Types of Facial Eczema
What is facial eczema?
Facial eczema is an irritating and itchy red rash on your face. Atopic dermatitis is the most common form of eczema, causing dryness, scaling, and itching on the face and other areas of your body. It is more common in children, affecting 10% to 30% of kids. But it also occurs in about 2% to 10% of adults.
The cause of eczema is not fully understood, but genetic and environmental factors (such as living in an urban environment) may play a role. While not dangerous, eczema does weaken your skin’s protective outer layer, making you more vulnerable to skin irritation and infections.
Main signs of facial eczema
The main symptom of facial eczema is an itchy rash on your face. The rash is often scaly and red, or it may appear lighter or darker than your natural skin tone. If the irritation is chronic, your skin can become thickened and dry.
The itch can be so intense that you could have breaks in your skin from scratching, which can lead to an infection. Sometimes, the itching may be so severe that it interferes with your sleep.
Check out your palms. If you have hyperlinear palms (many lines and deep creases), it may mean that you have a higher chance of developing atopic dermatitis and ichthyosis (dry, scaly skin). —Dr. Edward Bae
Types of facial eczema
Atopic dermatitis is the most common form of facial eczema. It most often affects infants and babies under 2 years old. It is commonly on the cheeks, but it can also be on the scalp, neck, torso, elbows, and knees. Up to 90% of infants with atopic dermatitis will have facial eczema by 6 months of age.
Adolescents and adults can develop atopic dermatitis, but usually on their eyelids.
Repeated exposure to saliva causes this form of eczema, which appears around the lips. Lip-licker’s eczema often affects children.
Eczema on the eyelids is most common in older children, teens, and adults. Chronic irritation of the eyelids may lead to more prominent skin markings (known as lichenification) or darkening of the skin around your eyes.
Neurodermatitis affects small areas of the skin and is intensely itchy. It’s more common in older people, and it can affect the eyelids, according to the National Eczema Association.
Seborrheic dermatitis is a mild fungal infection. It causes itching and greasy scaling on the scalp and face.
This type of eczema is caused by exposure to an environmental irritant or allergen. Common culprits of contact dermatitis include personal care products (shampoo, cosmetics), topical over-the-counter antiseptics (like Neosporin), and nickel (commonly used in jewelry and belt buckles).
Eczema vs. psoriasis
Eczema and psoriasis have some similar symptoms, like itching, and facial eczema sometimes looks like psoriasis. But itching is milder in psoriasis and psoriasis lesions tend to be thicker and scalier than eczema patches. It is also less common than eczema, according to the American Academy of Dermatology.
The areas affected also vary. Psoriasis is more likely to appear on the scalp, buttocks, knees, and the back of your elbows. Eczema, on the other hand, usually develops on the inner elbows and the back of the knees.
Facial psoriasis is less common than facial eczema. Facial psoriasis usually occurs near the hairline and behind the ears, while facial eczema tends to affect the eyelids and central face. Facial psoriasis often looks like dandruff on the face with red greasy patches and flaky scales.
Children with atopic dermatitis can outgrow their eczema. When you develop atopic dermatitis later in life, it is likely to be as facial dermatitis or hand dermatitis. But facial eczema is almost never caused by food in an adult who doesn’t have a previous history of food allergies. —Dr. Bae
What triggers eczema flare-ups?
Triggers differ with age. For infants and children, food is a common culprit (30% of children and infants with eczema have food sensitivities). Common trigger foods include:
In patients who have moderate to severe atopic dermatitis, the following can worsen the disease:
- Dust mites
- Pet dander
How to treat eczema on the face
The first step in treating facial eczema is seeing your primary care doctor or dermatologist to identify the cause.
Topical therapies for mild to moderate eczema
- Moisturizer. Moisturizing your skin is one of the most important therapies for eczema. The best time to apply it is shortly after bathing. Use moisturizer daily, even when you’re not experiencing a flare.
- Antihistamines. If itchiness is keeping you up at night, your doctor may recommend allergy medication to lessen itchiness and help you sleep.
- Steroid creams or ointments. The main prescription medication for eczema is a steroid cream or ointment. When you’re experiencing a flare, these can be used up to twice a day for several weeks to calm inflammation (or for a shorter period of time if your flares are mild). Using them over the long term isn’t recommended because they make your skin thin, especially when applied to sensitive areas, like your face, armpits, and groin. Steroid treatments should be applied before putting on moisturizer.
- Non-steroid topical therapy. If you need long-term treatment, immunosuppressive prescription medications such as tacrolimus, pimecrolimus, or crisaborole can be used. These medications don’t thin the skin and can safely be applied to the face, armpits, and groin. The most common side effect is a stinging or burning sensation, but this decreases after you’ve used them several times.
How long do I need to use the medicine before noticing an improvement? Many patients stop using a prescribed or recommended treatment after 1–2 days thinking it wasn’t working. Often, treatments take several days to weeks (2–3) to work. —Dr. Bae
For severe eczema
If your eczema is severe, your doctor may recommended these treatments:
- Phototherapy. Phototherapy (light therapy) can reduce inflammation of your skin. It may be used along with topical steroids. Usually, people who get phototherapy need to be treated several times a week. It may cause a mild sunburn. With long-term use, you may experience premature skin aging and have an increased risk for skin cancer. It’s important to note that phototherapy is not the same as a tanning bed because the type of light used is controlled in phototherapy.
- Systemic therapy. In some cases, oral medications that target the immune system may be used to control severe eczema. These are recommended when other treatments aren’t effective. They have serious side effects. Speak to your doctor about the risks and benefits before starting them.
Dr. Levy is a board certified dermatologist specializing in medical derm with expertise in acne, rosacea, skin cancer, psoriasis, and skin manifestations of rheumatologic disease. Her undergraduate education was completed at the University of Pennsylvania where she graduated summa cum laude and was inducted into the Phi Beta Kappa honors society. She graduated with a distinction in research from the Icahn School of Medicine at Mount Sinai and was inducted into the Alpha Omega Alpha Honor Medical Society. During medical school, she received a one year Doris Duke Clinical Research Fellowship Award. During that time, she investigated imaging techniques for early diagnosis of head and neck cancer. Her training continued with a medical internship at Memorial Sloane Kettering Cancer Center followed by dermatology residency in the Department of Dermatology at Yale University, one of the most prestigious dermatology departments in the country. Following her residency, she worked as a clinical Instructor at Yale School of Medicine. She currently sees patients in New York City and Westport Connecticut and is a Clinical Instructor in the Department of Dermatology at Mount Sinai School of Medicine. She is a Fellow of the American Academy of Dermatology.
Dr. Levy is well published in the field of dermatology having written articles on atopic dermatitis, psoriasis, acne, and skin manifestations of systemic disease. She is an avid lecturer and has been invited to lecture at state wide dermatology meetings. She is the editor of a board review Dermatology textbook.