Signs of eczema on the face

What does facial eczema look and feel like?

• Itching is a major clue, especially when the rash is intensely itchy.
• The skin can feel dry and rough, with visible flakes, cracks or crusts.
• Affected patches can look red, purple, grey or white, or lighter or darker than surrounding skin.
• During an active flare, patches can become swollen, blistered or weepy.
• Longstanding patches can become thickened and scaly, particularly with repeated rubbing or scratching.

Redness can be less obvious on darker skin, so look at texture, itching and swelling as well as colour. Lighter or darker marks can remain after inflammation settles; a colour change alone does not tell you whether eczema is still active.23

Where does it appear?

In babies, the cheeks are a common starting point. Atopic facial eczema can affect both eyelids and the skin around the mouth, reaching the lips. In children, dribble and food can contribute to dermatitis around the mouth and chin. Persistent eyelid eczema can leave extra folds beneath the lower eyelids.23

An intensely itchy eyelid patch can also occur with neurodermatitis, a type of eczema driven by repeated scratching and rubbing. The patch can become raised, rough and leathery, and scratching can make the itch stronger. Repeated scratching can also cause bleeding sores and increase infection risk.4

Could the rash be something else?

An itchy facial rash is not automatically atopic eczema. Contact eczema can be uneven or mainly on one side, sometimes with a sharp border. Seborrhoeic dermatitis commonly causes white or yellowish flakes around the eyebrows, hairline and nose folds, often with scalp involvement. A ring shaped rash with a scaly edge can be a fungal infection. These patterns are clues, not a diagnosis.3

Arrange a medical appointment for suspected eczema, or if treatment is not helping. Atopic eczema is usually diagnosed through a clinical assessment rather than laboratory tests. Patch testing, which checks for contact allergies, can be considered when dermatitis resists treatment.12

What can you do while waiting?

Moisturising treatments are called emollients, because even a moisturiser apparently needs a second job title. Apply an emollient at least twice daily and continue when the skin improves. Avoid known triggers, including soap, and keep cool if heat worsens itching.1

An emollient can also be used for washing instead of soap, so the bathroom shelf need not have a product for every verb. Use a pump or clean spoon rather than putting fingers into a pot. Avoid scratching and keep nails short; repeated rubbing around the eyes can cause eye damage.12

When should you get urgent help?

Seek urgent medical care if patches develop yellow or honey coloured crusts, pus, leaking fluid or blisters, especially with pain, warmth or swelling. Sudden worsening, a spreading rash, fever or feeling unwell also need urgent assessment. These changes can signal infection, including eczema herpeticum, a potentially serious infection.145