Eczema on the face in kids

What does facial eczema look like?

Atopic dermatitis, often called eczema, causes dry, itchy, inflamed skin. Babies commonly develop dry, rough patches on the cheeks. Babies who cannot scratch often rub affected areas instead. During a flare, skin can weep, crust or blister; with repeated rubbing, patches can become thickened, scaly or cracked. In darker skin, inflammation can look purple rather than red, and lighter or darker patches can remain after inflammation.3

Eczema is not contagious. Itchy raised bumps can develop after scratching, and scratched bumps can leak fluid and crust. However, raw sores around the nose or mouth with thick yellowish brown crust can be impetigo, a contagious bacterial infection that needs treatment. A rash caused by something touching the face can be contact dermatitis. Appearance alone is not enough to choose a treatment.2

How do you care for eczema on a child's face?

The same gentle washing and moisturizing principles used for childhood eczema apply to facial care. Use the child's prescribed plan for medicines, especially near the eyes.1

1. 1Wash gently with warm, not hot, water. Use a mild, fragrance free cleanser only where needed. For bathing, limit time in the water to 5 to 10 minutes and avoid bubble bath.
2. 2Pat the skin partly dry rather than rubbing. If applying medicine after bathing, let the skin become almost dry first.
3. 3Apply the prescribed medicine to the areas your clinician has identified, using the amount and frequency in the treatment plan. Keep steroid and moisturizer applications about 30 minutes apart, following the order your clinician gives you.
4. 4Apply moisturizer gently without vigorous rubbing. Use moisturizer at least twice daily and more often when the skin needs it.

Which moisturizer should you use?

A thick cream or ointment is a useful starting point for dry eczema. Fragrance free petroleum jelly works well for many children. Trying different moisturizers can help you find a suitable one, but the bathroom does not need to become a product showroom. Ointments hold moisture well; a less greasy cream can be easier before school, with a thicker product at night. Moisturizers support the skin barrier and can reduce the need for topical steroids.15

Frequent application matters more than applying a thick layer. For a tub, use a clean spoon or spatula to transfer a small amount onto a saucer rather than dipping fingers into the container. Discard any leftover portion rather than returning it to the tub. Keep supplies available when you are away from home so treatment does not get interrupted.456

Can children use steroid cream on the face?

Yes, when the strength, amount and duration are chosen for the child and the facial area. Topical corticosteroids are medicines applied to skin to reduce inflammation. Hydrocortisone 1% is one mild option used in children's facial treatment plans. Potent and very potent steroids are rarely used on faces. Do not borrow another person's prescription or use a body treatment on the face without checking.456

A flare treatment can involve once daily steroid application, followed by less frequent maintenance treatment when prescribed. The right schedule depends on severity and the medicine. Ask the clinician to show you the amount: a vague instruction to apply cream thinly can lead to too little treatment. A written treatment plan keeps each cream's job clear, rather than asking a row of tubes to explain themselves.45

For facial or eyelid eczema, a clinician can consider medicines called topical calcineurin inhibitors, such as pimecrolimus or tacrolimus. These reduce inflammation and can be used for maintenance; skin thinning is less of a concern than with steroids. Their strength and schedule need prescribing instructions. They are generally not suitable for acutely infected eczema.57

What can make facial eczema worse?

Overwashing, perfumed cosmetics and wool can aggravate eczema. Dribble and food touching the skin can cause dermatitis around a child's mouth and chin. Avoid overheating and very dry air, which can fuel itching and scratching. Keep nails short and smooth to reduce skin damage. Rinse shampoo separately from bathwater to limit contact with irritated skin.1367

Most childhood eczema does not have one clear allergic cause. Food allergy can coexist with eczema, and particular foods aggravate eczema in some children, but routinely removing foods is rarely helpful. Broad elimination diets can leave children short of nutrients. If food allergy is strongly suspected, assessment can include testing and a supervised food challenge rather than an expanding list of banned foods.17

When does your child need medical help?

• Contact a doctor if eczema suddenly worsens, becomes wet or oozing, develops yellow crusting, or your child feels unwell. These can be signs of infection.
• Get immediate medical assessment for groups of small blisters or shallow sores that spread quickly, especially with pain, fever or poor appetite. These can signal eczema herpeticum, an infection caused by the cold sore virus.
• Suspected cold sore infection near the eye needs urgent eye specialist assessment. Keep children with eczema away from active cold sores, and do not kiss your child if you have one.
• Arrange a treatment review for severe eczema, symptoms that remain uncontrolled despite prescribed treatment, or persistent rubbing around the eyes. Repeated rubbing around the eyes can cause eye damage.

Infected eczema needs treatment for both the infection and the eczema flare. Antibiotics alone do not restore control of the underlying eczema. Get specific instructions about creams and steroids during infection rather than stopping or restarting them yourself.4

Will your child grow out of eczema?

Eczema often improves during the school years, but an individual child's course cannot be predicted. There is no cure, although treatment can control symptoms. Sensitive skin can persist, and eczema can return after years of clear skin. Flare treatment length depends on severity; ask when to expect improvement and when the prescribed course needs reviewing.345