When atopic dermatitis (AD) affects the face, it can be devastating. Redness, itching, and oozing caused by this chronic inflammatory skin disease is not only painful, it can also feel embarrassing. An estimated 17.8 million people in the U.S. have atopic dermatitis, and many suffer from lesions on their faces.
Members of MyEczemaTeam talk frequently about the impact of facial AD on their self-esteem and quality of life. “It makes me feel so ugly and self-conscious,” lamented one member. Another said, “I get a sick feeling looking at my face in the mirror each day.”
Atopic dermatitis on the face can attract unwanted attention. “People constantly ask me what happened to my face. I’m afraid to go out in public,” shared one member. “It feels like everyone is staring or judging me,” another said.
People with facial AD are often afraid to go to work, which can affect job performance, professional relationships, and attendance. “I’m embarrassed to be at work,” admitted one member. Another said, “I have an interview tomorrow and instead of preparing, all I can think of is peeling dry skin off my face.”
Covering up facial atopic dermatitis with commercial cosmetics or certain topical treatments can aggravate symptoms of redness and itchiness. “I’ve tried all sorts of creams and steroid treatments. Nothing seems to work for me,” said one member.
In fact, managing AD on the most visible body part can be costly. Many people incur heavy out-of-pocket medical expenses — and often miss work — while treating flare-ups, blisters, and skin infections, according to a 2015 study reported in JAMA Dermatology. “I haven't left my house since last Tuesday other than to go to the hospital,” said one member who developed facial infections from a recent flare.
Children frequently suffer with facial atopic dermatitis. Up to 19 percent of children in the U.S. develop AD within the first few months of life. Symptoms usually appear on the cheeks and neck before moving to other parts of the body, according to the American Academy of Family Physicians (AAFP).
Children often develop atopic dermatitis on the face. (DermNet NZ)
One member worries about her 7-month-old son. “He has terrible, severe eczema all over his face and ears that oozes all day!” she said. In older children, the entire face and eyelids can be impacted.
Among adults, facial atopic dermatitis can occur as part of generalized eczema or as an isolated event, according to the National Eczema Society. Symptoms may last for just a week or two, or longer. There’s usually no identifiable cause, but triggers can include a history of atopic dermatitis, contact with an external irritant or allergen (also known as contact dermatitis), or even a change in weather. Allergy testing can also determine if the AD is an allergic reaction.
Because AD is a chronic and relapsing disease, it can return at any age. “My eczema has been in 'hibernation mode' since I was a teenager. This year, however, big red-hot patches suddenly appeared on my neck and started moving down my body,” said one member.
Hormonal changes can also set off a facial flare. Some members of MyEczemaTeam report a recurrence or worsening of atopic dermatitis on the face after the start of menopause. “I've had eczema since age 5 — and many times my skin was clear. Now at 50, it’s the worst it has ever been,” shared one member. Another said, “I’m 68 and have the worst face eczema in my life.”
Although there’s no cure for atopic dermatitis, the standard of care aims to relieve symptoms, prevent flares, and improve appearance to enhance quality of life. Proper treatment lowers the risk of scarring and complications from post-inflammatory skin changes, skin atrophy, and even obsessive picking and scratching. “I'm not strong enough to stop picking at my face. I set a timer for 15 minutes to see if I could stop. I failed,” one member admitted.
Because facial skin is more delicate — and can be easily irritated by cosmetics and prescription therapies — AD treatments are often different and gentler than those used on other affected parts of the body.
Cosmetic or commercial skin care products — soaps, skin cleansers, exfoliating scrubs, moisturizers, sunscreens, and makeup — all contain ingredients that can aggravate lesions. Skin with eczema has microscopic cracks in it, so any product that enters these cracks can irritate. Even products labeled “natural,” “dermatologically tested,” or “hypoallergenic” can cause allergic reactions. When applying makeup, avoid bacteria-laced brushes, warned a beauty expert on the National Eczema Association website. “Wash your hands well and use your fingertips to dab on makeup,” she advises.
When skin is prone to inflammation and dryness, moisturizing is critical. Although the amount of daily moisturizing has not been defined, liberal application several times daily — even when active symptoms are not present — is advised. A randomized, controlled trial of infants with moderate-to-severe atopic dermatitis revealed that regular emollient use improved symptoms and reduced the need for topical corticosteroids. Many doctors recommend applying moisturizer immediately after bathing to lock in moisture.
Not all moisturizers are the same. Thick creams (such as Cetaphil or Eucerin brands) or ointments (Aquaphor or petroleum jelly) that are high in oil content and low in water are generally preferred by dermatologists for maximum moisturizing. Because these products are greasy and can make skin look shiny or highlight AD lesions, they’re recommended for use at bedtime.
For a better cosmetic result during the day, lotions and creams with high water content can be used. Creams are thicker than lotions, but not as greasy as ointments. Although they don’t create undesirable residue on the skin, these skin care products are absorbed into the skin more quickly and may require frequent application.
Because facial skin is more prone to acne, look for moisturizers that do not clog pores or are noncomedogenic. The products have been proven safe to use on the face and will not cause acne.
The National Eczema Association’s Eczema Product Directory lists products that have been created and approved specifically for use with eczema and severely sensitive skin. This includes a new generation of barrier-repair moisturizers (under brand names CeraVe and Cetaphil’s Restoraderm), which are designed to add ceramide lipids — a protective waxy molecule — to skin in addition to hydration. These barrier restoration creams can fill in microscopic cracks in the skin.
In addition to moisturizers, a mild, moderate, or strong topical corticosteroid that blocks inflammatory activity may be recommended for short-term use (daily for up to two weeks) on face and neck, depending on the severity of AD. During a flare, stronger potency creams may be prescribed.
Corticosteroids should only be used under the close supervision of a dermatologist, because they carry a higher risk of skin-thinning, systemic absorbption, and permanent skin damage. Only apply steroids to affected areas of the skin.
For people with moderate-to-severe facial AD who are at risk for skin atrophy from topical corticosteroids, calcineurin inhibitors may be prescribed by a doctor as a second-line treatment on the face and neck and in skin folds.
These immune-system suppressors, which include Elidel (pimecrolimus) and Protopic (tacrolimus), can make skin more light-sensitive and should be used at night or with sun protection. Although the U.S. Food and Drug Administration (FDA) has issued a boxed warning for these drugs regarding a possible link between calcineurin inhibitors and skin malignancies and lymphoma, studies have not demonstrated a clear link when used appropriately by people over the age of 12.
Recently, an ointment called Eucrisa (crisaborole) has been approved to treat eczema and atopic dermatitis. It is safe to use on the face and body. Because it does not contain steroids, there is no risk of thinning skin.
Other treatments for recurring facial atopic dermatitis include phototherapy and the use of oral medications that suppress immune system activity, such as prednisone, methotrexate, or antibiotics. An injectable drug called Dupixent (dupilumab) may also be prescribed if topical medications are not effectively managing symptoms. Always consult with a dermatologist before starting any treatment regimen for your face, and use AD medications exactly as prescribed.
Members of MyEczemaTeam frequently share products, skin care tips, and advice that helps them soothe inflamed skin and manage flares.
One member gets relief by applying high-grade olive oil to the face overnight. Another swears by 100 percent coconut oil. “It takes down the redness and itching, and makes my skin smoother.”
Icing, cold compresses, and gel packs on the face help many members calm itching. One member claims she has been “itch-free” from applying shea butter three or four times a day. Another says taking fish oil supplements relieved her itchy symptoms.
Taking this nonpsychotropic substance derived from the cannabis plant can help with facial AD symptoms. “I take it sublingually — even my eyelids are clear,” said one member.
“I take a collagen supplement to keep my skin healthy from the inside out,” shared one member.
Foods that can cause inflammation — such as tomatoes, dairy, sugar, wheat, and processed foods — are sometimes thought to trigger eczema flares. “When I eliminated them from my diet, my itching stopped — and eczema almost cleared up,” said one member.
Aloe Vera for Children
“Consider purchasing a live aloe vera plant,” one member recommended. “Break off a small piece of one of the leaves, break it open, and apply the juice from inside the leaf to your baby's skin.”
Because atopic dermatitis affects each person differently, products or treatments that heal one member’s skin might aggravate another’s. Consult with your physician before starting any new oral, topical, or dietary products.
By joining MyEczemaTeam, the social network and online support group for those living with eczema and atopic dermatitis, you gain a support group more than 39,000 members strong. Atopic dermatitis on the face is a frequently discussed topic.
How do you take care of your face with atopic dermatitis? Go to MyEczemaTeam today and start or join the conversation. You'll be surprised how many others share similar stories.