Eczema on the face – Causes, symptoms and treatment for facial atopic dermatitis

Atopic dermatitis, also known as atopic eczema, often flares up on the face: this is commonly known as facial eczema or facial dermatitis. Eczema can be uncomfortable anywhere on the body, but dermatitis on the face is particularly painful and debilitating due to sensitivity of facial skin.

This article explains how to recognise the symptoms of facial eczema and looks at the possible causes and triggers. It offers suggestions on how to care for atopic skin on a daily basis, as well as advice on how to soothe and calm your skin during flare-ups.

Facial eczema can develop on its own, or with more widespread atopic dermatitis on the body. The symptoms of facial eczema are similar to those of atopic dermatitis in other areas:

• Skin becomes dry, itchy and irritable
• Redness/blotchiness
• Small, rough bumps
• Flakes (yellow flakes could indicate seborrheic dermatitis)
• Stinging or burning sensation
• Crusty blisters that can weep
• Bleeding (in severe cases)

If you notice dry patches on the face, you could be suffering from dry facial skin but not eczema. Unlike the tightness or mild flaking associated with dry skin, facial eczema usually involves cracked skin and severe itchiness. Scratching the itch only makes symptoms worse, and the damaged skin can become darker, infected and start to thicken.

Facial atopic dermatitis, as with all forms of atopic dermatitis, is particularly common in babies and children and normally appears when they are between two and six months old. Eczema on the forehead and cheeks often appears first, but dermatitis on the face can spread to other parts of the body as they get older. Read more in Atopic dermatitis and babies and Atopic dermatitis and children.

Many children grow out of the condition. However, it can persist into adulthood and some adults suffer from dermatitis on the face without having had it in their youth. Some individuals only suffer from facial eczema for a week or two, but it can become a long-term condition for others.

Adult facial eczema can appear on the scalp, forehead and cheeks, behind the ears and in the delicate area around the eyes.

Symptoms differ from person to person, from season to season, and even from day to day. The disease has two distinct phases: the flare-up, or acute phase, when the skin is at its most itchy and irritable, and the calmer period between flare-ups.

Face eczema is distressful precisely because it is so visible. Whilst non-contagious, it can create mental health issues for both children and adults, contributing to feelings of low self-esteem. It is known to have a considerable impact on the quality of life of those who suffer from it and their families. Read more about this in How atopic dermatitis affects sleep and quality of life.

Eczema on the neck

As an area, the neck can be compared to a set of skin folds, so it's one of the most common areas affected by atopic dermatitis in childhood. During adulthood, 'Head and Neck dermatitis' is a specific form of eczema located on the neck and the face.

Though a relatively small region, the neck is exposed to a number of triggers that can cause irritation, such as tight-necked clothes, jewellery and wooly scarves. Wearing cotton or fleece scarves and looser clothing can reduce tenderness. The neck is an easily-accessible area, so eczema sufferers can sometimes scratch their neck without realising.

Atopic dermatitis is not the only kind of eczema that can affect you or your child on the face. Other varieties include:

• Seborrheic dermatitis: Though the symptoms are similar,  the skin is rarely itchy. This normally occurs around the hairline, ears, eyebrows and nose. 
• Contact dermatitis: An allergic reaction to something with which your face comes into contact, such as make-up (although make-up may also trigger the symptoms of atopic dermatitis on the face). This often occurs around the hairline and eyes, as well as areas that come in contact with jewellery or perfumes like the earlobes and the neck.
• Photodermatitis: This occurs when the skin reacts to the sun. Sunlight can also be a trigger for atopic dermatitis, while other sufferers find that it can ease the symptoms. 

Atopic dermatitis is a genetic disease that is linked to a compromised skin barrier function and an immune disorder. Triggers vary from person to person but can include climate and pollution, stress or sensitivity to allergens like dust.

Other external aggressors include harsh facial cleansers, household products like soap or synthetic fibers, and certain make-up products. One person's eczema could be triggered by a fragranced product, but the same product may not cause a reaction for somebody else. This is why it’s important to speak to a doctor about your facial eczema. 

The symptoms of atopic dermatitis are also its triggers. When your face feels itchy, it is very tempting to scratch it. This causes a bacteria called staphylococcus aureus to multiply and infect the skin, and this infection causes inflammation and itching, which worsens the condition. This vicious cycle is known as the ‘Atopic Skin Cycle’; you can find out more about it in Understanding Atopic Dermatitis.

There is no known cure for atopic dermatitis, but there are steps that you can take to reduce flare-ups, both in terms of their number and severity. There are also ways in which you can prolong the periods between flare-ups and calm and soothe your skin during a flare-up.

Effective treatment requires an accurate diagnosis of your symptoms to check that you or your child do actually have atopic dermatitis, rather than one of the other kinds of facial dermatitis. Consult your doctor for advice and recommendations on the most appropriate treatments for your skin.  Identifying any potential triggers and taking steps to avoid them is a key step towards reducing flare-ups.

Facial dermatitis requires careful treatment as the skin on our face can be irritated easily, and is vulnerable to the side effects of topical therapy.

Regular moisturisation
When caring for atopic facial skin on a daily basis, the primary aim is to prolong the non-acute phase, and regular moisturisation is crucial here. Look out for moisturisers (also known as emollients) that contain proven ingredients, such as:

• Licochalcone A: soothes skin and reduces redness
• Ceramides: strengthens the skin’s barrier function
• Omega-3 and Omega-6: soothes and nourishes the skin, while replenishing its protective barrier.

These are the key ingredients in Eucerin AtoControl Face Care Cream, which is proven to give atopic skin the daily care that it needs for an eczema on the face treatment.

Eczema cream for the face
Eucerin AtoControl Face Care Cream can also be used during a flare-up, but you may find that your face needs additional care in order to relieve itching and soothe redness and irritation.

Eucerin AtoControl Acute Care Cream (with antibacterial Decanediol and cooling Menthoxypropandiol) has been specially formulated to give skin the care and comfort that it needs during flare-ups. 

Both products can be used as an eczema cream for the face, alongside medical treatments which often help to calm severe symptoms. Find out more about them in Identifying and managing flare-ups.

Gentle cleansing
Harsh cleansers and soap can exacerbate eczema on the face, so choose a mild facial cleanser such as Eucerin UltraSENSITIVE Cleansing Lotion. If you like to rinse your cleanser off with water, use lukewarm instead of hot water. Hot showers can cause further dryness and trigger facial eczema in some people. Pat gently with a soft towel to dry the skin instead of rubbing. 

Sun protection
Some people find that a little bit of sun helps with their symptoms, whilst others find that it exacerbates them. Either way, make sure you give your skin the protection that it needs, with products that are proven to be suitable for atopic facial skin. You can read more about the importance of sun protection in skin and the sun.

Make-up
Choose products that are fragrance-free and, ideally, that have been proven to be suitable for sensitive skin. Applying make-up over a facial eczema rash can sometimes cause further irritation. Liquid foundations should be used instead of oil-absorbing powders, which can increase existing dryness. Be sure to remove your make-up fully before you go to bed.

On the whole, treatment for facial dermatitis involves avoiding further irritation from triggers, switching to a gentle skin cleansing routine and treatment with medical products. Mild facial eczema can sometimes be treated with consistent moisturising and the skincare practices mentioned in this article. However, in many cases topical treatments are required.

Topical corticosteroids: Steroid creams are a key method of getting rid of the eczema on the face because they ease red, itchy skin. If recommended by your doctor, 1% hydrocortisone creams are preferred, as they post less risk of skin thinning. For this reason, they’re recommended for a short amount of time only (less than a month).

Topical calcineurin inhibitors: TCIs might be prescribed to treat facial eczema instead. The non-steroidal medications block chemicals that can make your eczema flare-up. These creams and ointments do not lead to skin thinning, so are commonly used for eczema on the face, including around the eyes and on the eyelids.

Ultraviolet phototherapy: This may be recommended for moderate to severe facial eczema if cream medications haven't treated the condition.