What does eczema on the face look like?

What should you look for besides color?

Itch is a major clue, especially alongside roughness, scaling and dryness. During an active flare, facial atopic eczema can become swollen, cracked and crusted. Between more intense flares, the skin can remain dry and slightly pink. With longstanding eczema and repeated scratching, patches can become thick and leathery, with darker or lighter color. Extra creases beneath the lower eyelids can also appear. These changes need not all be present at once.34

Where does facial eczema appear?

The cheeks are a common site, but eczema can affect skin from the chin to the forehead. Babies often have facial eczema, including slightly raised patches across the cheeks; the area around the mouth can be spared. In adults, atopic eczema often affects the skin around the eyes, where patches can be especially dry, itchy, thickened and darker. Atopic eczema can also affect skin around the mouth up to the lips, often on both sides.13456

Can another facial rash look like eczema?

Facial eczema includes several types, including atopic dermatitis, contact dermatitis and seborrheic dermatitis, and their patterns differ. Contact eczema can be irregular or affect one side more than the other; irritation from direct contact can leave a sharp border. Seborrheic dermatitis commonly causes white or yellowish flakes around the eyebrows, hairline and creases beside the nose, often with scalp involvement. Psoriasis and fungal infections can also cause scaly facial rashes. Appearance alone is not enough to choose treatment: a clinician can examine the rash and arrange allergy testing or an infection swab when needed.134

Which changes need urgent care?

Get urgent medical advice if eczema develops any of these changes:

• New blisters, crusting, leaking fluid or spots filled with pus.
• Pain, warmth or swelling.
• Sudden worsening or spreading.
• Fever or feeling generally unwell.

In children, honey colored crusts, pus filled blisters or sores resembling cold sores are infection clues. Eczema and infection can both ooze and crust, so do not assume these changes are just another flare. A child with suspected infection and fever or flu like symptoms needs immediate medical care. Without fever, contact the child's dermatologist. Stop wet wraps or plastic coverings if infection is suspected until the dermatologist advises restarting.7

What can you do while arranging an assessment?

Use a gentle moisturizer designed for sensitive skin, even if another bottle has a more impressive autobiography. Apply an emollient, a moisturizing treatment, at least twice daily and continue when the eczema improves. Useful times include morning, after washing while skin is damp, and before bed. Wash with an emollient instead of soap, avoid scratching, and use a pump or clean spoon rather than putting fingers into a moisturizer pot.125

Choose skincare for sensitive skin rather than an elaborate collection, however compelling the bottles' campaign for more shelf space becomes. Avoid known triggers, including irritating soaps or makeup. Makeup can further irritate facial eczema and delay healing. If a moisturizer or topical medicine causes a new rash or pain, contact your clinician. Ask about the dose, frequency and side effects before starting a new medicine.1

A treated facial flare can take several weeks to clear, and eczema can return. Arrange an assessment for a new suspected eczema rash, or if treatment is not helping. Seek follow up if symptoms worsen or do not improve after several weeks.12