What is the treatment for facial dermatitis?

From the Guidelines

For most people with facial dermatitis, particularly atopic dermatitis, emollients and prescription topical therapies are sufficient to achieve control, with recent guidelines suggesting several effective topical treatments available. When considering treatment options, it's essential to prioritize the severity of the condition, its impact on the patient, and the efficacy, safety, and accessibility of available interventions 1.

Treatment Approach

The treatment approach for facial dermatitis typically involves:

• Identifying and avoiding triggers
• Gentle skincare
• Appropriate medications, such as emollients and topical anti-inflammatory medications
• Considering phototherapy or systemic therapies for more severe or widespread cases

Topical Therapies

Topical therapies are often the first line of treatment, with options including:

• Topical corticosteroids, such as hydrocortisone 1% for mild cases
• Stronger prescription options like triamcinolone 0.1% for moderate cases
• Topical calcineurin inhibitors like tacrolimus (Protopic) 0.03-0.1% or pimecrolimus (Elidel) 1% cream for stubborn cases

Systemic Therapies

For severe or persistent dermatitis, systemic therapies may be considered, including:

• Biologics, such as dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib, which have strong recommendations for use 1
• Janus kinase inhibitors, which have new evidence supporting their use
• Phototherapy, which may be considered for some patients, although more randomized controlled trial evidence is needed to better understand its role in treating atopic dermatitis 1

Shared Decision-Making

The decision to initiate these more advanced therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of the condition, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1.

From the FDA Drug Label

ELIDEL ® (pimecrolimus) Cream 1% is indicated as second-line therapy for the short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised adults and children 2 years of age and older, who have failed to respond adequately to other topical prescription treatments, or when those treatments are not advisable. About 75% of patients had atopic dermatitis affecting the face and/or neck region.

The treatment for facial dermatitis (atopic dermatitis affecting the face) is pimecrolimus cream 1% (2) (2), as it has been shown to be effective in patients with mild to moderate atopic dermatitis, including those with facial involvement.

• Key points:
  • Indicated for mild to moderate atopic dermatitis
  • Age range: 2 years and older
  • Second-line therapy: for patients who have failed to respond to other topical treatments
  • Short-term and non-continuous chronic treatment

From the Research

Treatment Options for Facial Dermatitis

• Topical corticosteroids are commonly used to treat facial dermatitis, but their use is limited due to the risk of treatment-associated side-effects, especially in children 3.
• Pimecrolimus cream 1% has been shown to be effective in treating mild-moderate facial atopic dermatitis in children who are intolerant of or dependent on topical corticosteroids 3.
• The efficacy of pimecrolimus cream 1% has also been demonstrated in treating seborrheic dermatitis, with significant reductions in lesion severity and no significant differences in response between different regions of the face 4.

Alternative Treatments

• Sertaconazole 2% cream has been compared to hydrocortisone 1% cream in treating facial seborrheic dermatitis, with similar efficacy and safety profiles 5.
• Pimecrolimus 1% cream has been shown to be a successful treatment choice for patients with resistant seborrheic dermatitis of the face, with statistically significant reductions in lesion severity and no significant adverse effects 4.

Considerations for Treatment

• The choice of topical corticosteroid should be based on the strength and potential risk of adverse effects, with lower potencies and shorter durations recommended for use in children 6.
• The quantity of corticosteroid prescribed depends on the duration of treatment, frequency of application, skin location, and total surface area treated, and correct patient application is critical to successful use 6.
• Pimecrolimus is a nonsteroidal agent that has been shown to be effective in treating seborrheic dermatitis, with a novel mechanism of action as a macrolactam immunomodulator 7.