What triggers eczema on the face?

Which everyday things can trigger a flare?

• Soaps and harsh detergents can irritate skin. Frequent washing, long hot showers and scrubbing can worsen dryness.
• Cold, dry weather, indoor heating, hot weather and sudden temperature changes can worsen atopic eczema.
• Sweat and nasal secretions can irritate skin. Rough fabrics, rubbing and scratching can also worsen eczema.
• Emotional stress, illness and skin infections can bring on or worsen flares.
• Pollen, mould, dust mites and animals can worsen symptoms in people with relevant allergies. Seasonal flares around the eyes or on other exposed areas are useful clues.

Could skincare, makeup or hair products be responsible?

Skincare products are a common cause of contact dermatitis, including products marketed as "natural" or "clean". Fragrances, preservatives and the hair dye ingredient paraphenylenediamine, also called PPD, are frequent causes of cosmetic reactions. "Unscented" products can contain fragrance to mask another smell; look for "fragrance free" or "without perfume" instead.36

Shampoo and conditioner count as cosmetics too, despite operating under a separate bathroom management team. They can run over the sides of the face and neck and cause contact reactions. An allergen can also reach the eyelids through your fingers, so the culprit does not have to be a product applied directly to your face. Hair dye, nail cosmetics, jewellery and baby wipes are worth considering.67

Why can a familiar product suddenly cause trouble?

Contact allergy can develop after years of using a product without problems. Allergic contact dermatitis usually appears 24 to 72 hours after exposure, so the last product you applied is not automatically responsible. Strong irritants can cause symptoms within minutes or hours; weaker irritants can take days or weeks of repeated exposure.67

Is food causing the eczema?

Atopic dermatitis is not itself caused by allergies, although allergies can worsen it. Many children with eczema do not have a food allergy. Food allergy needs assessment when a food causes an itchy or swollen rash, vomiting, wheezing or other reactions, or when severe eczema is not responding to treatment. Discuss suspected food triggers with your child's clinician before changing their diet.45

How do you find and reduce your triggers?

Record product names, exposures, symptom timing and what improves or worsens the rash, giving the bathroom shelf a performance review rather than a blanket dismissal. A dermatologist can use your history and the rash's location to investigate the cause. Some people with atopic eczema cannot identify a specific trigger.17

Avoid an identified irritant or allergen. Use a gentle cleanser instead of ordinary soap, keep washing brief and cooler, and avoid scrubbing. Apply moisturizer while skin is still damp, then moisturize regularly even when eczema is clear. Use prescribed treatment as directed; trigger avoidance is only one part of controlling atopic eczema. Recurrent or persistent suspected contact allergy can be investigated with patch testing to identify the allergen.12347

When should you get medical help?

Seek medical advice if home care or treatment is not helping, or the skin becomes painful, hot, weepy, crusted or develops pus or fever. Seek urgent medical attention for painful small blisters spreading across eczema, especially around the face or eyes: a cold sore virus infection can spread quickly on eczema prone skin. Avoid contact with active or healing cold sores.45