Atopic eczema is a chronic, non-contagious disease that occurs on the skin of the face or body.
It is a condition that causes the skin to become red, scaly, and itchy, also called dermatitis.
Different types of dermatitis can appear and can cause different symptoms.
The inflamed and irritated skin can appear anywhere on the body but can be particularly uncomfortable, painful, and itchy when it appears on the face.
Dermatitis on the face can cause red spots, small bumps, and scales on the skin. The skin can darken, thicken, and even become infected if you scratch too much.
Seborrheic dermatitis can be the most common skin condition at the same time as rosacea.
Although the two disorders are unrelated, a recent clinical study found that 26 percent of rosacea patients also had facial seborrheic dermatitis.
Seborrheic dermatitis is a common chronic inflammatory skin disorder, generally confined to areas where the sebaceous (oil) glands are most prominent.
The condition is not harmful or contagious but can be uncomfortable and unsightly.
Causes dermatitis on the face
Although the cause is unknown, several contributing factors may play a role in developing seborrheic dermatitides, such as abnormalities of the sebaceous glands and hair follicles, a yeast fungus with bacteria that grow in sebum or fat.
On the other hand, some general triggers could lead to an eczema flare:
Environmental irritants and allergens
These are materials, substances, and chemicals that are encountered daily.
They include ingredients in soaps, shampoos and cleaning products, fruit, vegetable, and meat juices, perfumes and fragrances, cigarette smoke, metal contact, fabrics and fabric dyes, and more.
Common allergens consist of mold, pet dander, dust, and pollen.
To date, researchers are unsure why stress can trigger eczema, but avoiding stress as much as possible can help reduce flare-ups.
For many people, the heat seems to cause eczema, which can involve sweating, hot showers, or humid air.
Alternatively, dry skin, often a byproduct of the winter months, can also trigger.
Women, in particular, can experience eczema flare-ups with the rise and fall of certain hormones.
Some factors appear to contribute to the potential development of this condition. These factors include:
- Family history of dermatitis.
- If a family member has dermatitis, blood relatives are also likely to develop it.
- Diagnosis of asthma or allergies.
- The chances of getting dermatitis increase when you have asthma or allergies.
- Autoimmune diseases.
When you have autoimmune problems, you can risk developing dermatitis, although people with a normally functioning immune system can also have the skin condition.
Dermatitis is more common in people who live in the Northern Hemisphere, metropolitan areas, or places with pollution.
Facial dermatitis is most common in infants or young children.
Many children eventually outgrow the disease, but eczema can continue into adulthood and affect people of all ages.
Signs and symptoms
Scaling and redness are the two dominant features of dermatitis on the face.
It can look like dusty or greasy scales on the face and has a burning sensation.
If it develops on the scalp, it can range from a mild case of dandruff to patches of thick scales and may have an itchy sensation.
The most common sites on the face include wrinkles around the nose, forehead, inner eyebrows, and outer ear canal.
The upper eyelids and the margins of the eyelids may be involved.
When dermatitis occurs on the face, the skin can become red, blotchy, itchy, and flaky.
If the face is scratched vigorously, the skin could become infected, thicker, darker, or scarred.
While there is no cure for facial eczema, many treatment options can make a living with this condition more manageable.
Diagnosis of dermatitis on the face
Diagnosis is made on physical examination and visual inspection of the skin.
Personal history of inhalation allergies and family history will often support the diagnosis.
Although itching is necessary but not sufficient to diagnose atopic dermatitis, other itchy rashes often need to be considered.
A skin biopsy (a sample of a small piece of skin that is sent to the laboratory for examination under a microscope) is rarely helpful in establishing the diagnosis.
Many patients with severe atopic disease may have a high number of certain types of white blood cells (eosinophils) and an elevated level of serum IgE.
These tests can support the diagnosis of atopic dermatitis; swab samples (long cotton tip applicator or Q-tip) can be sent to the laboratory to exclude staphylococcal skin infections, which can complicate atopic dermatitis.
Scrape/prick tests of the skin with a needle that contains a small amount of a suspected allergen and blood tests for airborne allergens are generally not as helpful in diagnosing dermatitis on the face.
Positive results of the skin scrape/prick test are difficult to interpret in people with dermatitis on the face and are often inaccurate.
Treatment of dermatitis on the face
As with rosacea, there is no cure for facial dermatitis; it comes and goes when the conditions are right.
Several years can go by without an outbreak, and with the help of your doctor, you can control and relieve symptoms when you have one.
Therapy is available to control your signs and symptoms, and treatment will depend on your skin type and the severity of the condition.
Treatment on the face may include medications such as antifungals and steroids that reduce inflammation and the buildup of flaking on the skin.
When seborrheic dermatitis with rosacea appears, a safe and effective antifungal alone can often be prescribed, as long-term use of topical steroids is associated with symptoms similar to those of rosacea.
This condition is known as steroid-induced rosacea. Treatment of seborrheic dermatitis of the scalp may include medicated anti-dandruff shampoos.
Steroid creams are a crucial part of treating dermatitis.
Over-the-counter hydrocortisone cream can help with red, itchy skin.
It should be applied once or twice a day for several weeks.
A stronger steroid prescription may be needed if that does not work well enough.
However, it should be used only for a short time because it can thin the skin.
Calcineurin inhibitors can be prescribed in place of a steroid cream.
These creams and ointments block chemicals that can cause the skin to become inflamed.
They are mainly used to treat dermatitis on the face, including the eyelids, neck, and skin folds.
How to deal with eczema on the face
Using a mild cleanser
Soap can be harsh and dry on your skin, making dermatitis worse. Instead, consider a mild, soap-free cleanser.
Wash your face with lukewarm water
Hot showers can act as a trigger for dermatitis in some people. Wash your face and shower with lukewarm water to reduce the risk of developing heart dermatitis.
Keep skin hydrated
If you have dermatitis, your skin may be drier, so it is essential to keep it hydrated.
There are various products to choose from, such as creams, lotions, ointments, and skin barriers such as ceramides.
Look for products that do not contain dye and fragrance to reduce the chances of irritation.
If the sun causes dermatitis, you may need to use sunscreen.
In general, products containing zinc oxide or titanium dioxide are more easily tolerated on sensitive skin, although the only downside is that they can leave a white tint.
You should wash your face and apply a moisturizer when you go out in the sun. Sunscreens can dry out the skin.
Using cosmetics with moisturizing ingredients
Facial eczema does not mean that a person can never wear makeup, but not all products are created equal regarding what they can put on their skin. Look for products that have hydrating ingredients like hyaluronic acid and shea butter.
The skin on the face should be kept away from ingredients such as parabens (a group of preservatives), salicylic and glycolic acids, fragrances, and retinol.
If itching and redness are experienced, an over-the-counter 1% hydrocortisone cream can be applied.
However, these creams are for short-term use, as long-term use can cause thinning of the skin.
If the over-the-counter cream does not work, your doctor may need to be seen to discuss other prescription options, such as immunosuppressants and biologics.
When treatments are unsuccessful, phototherapy may be the next step.
Phototherapy uses a device to cast ultraviolet B (also called UVB) light onto the skin, reducing itching and inflammation, increasing vitamin D production, and increasing the body’s natural ability to fight bacteria on the skin.
Living with facial dermatitis can feel like the face taking center stage.
To keep symptoms manageable, regular visits with a dermatologist should be scheduled.
The needs of the skin can vary with seasonal changes and with age.
The doctor can educate the patient on new medications and therapies, provide options for managing symptoms, and help develop the best skin care regimen to meet their skin needs.