What causes flaky skin with facial dermatitis?

Which type of dermatitis causes the flakes?

Contact dermatitis is inflammation caused by something touching your skin. Irritant contact dermatitis can follow exposure to soap, detergents, acids or hair dye, and can appear quickly with burning or stinging. Allergic contact dermatitis involves an allergic reaction, often to fragrances, preservatives or cosmetics; the rash can take hours or days to appear. Both can cause flaking, itching and swelling on the face, including the eyelids, cheeks and lips.12

Atopic dermatitis, also called atopic eczema, causes dry, itchy, inflamed skin through a combination of genetic and environmental factors. The skin's barrier function is impaired, and the condition tends to alternate between quieter periods and flares. Over time, affected skin can become thickened, scaly and cracked. Eczema often starts in childhood, but it can also begin in adulthood or return after years without symptoms.4

Seborrheic dermatitis can make facial skin look oily, dry or scaly. Yeast on the skin and sebum, the skin's oil, are thought to play a role. This type usually needs treatment to clear; a dermatologist can choose a plan that includes dandruff shampoo or medicine applied to the skin. Flakes alone do not identify which type you have.15

What if the flakes are around your lips?

Lip dermatitis, also called eczematous cheilitis, causes dryness, scaling, redness and cracks on the lips or surrounding skin. Causes include atopic eczema, irritation and contact allergy, often in combination. Lip licking is a major irritant trigger. Lipstick, lip care products, toothpaste, dental materials and foods can also be involved. A clinician can review these exposures and use patch testing to investigate an allergy.6

Discoid eczema causes circular or oval patches that can become dry and flaky, but it does not usually affect the face or scalp. A round patch is a reason to get the diagnosis checked rather than assume it is facial eczema.7

What should you do next?

1. 1Review what touches your face, including skincare, soap, cosmetics and hair products. Include familiar products in that review, because bathroom tenure is not a qualification.
2. 2Avoid an identified irritant or allergen. If you cannot identify the trigger, a dermatologist can examine the rash and consider patch testing for contact allergy.
3. 3For dryness worsened by cold weather, moisturize after every shower or bath and avoid hot showers. Ointments and oils are richer than creams, which are richer than lotions.
4. 4Use fragrance free soap and consider a humidifier if the air is dry. Indoor heating dries the air too, so the thermostat is not an innocent bystander.
5. 5Use prescribed skin medicines as directed. Do not extend hydrocortisone use beyond its directions, because prolonged use can itself cause a skin reaction.

How long should it take to improve?

Mild contact dermatitis can clear within days after avoiding the trigger. With treatment, itching can improve within a couple of days while the visible rash takes several weeks to disappear. Atopic eczema can relapse, and seborrheic dermatitis usually requires treatment rather than moisturizer alone.124

When should you see a doctor?

Make a dermatology appointment if facial redness lasts more than two weeks. Seek medical advice sooner for spreading rash, itching that wakes you, weeping, crusting, swelling or fever. Scratching can break the skin and lead to infection; pain and pus need assessment. Trouble breathing during an allergic reaction is an emergency: call 911.123