An Overview of Eczema on the Face

An eczema rash can pop up anywhere on the body. But eczema on the face can be especially uncomfortable, painful, and itchy. That's because facial skin is especially sensitive. The rash, which is red, dry, and flaky, can also even blister.

Facial eczema can appear on its own or alongside eczema on the body. And while some people have it only occasionally, others deal with it on a more consistent basis.

This article explains the types and causes of facial eczema and how the condition is diagnosed and treated.

Types of Facial Eczema

Eczema is actually a term for a group of conditions that cause itchy, red, and inflamed skin rashes. The types of eczema that are most likely to appear on the face are:

• Atopic dermatitis: This is the most common type of eczema overall. It is very common on the cheeks and chin, especially in infants. It can also appear around the eyes, on the eyelids, and around the lips. It can, however, occur anywhere on the face or the rest of the body.
• Contact dermatitis: This is also a common type of eczema. It is a skin reaction to a specific irritant. On the face, it is usually found around the eyes, the hairline, and in areas that contact perfumes and jewelry, like the neck and earlobes. But, like atopic dermatitis, this type of eczema can occur anywhere.
• Seborrheic dermatitis: This type 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:

• Redness/blotchiness
• Itching that is sometimes intense
• Stinging or burning
• Dryness and flaking (these flakes may be yellow in the case of seborrheic dermatitis)
• Rough or bumpy skin
• Swollen eyelids
• Small blisters that may weep or ooze
• Cracked skin that may bleed (in severe cases)

The skin may also feel sore and raw during a flare-up. If eczema (on the face or elsewhere) lasts long, the skin can eventually become thick, discolored, or scarred.

Nearly 30 million people live with eczema in the United States, and it impacts everyone differently. Some people may experience minor flare-ups, where their skin becomes mildly itchy. For others, flare-ups involve severe itching, dryness or oozing, and bleeding.

Eczema Around the Eye

When eczema occurs on the face, it often affects the skin around the eyes or eyelids (particularly in adults). Eczema that develops near the eyes needs special attention because the eyes themselves can be affected.

Those with eczema around the eyes are more susceptible to certain eye problems such as conjunctivitis (pink eye), inflamed cornea, and changes in the shape of the cornea (a condition called keratoconus).

Causes of Eczema on the Face

The exact causes of eczema aren't known. But there are a few things that seem to contribute to its development. These factors include:

• A family history of eczema: If a family member has it, you may also be likely to develop it.
• 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. However, individuals with a healthy immune system can have this skin condition, too.
• Your location: Eczema occurs more often in people who live in the Northern Hemisphere, metropolitan areas, or places with pollution.
• Your age: It’s more typical to see eczema in babies or small children—especially facial eczema. Many children eventually outgrow the condition. However, eczema can continue into adulthood and affect people of all ages.

Triggers

The skin on your face is especially delicate. It is, therefore, more susceptible to irritation. According to the National Eczema Association (NEA), some general triggers that could lead to a flare-up of eczema include:

• Environmental irritants and allergens: These are materials and chemicals that come in contact with your skin. They include ingredients in soaps, shampoos, cleaning products, fragrances, cigarette smoke, contact with metals, and fabric dyes. Common allergens (substances that cause an allergic reaction) include 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, and 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, hot weather seems to cause eczema to appear. Alternatively, dry winter air can act as a trigger as well.
• Hormone fluctuations: The rise and fall of estrogen or progesterone, in particular, may contribute to eczema flares.

Diagnosis

There is no specific test used to diagnose eczema. Instead, your healthcare provider will consider your symptoms and medical history and examine your skin.

If needed, patch testing, a skin scraping/KOH test, or a skin biopsy may be done to help with the diagnosis. Knowing what type of eczema you have will help your healthcare provider come up with 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. Also, unlike eczema, it clears up quickly with regular use of moisturizing creams.
• Acne: While this skin condition causes redness and bumpiness and is often irritating, the formation of a pimple distinguishes it from eczema.

Treatment

Although there’s no cure for eczema, there are plenty of treatment options to make living with this condition more manageable. That said, keep in mind the sensitivity of facial skin as you consider which treatment may be best.

If your eczema is mild, you may be able to keep it under control with good skincare practices and consistent moisturizing. In many cases, however, medications are needed.

Janus Kinase (JAK) Inhibitors

Newer treatments for atopic dermatitis are JAK inhibitors, including Cibinqo (abrocitinib) and Rinvoq (upadacitinib). The Food and Drug Administration (FDA) approved Cibinqo for the treatment of adults with refractory moderate to severe atopic dermatitis whose disease is not adequately controlled with other medications, and Rinvoq for children ages 12 years and older.

Both of these medications are taken by mouth daily and work by blocking pathways that cause many of the symptoms of atopic dermatitis, including inflammation and itching.

Skin Care

Good, gentle care of your skin is the most important aspect of treating facial eczema. Use only cosmetics that are fragrance-free and hypoallergenic (that is, are less likely to trigger allergies). Here are some things to keep in mind:

• 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 with lukewarm water. Hot showers can act as a trigger for eczema in some people. To reduce the risk of flare-ups from heat, wash your face 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. Also, look for products with emollient ingredients like ceramides. And make sure that they are dye-free and fragrance-free to reduce your chances of irritation.
• Be mindful of the sun. If the sun triggers your flares, you may need to wear sunscreen. Generally, sensitive skin more easily tolerates products that contain zinc oxide or titanium dioxide. 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 the same. 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.

Over-the-Counter (OTC) Hydrocortisone

Topical steroids are common treatments for eczema of the body. But for delicate facial skin, you must use them with care. Healthcare providers often prefer OTC 1% hydrocortisone cream, as it poses less risk of thinning the skin and changing skin color than more potent creams.

With your healthcare provider's OK, the cream can be used short-term (less than four weeks) to ease itching and redness. Hydrocortisone should not be used around the eyes.

Topical Calcineurin Inhibitors

Elidel and Protopic are medications that are commonly used to treat facial eczema. Since they are non-steroidal medications, they do not cause thinning of the skin. Therefore, you can safely use them around the eyes and on the eyelids.

Phototherapy

When these aren't successful, phototherapy may be the next step. Phototherapy uses a device to shine ultraviolet B (UVB) light onto the skin. This reduces itching and inflammation, boosts vitamin D production, and enhances the body's natural ability to fight bacteria on the skin.

Coping

Having eczema can be frustrating. But there are steps you can take to ease the burden of this skin condition.

Dealing With Itching

The itching that accompanies eczema can be extreme. Sometimes the itching is so bad that it interferes with your ability to sleep or carry on with your normal daily activities. Antihistamines and damp, cooling cloths placed over the itchy area can help in some cases.

Finding Support

Because facial eczema is easy for others to see, many people feel embarrassed during a flare-up. As a result, 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 healthcare provider if any local support groups meet near you or check out online options like those offered through the NEA.

Summary

Facial eczema is a red, flakey, itchy rash that appears on the face. The rash may crack or turn into blisters that bleed or ooze.

While a cause is unknown, certain things like allergies, asthma, and a family history of eczema may increase your risk of developing the condition. Eczema flare-ups are often triggered by exposure to chemicals, fragrances, heat, allergens, and stress.

There is no cure for eczema. However, many treatments can help you manage your eczema and prevent flare-ups. Keeping your skin moist, avoiding triggers, using medications, and phototherapy are all effective treatment options.