How to manage facial eczema?

Recognize facial eczema with its distinctive red, itchy patches. Discover effective care strategies for maintaining healthy facial skin.

Summary

Identifying facial eczema symptoms

Facial atopic dermatitis symptoms vary across different life stages.

Atopic dermatitis in infants

In babies, facial eczema symptoms primarily affect convex facial areas (forehead, cheeks, chin) while typically sparing the nose. Infants' facial dermatitis plaques are dry, scaly, red, with weeping, cracked folds behind and under the ears.

Facial eczema in children

In children over two years old, facial dermatitis becomes less common. The lesions may appear thick and whitish, causing intense itching. Noticeable signs include wrinkled folds under the lower eyelids (Dennie-Morgan sign) and common involvement around the mouth. Children tend to scratch facial eczema patches, which can appear red, inflamed, or even develop complications such as scratching lesions and impetigo (bacterial superinfection).

Child with atopic dermatitis on the face

Facial eczema in adults and adolescents

Facial eczema in adults and teenagers frequently presents as dry, rough, thickened skin. Chronic inflammation, regular flare-ups and consistent scratching may lead to pronounced wrinkles and skin color changes.

Understanding the causes of facial eczema

Causes of atopic dermatitis¹ ²

The causes of atopic eczema on the face are genetic, immune, and environmental. Genetic mutations impair the skin barrier, leading to water loss and increased skin permeability to allergens and irritants. An overactive immune response to environmental triggers is responsible for the eczema lesions.

Facial eczema vs. body eczema³

Bacterial imbalance on facial skin

Atopic dermatitis alters the bacterial balance on the face, with an increase in harmful bacteria like Staphylococcus Aureus and a decrease in beneficial bacteria like Propionibacterium acnes. This imbalance triggers more inflammation on facial skin than on the body.

Filaggrin anomalies

Filaggrin, an essential protein for the skin's outer layer, is crucial for creating natural moisturizing factors (NMF). Filaggrin malfunctions in eczema, particularly in facial eczema:

Up to one year of age, the skin on the cheeks has low levels of NMF, explaining the frequency of atopic dermatitis lesions in this region.
Exposure to UV rays from the sun disrupts the production of NMF from filaggrin, accentuating the distinction between facial and body eczema.

Environmental exposure

Facial skin encounters more environmental triggers of eczema like airborne allergens (pollens, dust), pollutants (pollution, tobacco smoke), cosmetics, and UV rays than body skin.

Differentiating facial eczema from psoriasis

Psoriasis

Eczema

Understanding the differences between eczema and psoriasis, both chronic inflammatory skin conditions, is crucial for accurate diagnosis and treatment. Key distinctions include:

Age of onset: Atopic dermatitis commonly starts during childhood, contrasting with psoriasis, which can emerge at any age but is notably prevalent among adolescents and young adults.

Patch characteristics: Atopic dermatitis plaques manifest as widespread, red patches with fine, dry scaling. Conversely, psoriasis is characterized by well-defined, redder lesions with robust, silvery-white scaling.

Affected areas: Facial eczema is frequently observed in infants and adults, particularly affecting cheeks, areas around the eyes, and mouth. Facial psoriasis is comparatively rare.

Itchiness: Intense itching is a characteristic of atopic facial eczema, whereas psoriasis usually involves minimal to no itching.

Background and associated symptoms: Eczema often occurs in people with allergies, sometimes accompanied by asthma and rhinitis. Psoriasis, a non-allergic disease, can come with joint and vascular involvement.

Clarifying the differences between facial eczema and rosacea

Rosacea and eczema, while both chronic inflammatory skin conditions, exhibit distinct characteristics that are key to their differentiation:

Age of onset: Rosacea predominantly appears in adulthood, whereas eczema usually starts in childhood.

Lesion characteristics: Rosacea is characterized by intermittent redness primarily on the nose, cheeks, and occasionally the forehead. These lesions may include visible small blood vessels (telangiectasia), papules, and pustules, akin to acne. Notably, rosacea can lead to skin thickening, particularly on the nose (rhinophyma).

Affected areas: Rosacea's symptoms are confined to the face, unlike eczema, which can appear on various parts of the body.

Absence of itching: A key differentiator is the absence of itching in rosacea, whereas itching is a primary symptom of facial eczema.

Background and associated symptoms: Rosacea may involve ocular symptoms (watery or dry eyes, tingling, and itching) and, in rare instances, may be associated with neurological, digestive, and cardiovascular disorders. Eczema occurs within an allergic context and is often associated with asthma and allergic rhinitis.

Effective management of facial eczema

The treatment of facial eczema, particularly atopic dermatitis, necessitates a careful and gentle approach due to the delicate and sensitive nature of facial skin, which is highly susceptible to the adverse effects of topical corticosteroids.

Treating flare-ups of facial eczema² ³ ⁴ ⁷

Managing flare-ups of atopic dermatitis on the face requires judicious use of corticosteroids to mitigate risks such as skin thinning and potential long-term damage.
Typically, doctors prescribe corticosteroids:

For short-term use, often less than two weeks.
With minimal potency, particularly for areas around the eyes.
For a once-daily application directly on affected areas, preferably before bedtime.

In situations where corticosteroids are ineffective or unsuitable, dermatologists may recommend alternative local treatments (topical calcineurin inhibitors). These do not cause skin thinning but may increase sensitivity to light (photosensitization).
For severe cases of eczema, advanced treatments like phototherapy, immunosuppressants, or monoclonal antibodies may be used.

Nurturing and protecting facial skin

Strategies for preventing facial eczema flare-ups

Adopt these skin care practices for atopic facial skin to reduce the occurrence of flare-ups:

Opt for mild cleansers over traditional soap to cleanse the skin while removing scales gently.
Pat the skin dry using a soft towel to avoid irritation. Don’t rub your skin.
Steer clear of cleansing and moisturizing products that contain potential irritants like detergents and fragrances.
Regularly apply a simple, non-irritating emollient at least twice daily across the entire face.
When using makeup, prefer non-irritating mineral-based products.
For makeup removal, use a moist cotton pad with a gentle cleanser. Emollients are equally effective as cosmetic makeup removers.⁴

Characteristics of facial eczema

Use mild cleaning products

Pat your dry skin

Avoid products containing perfume

Apply an emollient twice a day

References:

1. L’Assurance Maladie. Eczéma ou dermatite atopique : causes, symptômes et évolution. Ameli.fr. 2023 Sep. [Disponible sur :] https://www.ameli.fr/assure/sante/themes/eczema-atopique/reconnaitre-eczema-atopique
2. Nemeth V, Evans J. Eczema. [Updated 2022 Aug 8]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan [Disponible sur :] https://www.ncbi.nlm.nih.gov/books/NBK538209/
3. Contento M, Maher J, Cline A, Rose S. Why Does Facial Eczema Differ From Body Eczema? J Drugs Dermatol. 2022 Oct 1;21(10):1119-1123.
4. National Eczema Society. Facial Eczema Factsheet. National Eczema Society. 2022 Aug. [Disponible sur :] https://eczema.org/wp-content/uploads/Facial-eczema-Aug-22.pdf
5. Barrett M, Luu M. Differential Diagnosis of Atopic Dermatitis. Immunol Allergy Clin North Am. 2017 Feb;37(1):11-34.
6. Farshchian M, Daveluy S. Rosacea. 2023 Aug 8. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan. [Disponible sur :] https://www.ncbi.nlm.nih.gov/books/NBK557574/
7. L’Assurance Maladie. La consultation et le traitement en cas d'eczéma ou dermatite atopique. Ameli.fr. 2023 Sep. [Disponible sur :] https://www.ameli.fr/assure/sante/themes/eczema-atopique/consultation-traitement