Eczema on the face: causes and how to treat it

Eczema is a group of skin conditions that make skin dry, itchy and inflamed. The face is one of the most common places for it, and one of the most visible. A doctor should confirm that a facial rash is eczema, because several other conditions look alike on the face, and because facial skin needs a careful choice of treatment. This guide explains where eczema appears on the face, what causes it, how a doctor may treat it and how to care for facial skin day to day. For the condition as a whole, see the complete guide to eczema.

Where eczema appears on the face

Where facial eczema shows up depends on age.

Babies and toddlers. The NHS says atopic eczema is common on the face in babies and toddlers. The American Academy of Dermatology (AAD) says babies and young children often get it on the cheeks, forehead or scalp. On lighter skin it often looks like a red rash with bumps. On darker skin there may be several bumps, with or without redness, and darker patches.

Adults. The AAD says adults, unlike children, often have atopic dermatitis around their eyes, where the skin is often thick and darker than the skin around it and tends to be itchy. MedlinePlus Genetics says that in teenagers and adults, the rash usually appears on the eyelids, wrists and ankles, as well as the bends of the elbows and knees. The US National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) lists darkening of the skin under the eyes and an extra fold of skin under the eye among the common signs of atopic dermatitis.

Other rashes on the face

Atopic eczema is only one cause of a rash on the face. Three others are common:

• Contact dermatitis. This type of eczema is a reaction to something that touches the skin. The NHS says it most often affects the hands and face. MedlinePlus says hair products, cosmetics and perfumes can cause reactions on the face, head and neck, and lists fragrances, nail polish, hair dyes and adhesives such as false eyelash glue among common causes.
• Seborrheic dermatitis. The AAD describes a scaly rash on oily areas like the scalp and face. It can appear on the ears, eyebrows, beard or the skin around the nostrils. MedlinePlus adds the eyelids, the creases of the nose and the lips.
• Discoid eczema. This type causes round patches, but the NHS says it does not usually affect the face.

The guide to types of eczema explains each one in more detail. A doctor can tell them apart, and each needs different treatment.

What face eczema feels like

Facial eczema usually itches. The AAD says atopic dermatitis can make skin feel warm and swollen, and that the skin around the eyes tends to be itchy. MedlinePlus says contact dermatitis caused by an irritant can cause burning or pain as well as itching, and that dry, red, rough skin is common. Scratching and rubbing make the skin raw, and over time, the AAD says, skin that is rubbed often can become thick.

How to treat eczema on the face: what a doctor may offer

Facial skin needs extra care with medicine, which is the main reason to let a doctor choose the treatment for facial eczema.

Steroid creams. Steroid creams are the most common eczema medicine. The AAD says side effects are rare when a steroid cream is used as a dermatologist directs. It also says skin thinning is the most serious side effect on the skin, and that thinning is more likely when a high-strength steroid is used on the face or neck. Even hydrocortisone, which can be bought without a prescription, can cause side effects, the AAD says. The skin side effects it asks people to report include bruising, visible blood vessels, stretch marks, thinner skin, and breakouts that look like acne or rosacea.

For children, NICE, the UK body that writes guidance for doctors, tells doctors to use mild steroid strengths on the face and neck, with a moderate strength only for 3 to 5 days during a severe flare. A doctor chooses the strength for each person and each area of skin.

Non-steroid creams. The AAD says pimecrolimus cream and tacrolimus ointment are "steroid sparing," meaning they avoid steroid side effects such as thinning skin. It says a dermatologist may prescribe one of them when steroids stop working, do not work, or are not a good option, and that one may be prescribed for the skin around the eyes. The most common side effects are burning and stinging, which tend to fade as the skin heals. NICE says that when facial eczema in children needs mild steroids often or for a long time, doctors should consider stepping up to one of these creams. Other non-steroid creams are covered in the guide on how eczema is treated.

For contact dermatitis. The NHS says the most important step is to find and avoid the substance causing it. A doctor may arrange patch testing, which places small amounts of possible allergens on the skin and checks the reaction over several visits, according to MedlinePlus.

For seborrheic dermatitis. MedlinePlus says a doctor may prescribe a shampoo, cream, ointment or lotion containing ketoconazole, ciclopirox, a steroid, or tacrolimus or pimecrolimus.

Whatever the plan, keep to the directions you are given, and talk to your doctor before you stop or change a prescribed treatment.

Daily care for facial skin

Good skin care helps every type of facial eczema:

• Moisturize often. The NHS says it is especially important to apply moisturizer to the hands and face regularly, because they are more exposed than the rest of the body.
• Wash gently. The NHS advises washing with a moisturizer instead of soap, because everyday soaps dry the skin and can make eczema worse. MedlinePlus says not to scrub the skin too hard.
• Choose fragrance-free products. The AAD says fragrance can cause atopic dermatitis to flare, and that "unscented" products can still contain a fragrance that has been covered up. It recommends products labelled "fragrance free."
• Test new products first. The AAD suggests applying a small amount of a new product to the inside of your arm every day for 7 to 10 days, and using it only if your skin stays clear. The guide on how to patch test a new skincare product walks through the steps.
• Watch for acne-like spots. The NHS says some moisturizers can cause rashes on the face that make acne worse. If that happens, ask a pharmacist or doctor about a different product.

Weather, sun and facial eczema

The face is exposed to the weather more than most skin, and weather affects eczema. The AAD says cold temperatures can dry the skin and make atopic dermatitis flare, and that overheating and sweat can also trigger a flare-up. MedlinePlus lists cold, dry winter air among the things that make atopic dermatitis worse.

Sunlight is a mixed case. MedlinePlus says sunlight may improve seborrheic dermatitis, and that some people find it gets better in summer. For atopic dermatitis, the AAD says not to use tanning beds, sunlamps or sitting in the sun as a home version of light treatment, because overheating or sunburn can cause a flare and raise the risk of skin cancer. The AAD also says people should stay out of the sun and avoid tanning beds while tacrolimus or pimecrolimus is part of their treatment plan.

Eyes: when to see a doctor quickly

Eczema near the eyes can come with eye problems. NIAMS lists conjunctivitis (pink eye), which makes the inside of the eyelid and the white of the eye red and swollen, and blepharitis, which makes the eyelid red and inflamed, among the complications of atopic dermatitis. The AAD says adults with eczema should watch for eye problems.

Blisters near the eyes need urgent care. MedlinePlus says to contact a doctor for sores or blisters near the eyes caused by the cold sore virus. NICE says that if eczema herpeticum, a serious cold sore virus infection of eczema, affects the skin around a child's eyes, the child should see an eye specialist and a dermatologist the same day.

Babies with eczema on the face

The NHS says atopic eczema is common on the face in babies. Any rash on a baby's face should be checked by a doctor, who can confirm what it is and explain how to care for it. The NHS says to ask for an urgent appointment if a baby's eczema is blistered, crusty, leaking fluid, painful, swollen or warm, if it suddenly gets worse, or if the baby has a high temperature.

Marks left after facial eczema

The AAD says that after atopic dermatitis heals, the skin may be lighter or darker where the rash was. For seborrheic dermatitis, the AAD says people with darker skin tones can develop dark spots and patches that are noticeable on the face, and that early treatment can prevent them. The guide does eczema go away? covers how long eczema and its marks tend to last.