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 1. The treatment guidelines for atopic dermatitis (eczema) of the face prioritize a comprehensive approach that addresses both the skin barrier dysfunction and inflammation that characterize eczema.

Key Considerations

• 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 corticosteroids like triamcinolone 0.1% or tacrolimus 0.03-0.1% ointment, which doesn't thin the skin.
• Apply these medications in a thin layer once or twice daily for 7-14 days as directed.
• Moisturize frequently throughout the day with ceramide-containing products. Some key points to consider when treating facial eczema include:
• Avoid known triggers such as harsh soaps, fragrances, extreme temperatures, and stress.
• Take short, lukewarm showers and pat skin dry rather than rubbing.
• If symptoms persist beyond two weeks of treatment, develop yellow crusting, or show signs of infection, consult a healthcare provider. 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 AD, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1.

Additional Therapies

• The updated guidelines highlight new evidence that has emerged since the previous guidelines, further informing the management of AD with systemic therapies 1.
• New recommendations are issued for the use of biologics and Janus kinase inhibitors, with strong recommendations for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib.
• Conditional recommendations are made in favor of using phototherapy, azathioprine, cyclosporine, methotrexate, and mycophenolate, and against the use of systemic corticosteroids.

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

From the Research

Treatment Guidelines for Atopic Dermatitis (Eczema) of the Face

• The treatment of facial atopic dermatitis can be challenging due to the limited use of topical corticosteroids (TCS) in this area, as they can cause side effects such as skin thinning and atrophy 3, 4.
• Alternative treatments, such as pimecrolimus cream 1%, have been shown to be effective in controlling eczema and pruritus in children with mild to moderate facial atopic dermatitis who are intolerant of or dependent on TCS 3, 5.
• Tacrolimus has also been found to be effective in treating atopic dermatitis, with studies showing significant improvements in disease severity and quality of life 4, 6.
• A network meta-analysis of topical anti-inflammatory treatments for eczema found that potent TCS, tacrolimus 0.1%, and ruxolitinib 1.5% were among the most effective treatments, while mild TCS, roflumilast 0.15%, and crisaborole 2% were among the least effective 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, with significant improvements in clinical signs and symptoms 7.

Topical Treatments

• Pimecrolimus cream 1%: effective in controlling eczema and pruritus in children with mild to moderate facial atopic dermatitis 3, 5.
• Tacrolimus: effective in treating atopic dermatitis, with significant improvements in disease severity and quality of life 4, 6.
• Topical corticosteroids (TCS): can be used to treat facial atopic dermatitis, but their use is limited due to the risk of side effects such as skin thinning and atrophy 3, 4.
• Barrier repair therapy with a non-steroidal emollient cream: effective in treating facial atopic eczema, with significant improvements in clinical signs and symptoms 7.

Considerations

• The choice of treatment should be based on the severity of the disease, the patient's age and medical history, and the potential risks and benefits of each treatment option 3, 4, 6.
• Patients with facial atopic dermatitis should be monitored closely for signs of treatment-related side effects, such as skin thinning and atrophy 3, 4.
• Barrier repair therapy may be a useful adjunct or alternative to traditional topical treatments for facial atopic dermatitis 7.