What are the treatments for facial atopic dermatitis (eczema)?

From the Guidelines

Facial eczema can be effectively managed with a combination of gentle skincare and appropriate medications, prioritizing low-potency topical corticosteroids and moisturizers as first-line treatments. For mild to moderate facial eczema, start with a low-potency topical corticosteroid like hydrocortisone 1% cream applied thinly twice daily for up to 7-10 days, as recommended by recent guidelines 1. Pair this with a fragrance-free moisturizer like CeraVe, Cetaphil, or Vanicream applied multiple times daily, even when symptoms improve.

Key Considerations

• The facial skin is thinner and more sensitive than other body areas, making it more susceptible to irritation and side effects from stronger medications, which is why milder treatments are recommended.
• Identify and avoid personal triggers such as certain foods, stress, or environmental factors that can exacerbate eczema symptoms.
• Wash your face with lukewarm water and a gentle, soap-free cleanser, avoiding hot water, harsh soaps, and fragranced products that can trigger flares.

Treatment Approach

• For more severe cases, prescription treatments like tacrolimus (Protopic) or pimecrolimus (Elidel) may be needed, as these calcineurin inhibitors don't thin the skin like steroids can 1.
• If symptoms persist beyond two weeks of home treatment, develop crusting or oozing, or if you experience severe itching or pain, consult a healthcare provider for further evaluation and treatment.

Evidence-Based Recommendations

• Recent guidelines from the American Academy of Dermatology suggest that emollients and prescription topical therapies are sufficient to achieve eczema control for most people with atopic dermatitis 1.
• The guidelines also highlight the importance of shared decision-making between patients and clinicians when considering more advanced therapies, taking into account the severity of eczema, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1.

From the FDA Drug Label

About 75% of patients had atopic dermatitis affecting the face and/or neck region. The FDA drug label does support the use of pimecrolimus cream for eczema on the face.

• Eczema on the face is a common condition that can be treated with pimecrolimus cream.
• Pimecrolimus cream can be applied to the affected areas of the skin, including the face, twice a day.
• It is essential to follow the doctor's advice and use the smallest amount of cream needed to control the signs and symptoms of eczema.
• Patients should stop using the cream when the symptoms go away or as directed by the doctor 2.

From the Research

Eczema on the Face

• Eczema, also known as atopic dermatitis, is a chronic relapsing and remitting inflammatory skin disease that can affect the face, causing intensely pruritic skin lesions 3.
• The American Academy of Dermatology has created simple diagnostic criteria based on symptoms and physical examination findings to diagnose atopic dermatitis 3.
• Treatment for eczema on the face typically involves the use of topical corticosteroids, which are effective in reducing inflammation and relieving symptoms 4, 3, 5.

Topical Corticosteroids for Eczema

• Topical corticosteroids are the first-line treatment for eczema flare-ups, and their effectiveness and safety have been extensively studied 4, 5, 6.
• Potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids in treating eczema, primarily in moderate or severe cases 4.
• The frequency of topical corticosteroid application, whether once daily or more frequently, does not seem to affect the treatment outcome significantly 4, 7.
• Local adverse events, such as abnormal skin thinning, are rare and usually associated with the use of higher-potency topical corticosteroids 4, 6.

Prevention of Eczema Relapse

• Weekend (proactive) therapy with topical corticosteroids probably results in a large decrease in the likelihood of eczema relapse compared to no topical corticosteroids or reactive application 4.
• Maintenance therapy with liberal use of emollients and daily bathing with soap-free cleansers can help prevent eczema relapse 3.
• Other treatments, such as topical calcineurin inhibitors and ultraviolet phototherapy, may be effective in preventing eczema relapse, but their use is typically reserved for more severe cases or when first-line treatments are not adequate 3, 5.