An Overview of Eczema on the Face

Woman checking her face in the mirror

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Eczema is the name given to a group of conditions that can cause an itchy, red, and inflamed skin rash, according to the National Eczema Association (NEA). The rash can pop up anywhere on the body, but it can be especially uncomfortable, painful, and itchy when it appears on the face. While facial eczema is quite common in babies and toddlers, it can appear in people of any age.

Symptoms

Eczema is a general term that describes inflamed, itchy skin. Most people use the term eczema to refer to atopic dermatitis (the most common type of eczema), but there are actually many different types.

The forms that are most likely to appear on the face are atopic dermatitis, contact dermatitis, and seborrheic dermatitis.

Although they are slightly different, all types of eczema have similar symptoms, including:

  • A red, blotchy complexion
  • 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 which may weep or ooze
  • Cracked skin that may bleed (in severe cases)

The skin may also feel sore and raw during a flare. If eczema lasts over long periods of time, the skin could eventually become thicker, discolored, or scarred.

Atopic dermatitis 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). But this form of eczema can occur anywhere on the face.

Contact dermatitis is also common around the eyes, 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 on the skin.

Seborrheic dermatitis occurs most often around the hairline, in the eyebrows, around the ears, and on the sides of the nose.

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.

Eczema Around the Eye

Eczema is very common around the eyes and on the eyelids. Although the eczema that develops around the eye isn't any different than eczema that develops on other areas of the face, the eye area 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, you should see a doctor.

Prompt treatment can help prevent eye problems from getting worse. It's important to catch them early, as untreated they can cause vision loss.

In general, eczema around the eyes is more common in adults than young children.

Causes

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: f 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 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 seems to cause eczema to appear—which can involve sweating, taking hot showers, or humid air. 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 or cleansers, and other facial products.

The skin on your face is especially delicate and is, therefore, more susceptible to irritation.

Diagnosis

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 irritated, the giveaway is the formation of acne pustules.

Treatment

Treating eczema on the face presents unique challenges because the skin is very delicate in this area. Although there’s no cure for facial eczema (or eczema located on other parts of the body), there are plenty of treatment options to make living with this condition more manageable.

Facial eczema is incredibly common in babies and toddlers, and may not be treated at all. Get advice from your child's pediatrician before embarking on a treatment plan.

Skin Care

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 protection. 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 on sensitive skin, though the one drawback is they can leave a white tint. When you’re out of the sun, wash your face and apply a moisturizer; sunscreens 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 when it comes to what you can put on your skin. Look for products 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 these can worsen irritation.

Medications and Procedures

If your eczema is mild, you may be able to keep in under control with good skincare practices and consistent moisturization. But medications are needed in many cases to manage this skin condition.

Over-the-counter hydrocortisone: OTC 1% hydrocortisone cream can be used to ease itching and redness. Unfortunately, these should not be used in the eye area. Also, they shouldn't be used long-term to keep eczema in check.

Topical corticosteroids: These are cornerstone treatments for eczema of the body, but for the face, they must be used with care. Weak steroids can be used for facial eczema, for the short-term. The delicate facial skin is more susceptible to thinning and pigmentation changes that are side effects of topical steroids.

Topical calcineurin inhibitors: These medications are commonly used to treat facial eczema. Because they are not steroid medications they do not cause thinning of the skin. They can safely be used around the eyes and on the eyelids.

Phototherapy: When treatments are unsuccessful, phototherapy may be the next step. Phototherapy uses a device to emit ultraviolet B light (also called UVB) 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.

Coping

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.

Finding Support

Because facial eczema is so front-and-center, many people feel embarrassed during a flareup. You may feel less self-confident or withdraw from social situations. These feelings are, to a large extent, normal.

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 support groups like what is offered through the National Eczema Association.

A Word From Verywell

When you live with facial eczema, it can feel like your face takes center stage. To keep the 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 skincare regimen to meet your skin’s needs.

Remember, what works for one person may not work for another. Additionally, don’t be afraid to reach out for support—either online or in-person—to find out how others cope with eczema. Knowing you’re not alone can make things just a little bit easier. 

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Article Sources

  1. Thyssen JP, Toft PB, Halling-Overgaard AS, Gislason GH, Skov L, Egeberg A. Incidence, prevalence, and risk of selected ocular disease in adults with atopic dermatitisJ Am Acad Dermatol. 2017; 77:280-6. doi:10.1016/j.jaad.2017.03.003


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