Don’t stress. No, really — it can trigger a flare-up.
Eczema on the face is a totally different, frustrating ballgame. “Eczema comes from the Greek meaning ‘to boil over,’ and it’s used to describe itchy, red, and inflamed skin,” says New York-based board-certified dermatologist Macrene Alexiades, MD. To be real, anything “boiling over” on our face is something we’d like to avoid.
According to the National Eczema Association, 31.6 million people in the U.S. have some form of eczema, making it one of the most common skin conditions. If you’re experiencing red, irritated skin on your face (especially your eyebrows, eyelids, cheeks, or chin), there’s a fairly good chance it’s facial eczema. You may already have it elsewhere on your body, or it could be on your face alone. And while there is no study evaluating the prevalence of facial eczema, specifically, New York City-based dermatologist Neil Sadick, MD, says he believes the disorder affects about a third of the population.
With facial eczema, you’ll have to do a bit of detective work to identify what’s causing it. There are a few types — atopic dermatitis and contact dermatitis being the two most common forms — and they act a little differently. Some types will resolve in a few weeks with treatment, while other cases are chronic and need constant management. But you’re not alone. There are solutions as well as ways to keep it under control.
Facial eczema can be itchy, flaky, and frustrating — your face is usually the first thing people see — and with so many types of eczema to parse through, it can be overwhelming. To help, we spoke with several board-certified dermatologists to find out what exactly constitutes facial eczema, what triggers the condition, and most importantly, how to keep symptoms at bay.
What Is Facial Eczema?
“Eczema is an inflammation of the skin caused by either an allergen or irritant,” says New York-based board-certified dermatologist Anthony Rossi, MD. It can also be genetic, and triggered by irritants.
Facial eczema has many different symptoms that can manifest themselves differently from person to person, but some common things to look for are red patches, itchy skin, stinging, and dryness. With darker skin tones, it also tends to be scaly, says Dr. Rossi.
Eczema is a common condition that can appear anywhere on the body, but if you’re grappling with facial eczema, it’s likely on the eyelids, eyebrows, cheeks, or chin. And while it is common, you definitely should bring it to your dermatologist. “Eczema that develops near the eyes needs special attention because the eyes themselves can be affected,” adds Dr. Alexiades. “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.”
Causes of Facial Eczema
There are a few different types of facial eczema — which will be key in not just identifying what you’re dealing with, but how you treat it. The most common type of facial eczema is atopic dermatitis. “Atopic dermatitis is genetic and flares can be triggered by dry environmental conditions, not moisturizing, stress, and allergies,” says New York-based board-certified dermatologist Hadley King, MD.
The second type is contact dermatitis, which comes from exposure to an irritating substance or something you may be allergic to (common perpetrators are cosmetics, dyes, soaps, detergents, fragrance, or smoke — in addition to environmental allergens like pet dander or pollen). “Some people break out in an eczema rash after eating certain foods, such as nuts, shellfish, milk, and eggs,” says Dr. Alexiades.
Try to note when you see an eczema flare and note any common denominators to your dermatologist. This should help both you and your dermatologist narrow it down and get to the root cause.
How to Prevent Facial Eczema
The best way to prevent eczema on the face is the most obvious but perhaps the most important method: identify the trigger and remove it. “For example, if you notice red patches when you wear jewelry, you may be allergic to nickel. Stop wearing jewelry and your eczema may go away,” says Dr. Alexiades. “If you notice red itchy patches after a night out, it may be perfume that is your trigger, in which case stop wearing fragrances and look for fragrance-free cosmetics.”
The same goes for cosmetics and skincare. “Know what’s in your skincare and if you’re prone to allergies,” says Dr. Rossi. It may be beneficial to go on a “product diet.” Pare down your routine to one gentle product (a cleanser is a good place to start) and add them back in slowly, one by one, to see if you can identify which product is causing your facial eczema. Patch testing—applying a small amount of a product to the sensitive skin on the inside of the arm to see if there is a reaction within 24 hours—can also help to narrow things down.
If you find that your flare-ups happen when you’re stressed, you may need to identify some lifestyle changes like taking on fewer projects, getting more rest, or finding more time for mindfulness. Likewise, if you notice that your facial eczema gets worse in dry or hot weather, try to plan ahead for AC breaks, come prepared with sunscreen, and find a thicker and more reliable moisturizer that can hang on all day.
How to Treat Facial Eczema
Sometimes, simply removing your facial eczema triggers will totally cure your skin within weeks. But if your facial eczema is very severe and you can’t identify any bad actors, you may want to try over-the-counter hydrocortisone or get a topical steroid prescription from your dermatologist. “A topical corticosteroid cream will help treat any of the causes of facial eczema,” says Dr. King. “Topical corticosteroids have anti-inflammatory effects.” They can be used as needed to treat flares but not for ongoing maintenance, according to the National Eczema Association, since prolonged use can cause withdrawal side effects like red, irritated skin and pimple-like papules.
Dr. Rossi adds that antihistamines can be an effective short-term solution if the eczema is caused by an allergen. Otherwise, “there are more systemic medications for severe or widespread cases,” he says.
How to Curb Flare-ups
Not all types of eczema have a surefire “cure,” but you can definitely make it more manageable and lessen your flare-ups. You may be able to curb irritation with good lifestyle habits, over-the-counter products, and consistent skincare with gentle but moisturizing products.
“Good, gentle care of your skin is the most important aspect of treating facial eczema,” says Dr. Alexiades, who recommends fragrance-free and hypoallergenic products if you find that you’re prone to flare-ups. “Consider a mild cleanser and wash your face with lukewarm water, since heat can cause a flare-up.”
Dr. Alexiades also touts the benefits of keeping your skin hydrated. She recommends moisturizers with emollient ingredients like ceramides and cosmetics that also have moisturizing ingredients. “Having facial eczema doesn’t mean you can never wear makeup, but not all products are the same,” she says. “Look for ingredients like hyaluronic acid and shea butter.” Moisturizers and cosmetics with moisturizing ingredients (like hyaluronic acid and shea butter) can help to protect the outer skin barrier—which can be damaged or compromised by eczema, according to the National Eczema Association.
Should I treat facial eczema differently than I would eczema on my body?
Yes. Both Sejal Shah, MD, a board-certified dermatologist in New York City, and Dr. Sadick recommend using milder products on your face because the skin is thinner and more sensitive than the skin on your body. “I would use eczema skin-care products designed for face and body respectively as they contain different concentrations of active ingredients,” says Dr. Sadick.
Adam Friedman, MD, FAAD, an associate professor of dermatology at George Washington School of Medicine and Health Sciences in Washington, D.C., recommends using weaker topical steroids, as he says, “facial skin is more sensitive to the skin thinning and lightening effect of topical steroids.” According to a study by the National Eczema Association, prolonged use of strong topical steroids can cause a host of withdrawal symptoms once you stop using the cream—like burning, stinging, papules, or pimple-like bumps. However, short-term use is safe and effective with the guidance of a dermatologist.
What should I do if over-the-counter products aren’t cutting it?
Sadly, sometimes eczema on the face can prove extremely stubborn to the point where treatment may need to be prescribed by a doctor. “If home treatments are not helping, you may need prescription medications,” says Dr. Shah. “I usually prescribe either a topical steroid or a topical calcineurin inhibitor, a non-steroidal medication that can reduce inflammation and treat eczema.”
Dr. Shah says she sometimes prescribes special moisturizers called barrier repair creams for patients. And if the eczema is severe and not responding to topical treatments, other options include phototherapy, aka light therapy. There’s a wide range of treatment options for facial eczema, so it often comes down to trial and error in order to figure out what works for you. We’d recommend always consulting your dermatologist before trying anything new.
