How to care for mild eczema on the face

What does mild facial eczema look like?

Mild atopic eczema means small areas of dry skin with occasional itching and little effect on sleep or daily life. There can be redness or a change in skin colour. On darker skin, inflammation can look purple or like a subtle darkening rather than bright red. Atopic eczema is usually itchy; a patch that never itches deserves a fresh look at the diagnosis. Frequent itching, disturbed sleep or a growing effect on everyday life are reasons to have the severity reassessed.1

Facial eczema can be atopic, caused by contact with an irritant or allergen, or seborrhoeic, which involves a reaction to yeasts on the skin. The basic skin care overlaps, but persistent facial patches need the right diagnosis because treatment differs. Seborrhoeic dermatitis commonly affects the face, scalp and ears. Eyelid dermatitis often has more than one cause. A clinician can often identify the problem from your history and an examination; tests are not automatically necessary.4

How should you wash and moisturize your face?

Build your facial routine around washing and moisturizing, rather than giving the bathroom shelf a full time job. Use a soap substitute instead of ordinary soap, and avoid perfumed cosmetics. Overwashing can dry the skin and trigger atopic eczema. Moisturizer, also called an emollient, is an ongoing part of care, not just something to reach for during a flare.13

1. 1Wash gently with a soap substitute and warm rather than hot water. Keep baths or showers to 5 to 10 minutes; longer exposure can dry the skin.
2. 2Gently dry your face, leaving the skin slightly damp. Smooth moisturizer over it straight away rather than rubbing vigorously.
3. 3Reapply moisturizer whenever your skin feels dry, including during the day. Choose fragrance free skin care; an unscented product can still contain fragrance.
4. 4If you have a prescribed steroid, keep it separate from moisturizer. Where practical, apply moisturizer first and wait 30 minutes before applying the medicine.

Which moisturizer should you choose?

A fragrance free cream or ointment is a good starting point for atopic eczema. Ointments contain more oil and hold moisture in well, but feel greasier; creams sit between ointments and lotions in oil content. For adolescents and adults with facial eczema, a lighter emollient can be preferable to avoid provoking acne or dermatitis around the mouth. A different moisturizer for your face and body is reasonable; the matching set can survive the disappointment. Choose the texture for the area rather than assuming the thickest product belongs everywhere.356

Stop a moisturizer that causes a reaction and ask a pharmacist or GP for an alternative. Avoid aqueous cream as a moisturizer left on the skin because it has a high risk of irritation. Some emollients are a fire hazard, so keep them away from naked flames. Use a moisturizer you can comfortably keep applying, because a jar that stays closed has an unusually easy job.16

Can you use hydrocortisone on your face?

Hydrocortisone 1% is one mild steroid used for atopic eczema, including delicate facial areas. Steroids reduce inflammation; moisturizer keeps the skin hydrated, so they have different jobs. Do not substitute a stronger body treatment or increase the strength yourself. Strength is not comparable by percentage alone: hydrocortisone 1% is mild, while mometasone furoate 0.1% is strong. Children also need an age appropriate treatment plan rather than an adult prescription borrowed from the cupboard.12

Apply the prescribed steroid to affected skin, not automatically across the whole face. Wash your hands first, smooth the treatment in the direction of hair growth and wash your hands afterwards. The aim is a thin, glistening layer. A fingertip unit is a line from the last finger crease to the fingertip and covers an area equal to two hands laid flat. Small patches need proportionately less. Most topical steroids work with once daily application, but follow your own prescription for frequency and duration.24

Correct use carries a low risk of side effects. Temporary burning or stinging can occur and usually settles within a few days. Strong steroids used for long periods on the face increase the risk of skin thinning and an acne like rash. Discuss topical steroid use with your doctor if you are pregnant or breastfeeding. Do not treat a suspected skin infection with a steroid alone, because steroids can make infections worse.2

What if the eczema keeps coming back?

Atopic eczema tends to have intermittent flares. Treatment length depends on the severity, medicine strength and location, so agree when to stop or reduce the treatment with your prescriber. Continue moisturizing between flares. If a prescribed treatment is not improving symptoms, arrange a review rather than repeatedly extending the course. Persistent facial eczema sometimes needs a different diagnosis or a maintenance treatment instead of another round of the same cream.236

Pimecrolimus and tacrolimus are prescription calcineurin inhibitors, medicines that suppress eczema inflammation without the long term side effects of potent steroids. They are particularly useful on the face. A clinician can consider them when steroid treatment has not adequately controlled facial eczema, and sometimes use them intermittently for maintenance. Initial stinging often improves with continued use. These medicines should not be used on infected eczema.14

How can you reduce future flares?

Test new skin care on the inside of your arm before putting it on your face. Apply a quarter sized amount daily for 7 to 10 days; if the area remains clear, you can start using the product. Fragrance is not the only possible trigger. Notice whether particular products, cold weather or overheating and sweating precede your flares. Avoiding an identifiable trigger is more useful than changing everything at once.5

A rash that persists or worsens with treatment can involve contact allergy, including allergy to a medicine applied to the skin. Patch testing can identify contact allergens; it is different from trying a cosmetic on your arm. Do not start broad food exclusion diets to treat facial eczema. Dietary changes are not routinely helpful for atopic eczema, and extensive exclusions can cause nutritional deficiencies. Suspected food allergy needs a targeted assessment.134

When should you get medical help?

See a GP if pharmacy treatment has not helped, or if patches develop excessive weeping or tenderness that suggests infection. Sudden painful clusters of similar looking blisters or open sores need emergency medical assessment: these can be eczema herpeticum, a herpes virus infection requiring urgent treatment. Mild atopic eczema can usually be managed in primary care. Specialist assessment becomes relevant when several treatments have failed or eczema is significantly affecting mental wellbeing.16