Everything You Need To Know About Facial Atopic Dermatitis

A red face often means a person is either super embarrassed or deeply sunburnt. But people with eczema know another possible explanation for their tell-tale flush: Atopic dermatitis on the face. Here's what you should know about atopic dermatitis—what it looks like, what symptoms are associated with it, what causes it—and how you can prevent and treat it.

Atopic dermatitis—one of the most common types of eczema—is an inflammatory skin condition, Tiffany Jow Libby, MD, director of Mohs micrographic and dermatologic surgery at Brown Dermatology in Providence, R.I., told Health.

In the simplest terms, that means people with atopic dermatitis have immune systems that overreact to things that aren't irritants to most people. They also often have compromised skin barriers, making it easier for potential skin irritants to get through the skin and into your body. That can cause patches of sore, itchy, discolored skin.

Atopic dermatitis can show up anywhere on the body. It most commonly appears on the wrists, ankles, elbows, and knees in adolescents and adults. Chronic skin conditions can affect the face, too.

This photo contains medical imagery.

See Image

What Is Facial Atopic Dermatitis?

Atopic dermatitis is a chronic inflammatory skin disease that can occur anywhere on the body, said Dr. Libby. When atopic eczema affects the face, it typically occurs on the cheeks and folds of the neck in children and around the eyes in adults.

Dr. Libby said that atopic dermatitis on the face could often be confused for other skin conditions because of how itchy and rashy it is.

For example, babies often get contact dermatitis—eczema caused by direct contact with an irritant—around their mouths because of drool or introduction to certain foods. Psoriasis and fungal infections such as ringworm, which can cause itchy, scaly patches on the body, can also be mistaken for atopic dermatitis.

Despite their similar appearance, these conditions have different causes and thus require other treatments.

Symptoms

There are a few key indications that what you're experiencing on your face is likely atopic dermatitis:

• Very dry skin: On its own, dry skin might be just that, but if combined with other symptoms, you're likely dealing with eczema.
• Itchy skin: This is the hallmark of atopic dermatitis, no matter where it occurs.
• Discolored patches: These can appear on your cheeks or around your eyes. More specifically, atopic dermatitis makes the skin look red in lighter-skinned people. Dr. Libby explained that the rash could be more subtle and look reddish brown, grey, or purple-grey in darker-skinned people. Darker-skinned people may also experience temporary pigment changes once their skin heals, lasting for a few months.
  

Causes and Risk Factors

Atopic dermatitis is caused by a few factors, no matter where it flares up on your body. 

As explained by Dendy Engleman, MD, FAAD, a board-certified dermatologist in New York, genetics can play a role. If your parents have it, that makes you more likely to develop it. Some (but not all) people with atopic dermatitis also have genetic mutations that affect their skin's ability to protect itself.

The most common risk factors of atopic dermatitis generally are:

• Existing allergies or asthma problems: Thank the "atopic triad" for this one. People with allergies or asthma are also more likely to have atopic dermatitis (and vice-versa).
• A change in seasons: Changing humidity and temperatures in the spring and fall are common eczema triggers, added David Kim, MD, a board-certified cosmetic dermatologist.
• Life stress: Stress can also trigger eczema flare-ups if you have the condition, said Dr. Libby.
• Other environmental factors: Some research suggests that air pollution and humidity may influence the risk of developing atopic dermatitis or triggering flare-ups.

Treatment and Prevention

All three dermatologists mentioned that steroids are the most common route for treating atopic dermatitis. However, the facial skin is fragile and delicate, making the treatment slightly different.

"When you're treating the face or the arms, you want to be a little more cognizant of the skin, and you try to stay away from using the most potent steroids," said Dr. Kim. 

That's because thinner skin absorbs more of the steroid—increasing a person's risk of experiencing side effects like thinning skin, discoloration, and stretch marks.

When treating atopic dermatitis on the face, Dr. Libby mentioned that she often prescribes a very low dose of topical steroid cream or resorts to non-steroidal topicals—including:

• Elidel (pimecrolimus)
• Protopic (tacrolimus)
• Eucrisa (crisaborole)

All of those fight itchy, inflamed and discolored skin. To reduce the risk of flare-ups, "maintaining a healthy skin barrier is going to be key," mentioned Dr. Libby. 

Translation: Bust out that moisturizer. It keeps your skin hydrated and ensures the proper functioning of your skin's barrier. Basically, it keeps the good stuff in and the bad stuff out.

Dr. Libby recommended looking for a moisturizer with ceramides, a type of lipid that protects the skin barrier and is often deficient in people with eczema. Dr. Engelman added that it also naturally declines as you age, so adding it back to your skin through moisturizer is essential.

Dr. Engelman said you'll also want to keep your skincare routine simple and gentle. Avoid harsh active ingredients like alpha-hydroxy acids (such as glycolic acid), beta-hydroxy acids (such as benzoyl peroxide), and retinoids, especially during flare-ups.

If you're also hoping to address acne or signs of aging, talk to your dermatologist for help putting together an effective routine that won't aggravate your sensitive skin. "Options like bakuchiol [a retinol alternative] are probably way better tolerated," Dr. Engelman provided as an example.

A Quick Review

Atopic dermatitis on the face can seem like an itchy, frustrating nightmare. However, with guidance from your dermatologist and the proper treatment, you can tamp down a flare-up in no time.