What are the treatment guidelines for atopic dermatitis (eczema) of the face?

From the Guidelines

Treating facial eczema requires a gentle approach focused on hydration, inflammation control, and trigger avoidance, with the most recent guidelines suggesting the use of emollients and prescription topical therapies as the first line of treatment, and considering phototherapy or systemic therapies for more severe cases 1. When managing facial eczema, it's essential to start with a mild, fragrance-free cleanser like Cetaphil or CeraVe, followed by applying a moisturizer while skin is still damp.

• For mild flares, use over-the-counter 1% hydrocortisone cream sparingly for up to 7 days.
• More severe cases may require prescription topical steroids like triamcinolone 0.1% or tacrolimus ointment (Protopic), which doesn't thin the skin with prolonged use.
• Apply these medications in a thin layer once or twice daily as directed, tapering use as symptoms improve.
• Avoid hot water, harsh soaps, and known triggers like certain foods, stress, or allergens.
• Pat skin dry rather than rubbing, and consider using a humidifier in dry environments. The decision to initiate more advanced therapies, such as phototherapy or systemic therapies, should be made using shared decision-making between patients and clinicians, taking into account the severity of atopic dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1. If symptoms persist beyond two weeks of treatment, develop yellow crusting, or show signs of infection, consult a healthcare provider, as these may be signs of a more severe condition or the need for alternative treatments 1.

From the FDA Drug Label

ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). ELIDEL Cream is for adults and children age 2 years and older who do not have a weakened immune system. Use ELIDEL Cream only on areas of your skin that have eczema. Use ELIDEL Cream for short periods, and if needed, treatment may be repeated with breaks in between. About 75% of patients had atopic dermatitis affecting the face and/or neck region.

The treatment guidelines for atopic dermatitis (eczema) of the face include using ELIDEL Cream as a second-line therapy for short periods, with breaks in between, for adults and children 2 years and older. Key points to consider:

• Apply a thin layer of ELIDEL Cream only to the affected skin areas, twice a day.
• Use the smallest amount of ELIDEL Cream needed to control the signs and symptoms of eczema.
• Stop ELIDEL Cream when the signs and symptoms of eczema go away, or as directed by your doctor. 2, 2, 2

From the Research

Treatment Guidelines for Atopic Dermatitis (Eczema) of the Face

• The treatment of facial atopic dermatitis is challenging due to the risk of side effects associated with topical corticosteroids 3.
• Topical anti-inflammatory treatments, such as pimecrolimus cream 1%, have been shown to be effective in controlling eczema and pruritus in children with facial atopic dermatitis who are intolerant of or dependent on topical corticosteroids 3.
• Tacrolimus is also a effective treatment option for atopic dermatitis, with studies showing that it can lead to significant improvement in disease severity 4.
• A network meta-analysis of 291 studies found that potent and very potent topical steroids, tacrolimus 0.1%, and ruxolitinib 1.5% were among the most effective treatments for improving patient-reported symptoms and clinician-reported signs 5, 6.
• Barrier repair therapy with a non-steroidal emollient cream containing rhamnosoft, ceramides, and iso-leucine has also been shown to be effective in treating facial atopic eczema 7.
• Local application site reactions were most common with tacrolimus 0.1% and crisaborole 2%, while skin thinning was not increased with short-term use of any topical steroid potency, but was reported with longer-term use 5, 6.

Treatment Options

• Topical corticosteroids (TCS)
• Topical calcineurin inhibitors (TCI), such as pimecrolimus and tacrolimus
• Phosphodiesterase-4 (PDE-4) inhibitors
• Janus kinase (JAK) inhibitors, such as ruxolitinib and delgocitinib
• Aryl hydrocarbon receptor activators
• Barrier repair therapy with non-steroidal emollient creams

Considerations

• The risk of side effects associated with topical corticosteroids, such as skin thinning and application site reactions
• The potential for dependence on or intolerance to topical corticosteroids
• The need for long-term treatment control and the potential for relapse
• The importance of patient-reported symptoms and clinician-reported signs in evaluating treatment effectiveness
• The need for further research to fully understand the relative effectiveness and safety of different topical anti-inflammatory treatments for eczema 5, 6