How to care for eczema on your face

Is every itchy facial rash eczema?

Eczema is a group of conditions that cause itchy, dry, inflamed skin. Atopic dermatitis is the most common type, but contact dermatitis can follow exposure to an irritant or something you are allergic to. Seborrhoeic dermatitis also affects the face, scalp and ears. Eyelid dermatitis often has more than one cause, so persistent facial symptoms deserve a diagnosis rather than repeated product changes.12

Facial eczema commonly affects the cheeks, lips and areas around the ears. Patches can be flaky, scaly, swollen or thickened. On darker skin, the rash can look purple, brown or gray rather than red. Eczema weakens the skin barrier, the outer protection that retains moisture and keeps outside irritants out. Eczema is not contagious.3

How should you wash and moisturize your face?

Gentle cleansing and moisturizing are the basic daily jobs, without giving your bathroom shelf a staffing problem. Use a mild liquid cleanser rather than a harsh soap bar, or an emollient soap substitute. An emollient is a moisturizing treatment that traps water in the skin.45

1. 1Wash with warm or lukewarm water. Keep baths and showers to 5 to 10 minutes rather than taking a long, hot soak.
2. 2If you use an emollient soap substitute, mix a small amount with warm water in your palm, spread it over the skin and rinse.
3. 3Pat your face gently rather than rubbing it dry. Leave the skin slightly damp.
4. 4Apply moisturizer promptly. After a shower, aim to moisturize within three minutes to help retain the water already on your skin.
5. 5Smooth the moisturizer gently in the direction of hair growth rather than rubbing it in.
6. 6Reapply whenever your face feels dry or tight. Aim for at least three or four applications daily, including after washing.

Emollient washes clean without normal soap's foam, so bubbles do not need a performance bonus.5

Which moisturizer should you choose?

For dry facial eczema, start with a mild, fragrance free cream or ointment rather than a thin lotion. Creams containing ceramides can help replace these naturally occurring moisture retaining substances, which can be reduced in eczema. Product names can promise soothing, repair or healing, but choosing a usable moisturizer matters more than choosing the bottle with the most ambitious autobiography.4

How can you avoid a product making things worse?

Choose products labeled "fragrance free", including laundry detergent. "Unscented" products can contain fragrance that has been masked. Test a new skincare product on a quarter sized patch inside your arm every day for 7 to 10 days before using it more widely. If the test area stays clear, you can use the product.6

Retinol, salicylic acid and other exfoliating facial products can irritate eczema prone skin. If you also want acne or anti aging treatment, ask a dermatologist which options fit your eczema plan. Natural products are not automatically gentler: citrus oils and tea tree oil can also irritate. Colloidal oatmeal has potential anti inflammatory benefits, but a new product still needs testing.4

What else can trigger facial flares?

Watch for patterns involving makeup, skincare, soaps, smoke, dry weather and stress. Dust, pollen and sunburn can also trigger flares. Cold weather dries skin, while heat and sweating can aggravate symptoms. Protect your face from cold conditions and avoid overheating. Focus on your known triggers rather than assuming every possible trigger affects you.36

When do you need medicine?

Moisturizers help manage dryness, but inflamed eczema can need medicine applied to the skin. Topical corticosteroids reduce inflammation. A clinician should select the strength and instructions for your facial treatment; stronger steroids and larger amounts increase the risk of side effects, including skin thinning. Apply prescribed treatment only to the affected areas and follow your prescriber's directions.7

Other options include tacrolimus and pimecrolimus, medicines called calcineurin inhibitors that suppress eczema inflammation. These can be particularly useful for the face because they avoid the long term side effects of potent steroids. If a contact allergy is suspected, a dermatologist can arrange patch testing to identify the substance responsible. This is different from trying a skincare product on your arm.2

Leave 20 to 30 minutes between an emollient and a steroid cream or another skin treatment, and ask your doctor which to apply first. The gap helps avoid diluting medicine or spreading it onto skin that does not need treatment.5

How long does facial eczema take to improve?

There is no single clearing time for facial eczema. Atopic dermatitis is a chronic condition: treatment can ease symptoms and produce clearer skin, but it cannot cure the condition. Some children improve as they grow older; other people have eczema for life. Continue moisturizing between flares and follow your treatment plan even when symptoms settle. If prescribed treatment is not helping, contact your prescriber rather than increasing the amount yourself.17

Babies commonly develop atopic dermatitis on the face. For a child's eczema, use short, warm baths, moisturize several times daily and help prevent rubbing or scratching. Keep room temperature steady, since changes in temperature and humidity can dry the skin. A child's medical treatment should follow their clinician's instructions.13

What should make you stop or seek help?

Stop an emollient that irritates your skin and ask a pharmacist or doctor for an alternative. Seek medical assessment for excessive weeping or tenderness, which can indicate infection. Steroid creams can mask or worsen an infection. Keep fingernails short and hands clean to reduce damage from scratching. Arrange a review if symptoms persist despite treatment or interfere with sleep.7

Use a clean spoon or spatula to take moisturizer from a tub. Keep emollients and fabrics that have absorbed them away from flames and cigarettes because those fabrics can catch fire easily.5