About facial eczema

Eczema often affects the face, and facial eczema can be particularly distressing because it is so visible. In addition, facial skin is very sensitive, and even the mildest degree of inflammation can feel sore, itchy and uncomfortable. Like eczema on other areas of the body, affected skin is red, dry and flaky, and sometimes weepy, crusty or blistering. In most people there is no identifiable cause, but usually there is a history of atopic eczema. In some cases, contact with an external irritant chemical or allergen can be the cause (contact dermatitis). If allergy is suspected, a referral to a dermatologist for patch testing is often required, as it is not always possible to tell if someone has an allergic facial eczema by appearance alone.

What types of facial eczema are there?

Types of facial eczema include:

• Atopic eczema
• Irritant contact dermatitis
• Allergic contact dermatitis
• Seborrhoeic dermatitis
• Light-sensitive eczema

How is it treated?

Eczema on the face requires careful treatment as facial skin is more easily irritated by and vulnerable to the side effects of topical therapy. It is important to consider the possibility of an allergic contact dermatitis in anyone with persistent facial eczema, even if they have a longstanding, in-built eczema tendency. It is important to get a diagnosis of which type of facial eczema you have in order to know which treatment is likely to work best, and to help give an idea of the expected outcome.

Emollients (medical moisturisers) are the main first-line treatment for eczema and are necessary to keep your skin moisturised. Emollients can be bought over the counter in pharmacies and some supermarkets, or supplied on prescription. There is a wide range of emollients, which vary in their levels of greasiness. The dryer the skin, the greasier an emollient is needed. Ointments are the greasiest type of emollient.

Topical steroids are the most common treatment for inflammation in eczema. They should be used according to the instructions of your GP. Usually only mild and moderate topical steroids are used on the face.

Topical calcineurin inhibitors (Elidel and Protopic) are helpful options for the long-term management of facial eczema as they do not carry any risk of skin-thinning. Topical calcineurin inhibitors can make the skin more light sensitive, so they should be used at night or with sun protection applied two hours after application. Topical calcineurin inhibitors can be prescribed by your GP.

If you have seborrhoeic dermatitis, anti-yeast treatments are likely to be needed.

For more information, please see our factsheets on Facial eczema and Seborrhoeic dermatitis