Facial eczema in adults

Eczema is an uncomfortable condition, no matter where it appears on the body. However, if you develop eczema on your face as an adult, not only is it uncomfortable, but you may feel self-conscious about it too. Symptoms can range from mild to severe, with most people experiencing flare-ups, where symptoms worsen and then gradually improve for a short period before flaring up again. We explore what causes eczema on the face in adults, how facial eczema differs from eczema in other areas of the body and investigate the practicalities of living with it .

Can you develop facial eczema as an adult?

While eczema is most common in children and often considered to be a disease of childhood, it can also flare-up in adulthood – often in individuals who suffered from eczema as a child. 

Facial eczema may occur on its own or as a symptom of more generalised eczema. Symptoms can appear on any part of the face but often develop around the eyes and eyebrows, cheeks, chin, and ear canals.

What is different about eczema on the face?

Facial eczema is distinct from eczema on the rest of the body¹. This is due to differences in the skin microbiome, higher sebaceous gland distribution and lower levels of natural moisturizing factor.

People with facial eczema typically have high levels of staph colonisation, which is known to irritate eczema prone skin. Gladskin, which targets just S. aureus can really help in these cases.

The face is also exposed to more environmental stress compared with the rest of the body. These stresses include airborne allergens, UV and cosmetics. This means that contact dermatitis from both irritants and allergens is more of a problem.

Management of facial eczema differs from that of body eczema. The topical steroids used to manage eczema must be used with caution on the face. This is because potent topical steroids can harm vision if used around the eyes for long periods². They can also thin the skin if used for prolonged periods and the skin on the face is thinner than on the rest of the body. Interestingly, the avoidance of topical steroids may in part contribute to the lack of microbiome diversity since topical steroid is associated with increased biome diversity.

Are there different types of facial eczema?

Various types of eczema can develop on the face in adults and the exact location is often a clue as to the type (and therefore best treatment). The most common types are:

• Atopic dermatitis (AD).  AD is typically found on the cheeks in infants and toddlers but usually resolves by the time children are 2 years old. In adults and teens, atopic dermatitis on the face tends to appear on the eyelids or around the lips. The skin around the eyes may darken and an extra fold of skin can develop under the eyes (Dennie-Morgan folds). AD flare-ups may be related to contact dermatitis and flare-ups are commonly associated with stress.
• Seborrhoeic dermatitis. This is the most common type of eczema in adults and typically affects the face. It is often mild, appearing simply as dry, scaly skin around the creases of the ears and nose and in the eyebrows. However, it can be problematic when the eyelids or ear canals are involved.  It is often associated with a proliferation of Malassezia yeasts in the skin biome. Environmental factors such as temperature and humidity can also trigger flare-ups, as can stress.
• Irritant or allergic contact dermatitis. The face is one of the most common sites for contact dermatitis because facial skin comes into contact with many potential irritants and allergens in daily life. These can include ingredients in toiletries (usually fragrances or preservatives), hair dye, nail varnish and adhesives. Even products marketed as being for sensitive skin can be irritating for some people. The drying effect of wet and windy weather and airborne allergens like pollen can also be problematic. 
• Light sensitive eczema. Although many people find that their eczema improves in warm, sunny weather, the unlucky few find that strong sunlight causes flare-ups.  This often affects the face, neck and backs of the hands, as they are frequently exposed to light. Shaded areas, under the chin and behind the ears, tend not to be affected, and this can be a helpful indicator that sunlight sensitivity is a problem.

Given the limited treatment options for facial eczema, it’s worth taking the time to figure out what is causing the problem. Working out what is causing the problem is really helpful in finding an effective management strategy.

How to treat facial eczema in adults

As with all things eczema, there are three main steps to managing facial eczema:

• a regular, emollient based skin care regime
• tracking down any triggers and dealing with them
• topical steroid treatments to control flare-ups

We’ll look at each of these in turn

Skincare for facial eczema

Switch to using a medical emollient instead of soap. Medical emollients typically contain fewer ingredients than cosmetic moisturisers so are less likely to irritate. Pat dry, don’t rub, however tempting! Moisturise your face at least two a day with a medical emollient. You may find using a heavier, greasier emollient and night and lighter one during the day more comfortable. There is a bewildering range of emollients available. Your pharmacist will be able to guide you.

Make-up is a common trigger for facial eczema. As a result many eczema sufferers just don’t use it or only use it on special occasions. If you can’t bear to go bare faced, it really is a case of trial and error to find products that work for you. Try to stick with mineral versions and avoid liquid foundation and mascara. The Green People range is a good place to start. Your regular emollient will make an effective make-up remover (use a damp cotton pad if it needs thinning). 

Tracking down eczema triggers

As described above, facial eczema triggers can often be identified by the exact location of the eczema patches. If you suspect you have seborrhoeic dermatitis, book a doctor’s appointment to confirm. They will be able to prescribe an appropriate treatment to control any Malassezia over growths. 

Allergic reactions can usually be controlled with over-the-counter antihistamines used for hay-fever. If your skin improves after a few days of taking them, it’s likely that your eczema is related to allergic contact dermatitis. You can either carry on taking the antihistamines or try and figure out what it is that you’re allergic to. If your eczema is particularly bad, you GP may be able to organise patch-testing to track down allergens.

If you suspect that make-up may be an irritant for you, stop using it and re-introduce products one at a time, to see if any particular product is causing the problem. Nail varnishes and gel nail adhesives can cause facial reactions, especially if you find it difficult not to touch your face.

You can find more on tracking down eczema triggers here.

Topical steroid and other prescription treatments

As topical steroid creams can cause complications when used on the face, it’s important to see a doctor or dermatologist if the eczema on your face cannot be controlled with emollients and trigger avoidance.

It’s important to follow medical guidance when using topical steroid creams. As a general rule mild and moderate steroid creams should only be used once a day for a maximum of two weeks. Potent and very potent steroid creams should only be used on the face under very close medical supervision – in children this would mean a hospital stay. Very potent creams should never be used near the eyes.

Topical calcineurin inhibitors can also be helpful options for the long-term management of facial eczema as they do not carry any risk of skin-thinning. However, they 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 are only available on prescription from skin care specialists (usually a dermatologist). These treatments can sting or burn when applied. This is normal however some people find this side-effect too much to deal with.

Top tips for managing facial eczema in adults

• Try not to touch your face. Given this is much easier said than done, keep your hands scrupulously clean to minimise the risk of skin infections
• Change your pillowcase regularly. If you find yourself using the pillowcase to rub with consider switching to a smoother silk or bamboo pillow case
• If you wear contact lenses, check the ingredients of the solution for your triggers. The preservatives can cause problems in some people.
• Emollients with ceramides and humectants (e.g. urea or glycerin) can help the skin to retain moisture for longer – a number of brands have versions designed specifically for use on the face. I get on well with Eucerin Urea Repair.

Our sources

1. https://pubmed.ncbi.nlm.nih.gov/36219049/
2. https://pubmed.ncbi.nlm.nih.gov/25754554/

At ScratchSleeves, we sell a unique range of clothing and nightwear designed to help protect delicate skin and prevent scratching. Browse our range of eczema clothes for adults in our online shop, and don’t hesitate to contact us if you have any questions about our products.