An eczema rash can pop up anywhere on the body, but it can be especially uncomfortable, painful, and itchy when it appears on the face because of the skin's sensitivity. Inflammation gives way to redness and dryness, often resulting in flakes and, in some cases, blisters.
Facial eczema can appear on its own or with more widespread eczema. And while some have acute cases, others deal with it on a more chronic basis. Facial eczema is also quite common in babies and toddlers, but it can appear in people of any age.
Types of Facial Eczema
Eczema is actually an umbrella term for a group of conditions that cause itchy, red, and inflamed skin rash. The types of eczema that are most likely to appear on the face are:
- Atopic dermatitis: This, the most common type of eczema overall, is very common on the cheeks and chin (especially in infants), as well as around the eyes, on the eyelids, and around the lips (for adults). It can, however, occur anywhere on the face or the rest of the body.
- Contact dermatitis is also common around the eyes, as well as around the hairline and in areas that come in contact with perfumes and jewelry, like the neck and earlobes. As with atopic dermatitis, this type of eczema can occur anywhere.
- Seborrheic dermatitis most often occurs around the hairline, in the eyebrows, around the ears, and on the sides of the nose.
Facial Eczema Symptoms
Although they are slightly different, all types of eczema have similar symptoms, including:
- Itching, sometimes intense
- Stinging or burning
- Dryness and flaking (these flakes may be yellow in the case of seborrheic dermatitis)
- Rough or bumpy skin
- Inflamed or swollen eyelids
- Small blisters that may weep or ooze
- Cracked skin that may bleed (in severe cases)
This photo contains content that some people may find graphic or disturbing. The skin may also feel sore and raw during a flare. If eczema (facial or otherwise) lasts over long periods of time, the skin could eventually become thicker, discolored, or scarred. Nearly 30 million people are living with eczema in the United States, and it impacts everyone differently. Some people may experience minor flare-ups, such as mild to moderate itchy patches of skin, while others can develop flare-ups that include severe itching, dryness, or oozing and bleeding of the affected area(s).
Eczema Around the Eye
When eczema occurs on the face, it very often affects the skin around the eyes and on the eyelids (particularly in adults). Although this isn't any different than eczema that develops on other areas of the face, it does need special consideration. Those with eczema around the eyes are more susceptible to certain eye problems such as conjunctivitis, inflamed cornea, and changes in the shape of the cornea (a condition called keratoconus). If you have problems such as painful or watery eyes, sensitivity to light, eye redness, or eye pain, see a doctor. Prompt treatment can help prevent eye problems from getting worse; untreated, they can cause vision loss. Though not a medical concern, eczema around the eyes can also cause skin wrinkling.
According to the American Academy of Dermatology (AAD), doctors are uncertain as to what causes eczema, but there are a few factors that seem to contribute to the potential development of this condition. These factors include:
- A family history of eczema: If a family member has it, you may be likely to develop it as well.
- A diagnosis of asthma or allergies: If you have asthma or allergies your chances of getting eczema increase.
- Autoimmune diseases: If you have autoimmune issues, you may be at risk of developing eczema, though individuals with a normal functioning immune system can have the skin condition as well.
- Your location: Eczema is more prevalent in people who live in the northern hemisphere, metropolitan areas, or places with pollution.
- Your age: It’s more typical to see eczema on babies or small children—particularly facial eczema. Many children eventually outgrow the condition, but eczema can continue into adulthood and affect people of all ages.
The skin on your face is especially delicate and is, therefore, more susceptible to irritation. The National Eczema Association (NEA) notes some general triggers, which could lead to an outbreak of eczema:
- Environmental irritants and allergens: These are materials, substances, and chemicals that you encounter on a daily basis. They include (but are not limited to) ingredients in your soaps, shampoos, and cleaning products, perfumes and fragrances, cigarette smoke, contact with metals, fabric and fabric dyes. Common allergens consist of mold, pet dander, dust, and pollen.
- Food allergens: Some people break out in an eczema rash after eating certain foods. Common trigger foods include nuts, shellfish, milk, or eggs.
- Stress: To date, researchers aren’t sure why stress can set off eczema, but avoiding stress as much as possible may help reduce flare-ups.
- Outside temperatures: For many people, heat (be it environmental, from a hot shower, or sweating) seems to cause eczema to appear. Alternatively, dry skin that’s often a byproduct of the winter months can act as a trigger as well.
- Hormone fluctuations: Women, in particular, may experience eczema flares with the rise and fall of certain hormones.
When it comes to eczema on the face, pay special attention to anything that is coming in contact with your skin like makeup, facial masks, toners, cleansers, and other facial products.
There is no specific test used to diagnose eczema. Instead, your doctor will take a detailed look at your symptoms and medical history, as well as perform a visual exam of your skin. If needed, patch testing, a skin scraping/KOH test, or a skin biopsy may be done to help with the diagnosis. It's important to know what type of eczema you have in order to get the proper treatment. Eczema, in some cases, can be mistaken for other similar-looking conditions:
- Rosacea: This skin condition also causes redness and bumpiness across the cheeks and chin. The main difference is rosacea is not generally itchy.
- Xerosis: More commonly known as dry skin, xerosis causes flaking, and sometimes redness and irritation. It may itch, but not as intensely as eczema. Unlike eczema, it clears up quickly with regular use of moisturizing creams.
- Acne: While this skin condition causes redness, bumpiness, and is often irritating, the formation of acne pustules distinguishes it from eczema.
Although there’s no cure for eczema, there are plenty of treatment options to make living with this condition more manageable. That said, the sensitivity of facial skin must be kept in mind. If your eczema is mild, you may be able to keep in under control with good skincare practices and consistent moisturizing. In many cases, however, medications are needed. Before treating a baby or toddler, be sure to get advice from your child's pediatrician. Facial eczema is incredibly in young children and may not be treated at all.
Good, gentle care of your skin is the cornerstone of your facial eczema treatment. Any cosmetic product that is used on the face should be fragrance- free and hypoallergenic.
Use a gentle cleanser. Soap can be harsh and drying on your skin, making eczema worse. Instead, consider a mild, non-soap cleanser.
Wash your face and shower with lukewarm water. Hot showers can act as a trigger for eczema in some people. To reduce the risk of developing eczema due to heat, wash your face and shower using lukewarm water.
Keep your skin hydrated. If you have eczema, it's essential to keep your skin moisturized. Creams and ointments will give your skin the most hydration. Look for products that are dye-free and fragrance-free to reduce your chances of irritation, and with emollient ingredients like ceramides.
Be mindful of the sun. If the sun triggers a flare, you may need to wear sunscreen. Generally, products that contain zinc oxide or titanium dioxide are more easily tolerated by sensitive skin. When you’re out of the sun, wash your face and apply a moisturizer; sunscreens are helpful, but can be drying to your skin.
Look for cosmetics with moisturizing ingredients. Having facial eczema doesn’t mean you can never wear makeup, but all products aren’t created equal. Look for those that have hydrating ingredients like hyaluronic acid and shea butter. Steer clear of ingredients like parabens (a group of preservatives), salicylic and glycolic acids, fragrances, and retinol, as they can worsen irritation.
Medications and Procedures
When more is needed to control your symptoms, medications can be considered:
Over-the-Counter (OTC) Hydrocortisone
Topical corticosteroids are cornerstone treatments for eczema of the body. But for delicate facial skin, they must be used with care. If recommended, OTC 1% hydrocortisone cream is the preferred option, as it poses less risk of skin thinning and pigmentation changes than more potent formulations.
The cream can be used short-term (less than four weeks) to ease itching and redness with your doctor's OK. Hydrocortisone should not be used in the eye area.
Topical Calcineurin Inhibitors
Elidel and Protopic are medications commonly used to treat facial eczema. Because they are nonsteroidal medications, they do not cause thinning of the skin. They can safely be used around the eyes and on the eyelids.
When these aren't successful, phototherapy may be the next step. Phototherapy uses a device to emit ultraviolet B (UVB) light onto the skin, which reduces itching and inflammation, boosts the production of vitamin D, and enhances the body's natural ability to fight bacteria on the skin.
Having eczema can be incredibly frustrating. There are steps you can take to ease the burden of this skin condition.
Dealing With Itching
Itching of eczema can be extreme, to the point that it interferes with your ability to sleep or carry on with your normal daily activities. Antihistamines can help in some cases, as can damp, cooling cloths placed over the itchy area. If your itching is severe, ask your physician about the best ways to manage the itch.
Because facial eczema is so front-and-center, many people feel embarrassed during a flare-up. You may feel less self-confident or withdraw from social situations.
Reach out to supportive family and friends. Finding people who understand can also do wonders for your mental outlook. You can ask your doctor if there are any local support groups that meet near you or check out online options like those offered through the NEA.
A Word From Honayst
When you live with facial eczema, it can feel like your face takes center stage. To keep bothersome symptoms manageable, schedule regular visits with a dermatologist. The needs of your skin may vary with seasonal changes and as you age. Your doctor can educate you about new medications and therapies, provide you with options to control symptoms, and help you develop the best skin care regimen to meet your skin’s needs.