Most eczema on the face settles with the right cream. However, finding what works in your situation can be difficult. Facial skin is thin and sensitive, so the strong steroid creams that clear an eczema flare on other parts of the body usually aren’t the right choice.
There’s a group of non-steroid prescription creams made specifically for eczema on the face and other sensitive areas. They settle a flare without thinning the skin, which is especially important for areas with naturally thin skin, like the eyelids.
In this article, we cover what facial eczema looks like, what treatment options are available in Canada, and how to see a doctor online for advice.
An Overview of Eczema on the Face
Eczema usually occurs on the creases of the elbows and knees, but some people also experience flares on the face. Facial eczema is a term that describes atopic dermatitis — the long-term, itchy skin condition most people simply call eczema — when it occurs on the face.
Eczema on the face tends to settle around the eyes, eyelids, mouth, across the cheeks, and in the folds of skin beside the nose. Facial eczema isn’t only a childhood problem. In a Danish study of nearly 3,900 adults with eczema, 42% had eczema on the head or neck. That share rose sharply with severity, from around a quarter of mild cases experiencing facial eczema to 86% of severe ones.
Like regular eczema, facial eczema can be triggered by a variety of things. Some people experience flares when the face is exposed to cold wind or dry indoor heat. Certain cleansers, makeup, shaving and active skincare can also cause a flare. Stress is a recognised trigger too. What drives eczema tends to be the same wherever it appears on the body, which we cover in more detail in our guide to eczema treatment.
What Eczema on the Face Looks Like
Facial eczema usually appears as dry, flaky patches that itch. There’s often some redness and mild swelling, and eczema on cheeks can leave the skin feeling tight. A patch that’s been scratched for weeks may thicken and turn leathery, and a bad flare can weep or crust over.
On darker skin tones, eczema inflammation frequently looks brown, violet, or ashen grey rather than red, which is why it sometimes gets missed or judged milder than it really is. The 2023 allergy guidelines rewrote their definition of eczema redness for that reason, so that it covers brown, violaceous, and grey skin as well as red. An itchy patch that keeps returning to the same spot is worth taking seriously, whatever colour it looks.
A few other facial rashes come close enough to eczema to cause confusion:
- Seborrheic dermatitis — greasy, yellowish scale on salmon-pink skin, settling in the eyebrows, the folds beside the nose, and around the ears. Caused by a yeast that lives on everyone’s skin, so it responds to antifungal treatment rather than an eczema cream.
- Perioral dermatitis — small inflamed bumps and pustules ringing the mouth, with the strip of skin right at the lip edge left clear. The bumps tend to burn rather than itch.
- Contact dermatitis — a reaction to something that touched the skin, such as a new cleanser, a hair product, or nail polish touching the face from your hands.
Reaching for a steroid cream on the wrong facial rash can make it worse, which is the main reason to get a diagnosis from a doctor if you think you have eczema on the face.
Why Facial Eczema is Difficult to Manage
The skin on your face is thinner than the skin on your body, and eyelid skin is the thinnest you have. A topical steroid is absorbed far more readily through eyelid skin than through thick skin like the sole of the foot, with roughly a 300-fold gap between those two extremes. Inflamed skin can increase absorption even further.
Greater absorption means more of the steroid’s effect, and more of its side effects in the same place. Used for too long or at too high a strength on the face, a topical steroid can thin the skin and leave small visible vessels behind. That thinning does reverse once the steroid stops, though the skin can take months to look normal again.
Guidance for treating facial eczema is deliberately cautious as a result. NICE recommends mild-potency steroids for treating eczema on the face and neck, allowing a moderate-potency cream only in short bursts of three to five days when a flare is severe. More broadly, a course of topical steroid shouldn’t run beyond two to four weeks at any strength.
A short course of a mild steroid is a normal and effective way to bring a facial flare down, and stronger options like Betaderm have their place under a doctor’s direction. What to avoid is applying a steroid to your face week after week. Where that becomes necessary, a non-steroid cream is likely a better choice.
Eczema on Face Treatment: The Options That Suit Thin Skin
Treatment for eczema on the face works in layers. The first step is often using a plain, fragrance-free moisturiser every day to help repair the skin barrier that eczema weakens. In a Cochrane review, regular moisturising meant fewer flares and less need for steroid cream compared to only treating flares as they arrived. Common advice is to keep skincare simple while skin is inflamed. Use a gentle cleanser, and pause using retinoids, acids and exfoliants.
When a facial eczema flare needs settling, treatment steps might look like this:
- A short course of a mild steroid. Mild-potency steroids are the usual choice for calming a facial flare, used over days rather than weeks. Betaderm and other stronger steroids sit above them, and should be used only briefly and under a doctor’s direction.
- A non-steroid prescription cream. Protopic (tacrolimus) and Elidel (pimecrolimus) settle the immune overreaction driving an eczema flare without thinning the skin. This is why they suit sensitive and thin-skinned areas, and can be used over longer stretches than a steroid. In one trial, tacrolimus 0.1% worked about as well as a potent steroid cream, and pimecrolimus cleared or nearly cleared facial eczema in 47% of patients
- Eucrisa (crisaborole). Another non-steroid cream used for mild-to-moderate eczema that has a different method of action to Protopic and Elidel.
The stronger steroids and all three non-steroid creams are prescription-only in Canada. Which one suits you depends on how severe the flare is, where exactly it sits, and your age. Our eczema treatment guide covers the full ladder, including what happens when creams alone aren’t enough.
Treating Eyelid Eczema and Eczema Around the Eyes
Eyelid eczema is the hardest form of face eczema to treat. This is because eyelid skin is the thinnest on the body and where a steroid cream poses the most risk. The eyelids are also the likeliest place for a rash to turn out to be something other than eczema, so be sure to speak with a doctor to make an accurate diagnosis.
Non-steroidal creams are the mainstay of treatment for eczema on the eyelids and around the eyes. In a trial of 200 adolescents and adults with mild-to-moderate head-and-neck eczema who kept relapsing on steroid creams or couldn’t tolerate them, pimecrolimus cleared eyelid dermatitis in 45% of patients.
When treating eczema around the eyes, be sure to keep any cream off the eye surface, and treat pain, light sensitivity, or a change in your vision as something to get looked at promptly by a doctor.
Signs Facial Eczema Needs a Doctor’s Attention
If you already have an eczema management plan in place, mild facial eczema that settles with your usual strategies may not need a doctor’s appointment.
In general, it’s recommended to see a doctor for eczema on the face if:
- A flare hasn’t improved after a week or two of moisturising and gentle care
- The skin is weeping, or crusting with a honey-coloured scab, which suggests infection
- The eye itself is involved, not just the eyelid
- You’ve been through several courses of steroid cream on your face without a longer-term plan
- Itching is disrupting your sleep
- You aren’t certain the rash is eczema at all
One urgent exception: a rapidly spreading crop of small, painful blisters, often with a fever, can mean a herpes infection has taken hold in eczema-affected skin. On the face, that puts the eye at risk, so it needs same-day care rather than a routine appointment.
How to Get Treatment for Facial Eczema in Canada
Facial eczema is diagnosed from your history and a look at your skin, so a video call is usually enough for a doctor to assess it and decide what to prescribe.
In Canada you can see your family doctor, go to a walk-in clinic, or speak to an online doctor. If you’re in British Columbia, an appointment with a doctor from Walk In is covered by MSP.
Frequently Asked Questions About Eczema on the Face
How do you get rid of eczema on your face?
Most facial eczema flares settle with daily moisturising plus a short course of a mild steroid, or a non-steroid cream like Protopic or Elidel where a steroid isn’t suitable. Eczema is managed rather than cured, so the aim is to settle the flare and then keep the skin calm in between.
Can you get rid of eczema on your face in one day?
Facial eczema doesn’t clear that fast. A flare usually takes several days to a couple of weeks to settle with the right treatment, and starting early is the ost reliable way to shorten it.
Can you use hydrocortisone on your face?
Low-strength hydrocortisone sits at the mild end of the steroid range and may be suitable for facial skin. It’s meant for short use on small areas, though, and a facial flare that hasn’t settled in about a week is worth getting looked at by a doctor.
How do you treat eczema on eyelids?
Eczema on eyelids calls for more caution than any other facial site. Eyelid skin is the thinnest on the body, so a strong steroid is rarely the answer there. Non-steroid creams are the usual choice, prescribed by a doctor who has confirmed the rash is eczema rather than a reaction to something touching the skin.
Can babies get eczema on the face?
Facial eczema is very common in babies, and the cheeks are often the first place it appears. What’s suitable differs for infants, though, so it’s worth going through a baby’s facial eczema with a doctor rather than applying an adult routine.
Getting Eczema on the Face Under Control
There are some important differences in how eczema on the face is managed compared to flares on other parts of the body. Stronger steroid creams generally aren’t suitable for the thin, sensitive skin on the face, especially the eyelids.
It’s recommended to use only milder steroid creams for facial eczema in short courses. In many cases, a non-steroid eczema cream might be a better fit. Several non-steroid creams are available specifically for treating eczema on the face and eyelids, but they all require a doctor’s prescription.
If you are experiencing eczema on the face, a doctor from Walk In can assess your condition, advise on treatment options, and if suitable, provide a prescription.
Speak to a Doctor Online About Eczema
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