How to care for eczema on a child's face

What does facial eczema look like?

Eczema causes dry, scaly, itchy patches that can look red or darker than the surrounding skin. Patches that persist can become thicker. Not every rash on a baby's face is eczema: baby acne and other infant rashes can look different and need different care. If the diagnosis is uncertain, have the rash assessed rather than treating every facial patch as eczema.23

How should you wash and moisturize the face?

1. 1Use warm water and a soap substitute or emollient wash. An emollient is a moisturizer that softens dry skin. Keep baths to no more than 10 minutes, with bathing frequency guided by your child's dermatologist.
2. 2Avoid rubbing the face. Smooth moisturizer onto the skin rather than massaging it vigorously.
3. 3Apply a fragrance free moisturizing cream or ointment within 3 minutes after bathing.
4. 4Reapply moisturizer whenever the face feels dry. Continue moisturizing when the visible eczema has cleared.
5. 5Use prescribed medicine exactly as directed, including the instructions for facial areas.

Fragrance free products belong in the routine, because facial care does not need a perfume department. Choose a pump or tube when possible. If moisturizer comes in a tub, take it out with a clean spoon or spatula. Change to another moisturizer if the current one irritates the skin or your child dislikes using it.12

Bathing and moisturizing can ease discomfort, decrease flares and improve the response to treatment. Good skin care can also reduce the need for medicine. Moisturizer is part of eczema treatment, not just something to add after the rash has settled.4

Which eczema medicines can go on a child's face?

Topical corticosteroids are medicines applied to the skin to reduce inflammation. Mild potency steroids are generally used on the face and neck; potent steroids are not recommended there. A clinician can prescribe a brief course of a stronger treatment for a severe facial flare. Follow the prescribed strength, amount and schedule rather than selecting these yourself. Steroids can go before or after moisturizer. Do not mix steroid medicine into moisturizer to make it weaker. Steroids usually stop when active eczema clears, while moisturizer continues, unless a clinician has prescribed a maintenance schedule.23

Ask for a written treatment plan that distinguishes everyday care from flare treatment. Keep the plan nearby so you know what to apply when the eczema changes. A written eczema plan keeps the instructions in one place, rather than making the bathroom a memory test. Sometimes moisturizer is all a child needs; frequent flares can need a preventive medicine schedule. Do not wait for each flare to become severe if your child's clinician has already prescribed preventive treatment.12

How can you reduce scratching and flares?

Scratching can make skin swell and itch more. Keep your child's fingernails short; soft gloves at night can help minimize scratching. Avoid drying soaps, hot or long baths and bubble baths. Stop using products that have previously irritated the skin.35

Look for a pattern before flares rather than changing the whole routine at once. Notice whether your child became overheated, missed skin care during a busy day or experienced stress at school. Help your child avoid known triggers and watch for new ones. Loose cotton clothing can help reduce irritation. Keep follow up appointments even when the routine seems familiar: eczema can move to different areas as a child grows, and triggers can change too.1

Will the eczema go away?

Eczema often lasts a long time, with periods when it improves and periods when it worsens. Atopic dermatitis, the most common type, often begins in babies and children. It can improve or disappear as children grow, although skin can remain dry and easily irritated. Eczema is not contagious, and its likely causes include both genetic and environmental factors. A flare returning does not mean eczema has spread from another person.5

When should you contact a doctor?

Contact your child's health care provider for:

• Wet or oozing areas, or redness that looks infected.
• Blisters, fever or other unexplained symptoms with the rash.
• A rash, blister or skin discoloration in a baby younger than 3 months.
• Significant scratching or, for a child under 2 years, no improvement after 3 days of home treatment.
• Facial eczema that has not responded to treatment, or eczema that remains out of control.

Bring a list of everything used on your child's skin to the appointment. Be ready to describe when the rash started, where it appears, whether it has spread and any other symptoms. Include soaps, detergents, creams, lotions, oils and medicines. Those details help the clinician assess the rash and its possible triggers.3