How to help eczema on the face

Is the rash definitely eczema?

Eczema describes several conditions that cause itchy, excessively dry skin. Atopic dermatitis is the most common type; contact dermatitis is another type, caused by a reaction to a substance. These conditions do not necessarily need the same treatment, so get a new facial rash assessed rather than assuming its cause. Atopic eczema can look red, white, purple or grey, or lighter or darker than surrounding skin. Facial eczema is particularly common in babies and toddlers, although eczema can start at any age.23

How to wash and moisturize your face

1. 1Choose a mild liquid cleanser or an emollient wash instead of ordinary soap. An emollient is simply a moisturizer; some can also be used for washing. Look for fragrance free, soap free products intended for sensitive or dry skin.
2. 2Use warm rather than hot water. If you shower or bathe, keep it to 5 to 10 minutes. Daily washing is possible, but long, hot showers encourage moisture loss.
3. 3Rinse and gently pat your face so it remains slightly damp. Apply moisturizer promptly after washing to help seal in moisture.
4. 4With clean hands, smooth the moisturizer in the direction of hair growth rather than rubbing it in. Leave a thin layer to soak in. Use a clean spoon to remove moisturizer from a tub instead of dipping your fingers into it.
5. 5Reapply whenever your face feels dry. Use moisturizer at least twice daily; three or four applications, or more when needed, can help keep skin moisturized. Morning and evening are useful starting points, not a limit.

If you use an emollient as a wash, mix a small amount with warm water in your palm, spread it over the skin, rinse and pat dry.6

Does moisturizer help eczema?

Yes. Moisturizers trap moisture in the skin and form a protective layer that helps skin repair. Keeping eczema prone skin hydrated helps relieve discomfort and reduce flares. Continue moisturizing when your skin improves, rather than saving moisturizer for the next flare. A mild, fragrance free cream or ointment is a useful starting choice. Ceramides, substances naturally present in skin, are another ingredient to consider: people with eczema can have less of them, and a ceramide moisturizer helps replace some.345

Texture alone does not identify the best moisturizer for every person. In a trial involving children with eczema, lotions, creams, gels and ointments were equally effective, while satisfaction differed between users. Ease of application, how often a product needs applying and its container all matter. The best texture is one you can use regularly, not one that wins an imaginary bathroom shelf competition.7

Which products should you leave out?

Choose fragrance free skincare. Products labelled "unscented" can still contain fragrance added to cover another smell. Other ingredients can also trigger a flare, so test a new product on a small patch inside your arm every day for 7 to 10 days before using it more widely. If the test area stays clear, you can introduce the product. Aqueous cream is not recommended as a moisturizer because it can irritate skin.16

"Natural" does not mean better for eczema. Citrus oils, tea tree oil and some seed oils can irritate skin. Colloidal oatmeal has potential benefits for inflammation, and unprocessed virgin coconut oil could be helpful, but neither needs to be added to a routine that already suits you.4

Does exfoliating help eczema?

Exfoliating is not a useful starting treatment for facial eczema. Facial acids, retinol and many acne or anti ageing products can irritate eczema prone skin. Exfoliants speed up the shedding of skin cells, which can cause irritation even without eczema. Leave exfoliating products out during a flare. If you also need acne treatment or other cosmetic skincare, ask a dermatologist which options fit alongside your eczema treatment.4

What else can reduce facial flares?

Watch for your own triggers rather than avoiding everything at once. Dry air, dust, pollen and sunburn can trigger flares. Cold weather dries skin, while heat and sweating can worsen eczema; protect exposed skin in winter and stay cool in hot weather. Keep nails short and smooth to reduce damage from scratching. Do not change your diet, or your diet while breastfeeding a baby with eczema, unless a doctor advises it. Pregnancy related hormonal changes can also worsen eczema.125

When do you need medicine?

See a doctor if you have symptoms of eczema or treatment is not helping. A pharmacist can advise on small areas that are dry and slightly itchy. More severe eczema needs medical care. Treatments include moisturizers and topical corticosteroids, steroid medicines applied directly to skin. Use prescribed medicines as instructed. If you use a topical steroid, leave at least 30 minutes between the steroid and moisturizer, and ask your clinician which to apply first.256

How long does improvement take?

There is no single timetable for clearing a facial flare. Eczema is a long lasting condition with better periods and flares; treatment controls symptoms rather than curing it. For children, allow a moisturizer at least two weeks to judge how it suits them unless it causes major problems. That is a trial period for the moisturizer, not a deadline for the rash to disappear. Early diagnosis and a treatment plan can help prevent eczema from worsening.37

What should make you stop or seek help?

Stop an emollient that makes your skin itchy or sore. Ask a pharmacist or clinician about burning or stinging that persists, inflamed hair follicles or a new facial rash. Keep emollient contaminated bedding and clothing away from flames and cigarettes, including when the product contains no paraffin. Washing fabric does not completely remove the buildup.56

Get urgent medical help if eczema becomes blistered, crusty, leaks fluid or develops pus filled spots; is painful, swollen or warm; suddenly worsens or spreads; or comes with fever or feeling unwell. These changes can signal infection, including eczema herpeticum, a potentially serious infection associated with eczema.2