Using steroids for eczema on the face

Which steroid belongs on the face?

Topical corticosteroids, meaning steroids applied to the skin, reduce inflammation and itch. Facial skin needs a different approach from thicker skin on the body: use the weakest steroid that controls the flare. A clinician can prescribe a moderately potent steroid when a mild one is insufficient, but this is a short course, not permission to use a stronger body treatment on your face.134

Do not use hydrocortisone for more than seven days unless a doctor or pharmacist tells you to. A prescribed facial course can be shorter; moderately potent facial treatment is generally limited to five days in Scottish eczema pathways. If you already have a longer prescribed course, ask before changing or stopping it.12

How to apply it

Check the packet or leaflet for your exact medicine's directions.2

1. 1Wash your hands before applying the medicine.
2. 2Apply enough to cover the affected patches in a thin layer, then gently rub it in.
3. 3Wash your hands afterwards, unless your hands are also being treated.

Hydrocortisone is usually applied once or twice daily; follow your prescription rather than adding extra applications. Once daily topical steroid treatment is often used at night. Moisturizer can go before or after the steroid. Do not cover treated skin with a dressing or wrap unless your clinician specifically directs it, because covering increases absorption.234

Use a fragrance free moisturizer at least twice daily, including after washing, which leaves the perfume counter out of the proceedings. Emollients, meaning moisturizing creams or ointments, keep skin hydrated and comfortable, which is a fairly ordinary job for a word wearing a lab coat. Light emollients are an option for facial care in adolescents and adults; the moisturizer does not need to audition for the role of perfume, even if the packaging has prepared an acceptance speech.56

What should improve, and when?

Itch can improve shortly after prescription treatment starts, while the rash may take days to weeks to fade. Treatment controls eczema rather than curing it, so flares can return. If the facial course ends without improvement, seek a review rather than extending it yourself. For children, contact the dermatologist if treatment has not worked within two weeks.35

Repeated flares need a maintenance plan. Options include a lower strength steroid, intermittent prescribed treatment, or a nonsteroid medicine such as pimecrolimus or tacrolimus. These medicines can be useful for facial eczema; initial stinging often improves with continued use. They should not be used on infected eczema.7

Who needs extra care?

Eyelids absorb steroids particularly readily. Potent steroids are best avoided there, and excessive eyelid use over weeks to months can cause eye problems, including glaucoma or cataracts. Have a clinician specify the treatment for eyelid eczema rather than assuming the rest of your facial prescription belongs there.4

Children are more sensitive to topical steroids than adults. Children under ten should use hydrocortisone only with advice from a doctor or pharmacist. During pregnancy or breastfeeding, check before starting hydrocortisone; most types can be used during pregnancy, with small amounts for the shortest necessary time. Hydrocortisone is not suitable for every facial rash, including some cases of acne, rosacea, cold sores or inflammation around the mouth.23

When to get medical help

Side effects are uncommon with appropriate supervised use. Report thinning skin, visible blood vessels, easy bruising or new acne like bumps. Strong steroids used on the face carry a greater risk of skin thinning. A worsening rash can also signal contact allergy to the treatment and needs reassessment.134

Seek medical care for swelling, pain or yellow pus. Sudden painful clusters of blisters or open sores need emergency assessment for eczema herpeticum, a herpes infection affecting eczema. Get urgent help for blurred vision, and immediate emergency help for difficulty breathing or swelling of the tongue or throat.1235