What does facial eczema look like?
Eczema typically causes itching with dry, cracked, scaly or thickened skin. Affected skin can look red, purple, grey, lighter or darker than the surrounding skin. Redness can be harder to see on darker skin, so look at texture and itching too. Atopic eczema can involve the cheeks, chin and eyelids, including in young children. Longstanding facial eczema can develop thicker skin with more obvious skin creases and changes in colour.134
Why would eczema affect just the face?
The face is a common site for contact dermatitis, which starts when a substance irritates the skin or triggers an allergic reaction. Symptoms can develop within hours or days of exposure. A rash after using a product is a useful clue, but does not by itself distinguish irritation from allergy.2
| Possible cause | Useful clues | What changes the approach |
|---|---|---|
| Atopic eczema | Itchy eczema in children or adults, sometimes with a family background of asthma or hay fever. | Moisturising and treatment of inflammation help manage symptoms. |
| Irritant contact dermatitis | Exposure to soaps, detergents or repeated contact with water. | Reducing or avoiding the irritating exposure matters. |
| Allergic contact dermatitis | A reaction to a substance such as perfume, hair dye or nickel. | Patch testing can identify the contact allergen. |
| Seborrhoeic dermatitis | Facial eczema with possible scalp or ear involvement. | This type involves a reaction to yeasts normally living on skin. |
How do you find the cause?
Review cosmetics, cleansers and other products that touch the affected area, including when you started using them and when symptoms appeared. Keep a list of the products you use so you can review them with your clinician, rather than asking your bathroom shelf to give evidence. Mention any suspected exposure and whether avoiding it has helped.12
A clinician can often diagnose dermatitis from your history and a skin examination. If contact allergy is suspected, patch testing can help identify the substance responsible. Sometimes a skin scraping is needed to check for a fungal infection, or a swab to check for infection. Rosacea and fungal infections can resemble dermatitis, so a persistent facial rash should not automatically be treated as eczema.1
How should you wash and moisturise your face?
- 1Wash gently with an emollient soap substitute or a mild liquid cleanser. Choose a fragrance free product and avoid regular soap.
- 2Use lukewarm rather than hot water. If you shower, keep it to about 10 minutes or less.
- 3Dry only enough to stop dripping, then moisturise promptly. After a shower or bath, apply moisturiser within three minutes.
- 4Use a cream or ointment rather than a lotion. Ointments hold moisture well but feel greasier; a cream can be more practical if that texture bothers you.
- 5Apply your emollient, meaning a moisturising treatment, at least twice daily and whenever skin feels dry. Continue when the eczema improves.
Which products should you avoid?
Fragrance can trigger irritation and eczema flares. Retinol, exfoliating acids and some acne treatments can also irritate facial eczema; discuss their use with a dermatologist rather than trying to treat both concerns by adding more products. Natural products are not automatically gentler, and citrus oils and tea tree oil deserve particular caution. A moisturiser containing ceramides can help replace some of the skin's natural moisture supporting substances.5
Avoid products that contain an identified irritant or allergen. Check the full ingredient list when choosing a replacement product, because the front of the bottle is occupied with being impressed by itself. If the information is unclear, check with the manufacturer. If an irritant or allergen gets onto your skin, rinse the affected area promptly with warm water and an emollient.2
Can you use steroid cream on facial eczema?
Steroid creams and ointments reduce eczema inflammation, but a facial rash needs a treatment plan suited to its cause and location. Do not copy a potent steroid routine intended for another body area. Ask your clinician which medicine to use, where to apply it and for how long, especially around the eyelids. Prescription alternatives include tacrolimus and pimecrolimus, which suppress eczema without the long term side effects associated with potent steroids and are particularly useful options for the face.1
How long does facial eczema take to clear?
Contact dermatitis usually improves or clears when the triggering substance is identified and avoided. Atopic eczema has no cure and tends to alternate between flares and quieter periods. There is no single clearing time for every facial rash. See a GP if symptoms persist, keep returning, are severe or are not responding to treatment. A dermatologist can investigate an unidentified contact trigger.23
When does facial eczema need urgent help?
Seek urgent medical assessment if eczema becomes blistered, crusty, leaks fluid or develops pus filled spots; becomes painful, swollen or warm; or suddenly worsens or spreads. Fever or feeling generally unwell also needs urgent attention. These can signal infection or eczema herpeticum, a potentially serious infection. Do not wait for a routine skincare change to help.3
Where this answer comes from
- 1Dermatitis: Types and treatmentsdermnetnz.org
- 2Contact dermatitisnhs.uk
- 3Atopic eczemanhs.uk
- 4Atopic Dermatitis Imagesdermnetnz.org
- 5Eczema Skin Care Routine: Best and Worst Productshealth.clevelandclinic.org
