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, as recommended by the 2024 guidelines from the Journal of the American Academy of Dermatology 1. The treatment approach should prioritize the use of mild, fragrance-free cleansers like Cetaphil or CeraVe, followed by applying a moisturizer while skin is still damp to lock in hydration.

• For mild flares, over-the-counter 1% hydrocortisone cream can be used 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 skin with prolonged use, as supported by the guidelines 1. Key considerations include:
• Applying medications in a thin layer once or twice daily as directed, avoiding the eye area.
• Moisturizing multiple times daily with products containing ceramides, hyaluronic acid, or colloidal oatmeal.
• Identifying and avoiding triggers such as harsh soaps, fragrances, certain foods, stress, and extreme temperatures.
• Using only lukewarm water when washing the face, patting dry gently, and considering the use of a humidifier in dry environments. If symptoms persist beyond two weeks of treatment, develop yellow crusting, or show signs of infection, it is essential to consult a healthcare provider promptly, as emphasized by the guidelines 1. 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, as recommended by the guidelines 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. Use ELIDEL Cream exactly as prescribed. Use ELIDEL Cream only on areas of your skin that have eczema.

The treatment guidelines for atopic dermatitis (eczema) of the face are to use pimecrolimus cream 1% as a 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.

• Apply a thin layer of ELIDEL Cream only to the affected skin areas, twice a day, as directed by your doctor.
• 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 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.