Topical Corticosteroid Selection for Facial and Periocular Eczema
For eczema around the face and eyes, low-potency topical corticosteroids such as hydrocortisone 1% are recommended as first-line treatment, with preservative-free dexamethasone 0.1% for moderate-to-severe cases requiring short-term use only. 1
Potency Selection Based on Location
- For facial and periocular eczema, use low-potency topical corticosteroids first due to the thin skin in these areas and increased risk of adverse effects 1, 2
- For moderate-to-severe periocular eczema, preservative-free dexamethasone 0.1% may be appropriate for short-term use (maximum 8 weeks) 1
- Avoid potent and very potent topical corticosteroids on the face and around eyes due to significantly increased risk of skin thinning and other local adverse effects 1, 2
Application Guidelines
- Apply topical corticosteroids once daily for facial eczema, as twice-daily application does not improve efficacy but increases risk of side effects 3
- Use the fingertip unit method for appropriate dosing (one fingertip unit covers an area equivalent to two adult palms) 2
- Apply after bathing when skin is slightly damp for better absorption 4
Duration of Treatment
- Use topical corticosteroids for short courses to control flares 1
- For moderate-to-severe periocular eczema requiring dexamethasone 0.1%, limit treatment to a maximum of 8 weeks 1
- Consider early introduction of steroid-sparing agents (tacrolimus ointment or ciclosporin drops) to facilitate tapering of ocular corticosteroids 1
Monitoring and Side Effects
- Monitor for signs of skin atrophy, telangiectasia, or striae, particularly in the periocular region 4, 5
- Be aware that the risk of adverse effects increases with prolonged use, higher potency, and application to areas of thinner skin such as the face 2
- Preservative-free formulations are recommended for periocular use due to increased incidence of allergic contact dermatitis 1
Adjunctive Therapies
- Use emollients regularly as soap substitutes and moisturizers 1, 4
- Apply emollients at least 30 minutes before or after topical corticosteroids 4
- For severe pruritus, sedating antihistamines may be useful as a short-term adjuvant during relapses 1, 6
- Non-sedating antihistamines have little to no value in treating facial eczema 1, 7
Treatment-Resistant Cases
- If no improvement after 4 weeks of appropriate treatment, consider referral to a dermatologist 4, 6
- For treatment-resistant periocular disease, consider combination treatment with topical corticosteroids, tacrolimus ointment, and ciclosporin drops in carefully selected cases 1
Special Considerations
- Avoid soaps and detergents as they remove natural lipids from the skin surface 1
- Use dispersible cream as a soap substitute to cleanse the skin 1
- Keep nails short to minimize damage from scratching 1
- Evaluate for secondary bacterial infection if treatment is not effective 6
- Consider patch testing to identify potential contact allergens that may be exacerbating the condition 6