What causes facial eczema, and can diet affect it?

Is all facial eczema the same?

Facial eczema describes where the rash appears, not one single diagnosis: atopic dermatitis, contact dermatitis and seborrheic dermatitis can all affect the face. The guidance below mainly concerns atopic dermatitis, the common form associated with dry, itchy skin and recurring flares. More than one type of eczema can occur together.3

Why does facial eczema happen?

The skin barrier is the outer layer that holds moisture in and helps keep irritants and germs out. In atopic eczema, gaps in that barrier let too much moisture escape. Environmental substances can enter more easily and cause inflammation, while germs can enter and cause infection. The result is skin that is dry, itchy and more reactive to things touching it.1

Genes, the immune system and environmental contact all play a role, although the exact cause is not fully understood. A family history of eczema, asthma or hay fever increases the likelihood of atopic eczema. Having an allergic condition alongside eczema does not mean that an allergy caused the eczema. In most cases, no specific allergy causes or triggers atopic dermatitis. Eczema is not contagious.14

What does facial eczema look like?

Facial eczema commonly affects babies' cheeks, while adults can have eczema on the eyelids. Skin can feel dry, rough and itchy, with scaling, cracking or thickening. An active flare can weep, crust or blister. Inflammation is not always red: affected skin can look purple, grey, lighter or darker than the surrounding skin. Repeated scratching and rubbing can thicken the skin, and rubbing around the eyes can cause eye damage.456

What makes a facial flare worse?

Common aggravating factors include:

• Soaps, detergents, perfumes and dyes in skincare.
• Makeup, smoke and other environmental pollutants.
• Cold, dry air, heat and sudden temperature changes.
• Frequent washing that dries the skin, and rough fabrics such as wool.
• Stress, skin infections and hormonal changes, including during pregnancy.
• Allergens such as pollen, dust mites or animals in people who react to them.

Can food cause or worsen facial eczema?

Food allergy and eczema are separate problems that can occur together. Children with atopic dermatitis have a greater likelihood of food allergy, but that association does not mean either condition causes the other. In some infants and children, a particular food consistently aggravates eczema. Egg, milk, peanut, wheat and soy are established food allergens associated with eczema. That list is not a shopping list of foods to remove.27

Do not change your diet, or a child's diet, without medical advice. This also applies if you are breastfeeding a baby with eczema. Removing many foods can deprive a growing child of essential nutrients and cause growth problems. Managing a confirmed food allergy matters, but removing allergens is not a substitute for treating eczema.47

Tell the clinician which food was involved, what reaction occurred and whether it happens every time. Food allergy symptoms usually appear within minutes to a few hours and can include hives, vomiting, stomach pain, wheezing or swelling. A positive allergy test alone does not settle whether a food worsens eczema. When food allergy is strongly suspected, assessment can include a medically controlled food challenge or a limited elimination diet with consistent improvement. Do not attempt a food challenge yourself.27

How should you care for facial eczema?

1. 1Wash gently with a soap substitute or gentle cleanser. Keep water contact brief and avoid hot water.
2. 2Do not scrub or rub hard while drying. Apply moisturizer while the skin is still damp to help retain moisture.
3. 3Moisturize at least twice daily, including morning and bedtime, and reapply when the skin becomes dry. Continue when the eczema improves.
4. 4Choose fragrance free and dye free products. Avoid products containing alcohol, scents or dyes that aggravate the skin.
5. 5Use prescribed eczema medicine as directed. Avoid your known triggers and keep nails short to reduce damage from scratching.

A moisturizer's useful role here is to help keep skin hydrated, not to give the bathroom shelf a main character. For adolescents and adults with facial eczema, a lighter emollient can be appropriate because heavier products can provoke acne or dermatitis around the mouth. Ask about a suitable texture if your current moisturizer causes problems.2

A cleanser can be replaced with an emollient wash, so the routine does not need a separate casting call for soap. Use a pump or a clean spoon for moisturizer pots rather than putting fingers inside. Keep emollient contaminated clothing and bedding away from cigarettes and naked flames because these fabrics catch fire more easily.4

What treatment helps, and how long does it take?

Moisturizers support daily care; an active flare can also need medicine to reduce inflammation. Facial treatments include topical corticosteroids and topical calcineurin inhibitors, medicines applied to the skin. Discuss the product, strength, frequency and duration with your clinician before starting a new medicine, including possible side effects and interactions with existing medicines. A facial flare can take several weeks to clear with treatment. The rash can return after clearing, and there is no permanent cure.3

See a clinician for a first suspected eczema rash, worsening symptoms or treatment that is not helping. Diagnosis usually depends on examining the skin and taking a history. If eczema resists treatment, patch testing can help investigate contact allergy. Persistent facial symptoms deserve assessment rather than another round of food restrictions.456

When should you get urgent help?

Get urgent medical assessment if eczema becomes painful, swollen, warm, suddenly worse or more widespread, or develops blisters, crusts, leaking fluid or pus. Fever or feeling generally unwell also needs urgent attention. These can signal infection or eczema herpeticum, a serious complication. Seek immediate medical care for a child's suspected food reaction involving trouble breathing or swallowing, facial or lip swelling, or faintness. If a moisturizer or topical medicine causes a new rash or pain, contact your clinician.347