Treatment for eczema on the face in adults

Make sure the facial rash is eczema

Eczema describes several types of dermatitis, meaning skin inflammation. Atopic dermatitis is the most common type, but contact dermatitis is another possibility on the face. The treatment below mainly concerns atopic eczema; a rash caused by contact with an irritating or allergenic product also needs its trigger addressed. Adults can develop eczema for the first time, or have eczema that began in childhood.134

Typical symptoms include itching, dryness and a scaly rash. Scratching can make swelling and itching worse. Eczema is not contagious, and its course can alternate between better periods and flares. Arrange a medical assessment for a new facial rash rather than assuming every dry patch needs the same treatment.35

How to care for your face each day

Emollients come as creams, lotions, ointments and gels, so the bathroom shelf does not need a supporting cast. Moisturizers relieve dry, cracked skin, decrease inflammation and help reduce the severity of flares and extend the time between them.25

1. 1Wash with an emollient instead of soap.
2. 2Apply your emollient after washing. Use it at least twice daily and more often as needed, including when the eczema improves.
3. 3Use any prescribed flare medicine on the affected areas exactly as directed. Confirm its frequency and duration with the prescriber, especially for eyelids.
4. 4Use a pump or clean spoon rather than putting your fingers into an emollient pot, and do not share it.

Avoid aqueous cream because it can irritate eczema. Keep away from smoking and naked flames: emollient residue on clothing and bedding makes those fabrics catch fire more easily.5

Which steroid is suitable for the face?

Topical corticosteroids are steroid medicines applied to the skin to reduce inflammation and itching. For delicate facial skin, a clinician generally starts with a mild strength, such as hydrocortisone 1%. A stronger steroid prescribed for body eczema is not automatically suitable for your face.12

If a mild steroid is insufficient, a clinician can sometimes increase the strength to a moderately potent steroid for a short facial course, with a maximum of five days. That is a prescribing decision, not a reason to increase the strength yourself. Follow the specific stop date for your prescription rather than continuing whenever the skin feels dry.1

What can replace steroids for recurring facial eczema?

Tacrolimus and pimecrolimus are topical calcineurin inhibitors, medicines that reduce skin inflammation. They are useful on the face and around the eyes because they do not cause skin thinning or stretch marks associated with prolonged steroid use. A clinician can prescribe them when facial eczema does not respond adequately to steroids or needs ongoing control.16

Apply a prescribed calcineurin inhibitor as a thin layer to affected skin. The usual schedule is morning and evening during treatment, then once daily on two days each week for maintenance after improvement. Your prescriber can adjust that schedule. Initial burning or itching usually settles within a few days.6

Do not use calcineurin inhibitors on infected skin or if your immune system is significantly weakened, including by immune suppressing medicines. Tell the prescriber about your current medicines. These treatments are safe when used as directed; there is no evidence that they increase cancer risk or damage the immune system.6

Other adult eczema treatments include crisaborole ointment for inflammation and itching, and ruxolitinib cream for short term treatment of mild to moderate atopic dermatitis. These are options for a clinician to assess, rather than interchangeable substitutes for your facial prescription. Antihistamine, antiseptic and antimicrobial creams are not routine treatments for atopic eczema.2

What if treatment is not working?

Treatment aims to control symptoms and reduce flares, not permanently cure atopic eczema. The time needed to settle a flare depends on the treatment plan; the five day limit for a stronger facial steroid is a safety limit, not a promised recovery time. Arrange a review if treatment is not helping.127

A changing pattern of facial eczema, or a reaction that worsens with treatment, can point to allergic contact dermatitis and needs reassessment. Frequent flares can call for a planned maintenance schedule rather than repeated unsupervised courses. Ask for specialist review if several treatments have failed or eczema is affecting sleep, daily activities or mental health.1

Reduce triggers without adding more products

Choose an emollient you find comfortable enough to use generously and regularly, rather than building a bathroom display worthy of a product launch. Long term emollient use remains part of treatment even between flares.1

Avoid soaps, lotions or other products that irritate your skin, and known allergens. Stress can also contribute to worsening eczema. Keep cool and keep nails short to limit scratching damage. Do not cut foods out of your diet unless a doctor advises it.37

Pregnancy and breastfeeding

Eczema can be treated during pregnancy and breastfeeding, but your treatment plan needs review. Tell your clinician if you are pregnant or planning pregnancy. Calcineurin inhibitors are not known to harm unborn babies because very little enters the body. During breastfeeding, avoid applying them where your baby's mouth could touch and wash your hands after application.46

When to get urgent medical help

Seek urgent medical assessment if facial eczema:

• Develops blisters, crusting, leaking fluid or pus filled spots.
• Becomes painful, swollen or warm.
• Suddenly worsens or spreads.
• Comes with a high temperature or feeling generally unwell.

Sudden clusters of painful blisters or open sores can indicate eczema herpeticum, a herpes virus infection that requires emergency treatment. Do not treat suspected infection as an ordinary flare.1