares and lower infection risk. Steroid treatment can relieve symptoms quickly. If steroids fail or are unsuitable, a dermatologist can consider tacrolimus ointment or pimecrolimus cream, medicines called topical calcineurin inhibitors. Persistent eczema can require other prescription creams, supervised light treatment or medicines that work throughout the body.1

In children, treatment stopping working does not mean the skin has become used to it. Infection or a reaction to the preparation needs consideration. Antihistamines do not reduce eczema itch and are of little use for that purpose. If a cream starts causing stinging together with increasing redness, stop applying it and seek medical advice about a possible allergy.6

Brief stinging or burning from a topical steroid can settle within a few days. Correct use carries a low risk of side effects. Strong steroids used for long periods on the face increase skin thinning risk and can cause an acne like rash. Course length depends on severity, strength and location; ask the prescriber how to stop or reduce treatment.2

If you are pregnant or breastfeeding, discuss topical steroid use with your doctor or specialist nurse. These medicines have been used by many pregnant and breastfeeding women without evidence of harmful effects, but safety information remains limited.2

When do you need medical help?

Get urgent medical help for blistering, crusting, leaking fluid, pus, pain, swelling, warmth, rapid spread or sudden worsening. Fever or feeling unwell also needs urgent assessment. These can signal infection or eczema herpeticum, a serious infection. Arrange a routine appointment if the diagnosis is uncertain or treatment is not helping.5

Infected childhood eczema needs treatment for both the infection and the eczema; antibiotics alone do not restore the skin barrier or manage the flare. Suspected herpes infection near the eye requires urgent eye specialist review. Severe eczema, or moderate childhood eczema that fails to respond to the prescribed treatment plan, needs specialist assessment.7