Eczema on the face and eyelids: gentle care and treatment options

Eczema on the face is common, and it can be hard to live with. The skin on the face and eyelids is thin and shows redness, flaking and swelling easily. It is also the skin that needs the most careful treatment. This article explains what usually helps.

Why the face needs extra care

Facial skin and eyelid skin are much thinner than skin on the rest of the body. Medicines are absorbed more easily there. That is why a cream that is safe on your arm may not be right for your eyelid.

Facial eczema can look like red, dry, itchy patches. Eyelids may look puffy, scaly or swollen. In some cases the skin looks shiny or cracked.

Gentle daily care

Good basic care helps every treatment work better.

• Wash with lukewarm water and a mild, fragrance-free cleanser. Hot water dries the skin.
• Pat dry. Do not rub.
• Apply a plain, fragrance-free moisturizer at least twice a day, and right after washing.
• Use a mineral sunscreen made for sensitive skin.
• Keep your hands off your face. Rubbing and scratching make eczema worse.

Test any new product on a small patch of skin for a few days first.

Short courses of low-potency steroids

Topical steroids calm inflammation. On the face they must be used with care, because steroids can thin the skin and, near the eyes, can raise eye pressure or lead to cataracts if used for a long time.

• Clinicians usually choose a low-potency steroid, such as hydrocortisone, for the face.
• They are used for a short time only, for example a few days to a couple of weeks.
• Use a thin layer on affected skin. Do not use it on healthy skin.
• Do not use a steroid on or near your eyelids unless your clinician said so.
• Do not use a steroid that was prescribed for your body on your face.

Steroid-free creams

Some creams reduce eczema without using a steroid. Clinicians often prefer them for the face and eyelids, and for long-term use.

• Tacrolimus ointment (Protopic) and pimecrolimus cream (Elidel) are calcineurin inhibitors. They calm the immune response in the skin. They may sting or burn for the first few days. Avoid strong sun on treated skin.
• Crisaborole (Eucrisa) is a different type of cream. It also eases inflammation and itch, and some people find it gentler at first.

Coverage and cost differ by province and by plan. Your clinician can tell you which option fits you. Some of these medicines need special authorization.

Common triggers

Finding triggers can reduce flares. Common ones include:

• fragranced soaps, lotions, makeup and shampoo;
• hair dye, nail products and cosmetics that touch the face;
• dry winter air and indoor heating;
• stress and lack of sleep;
• sweat, and sun exposure;
• pollen, dust mites and pet dander;
• touching the face with unwashed hands.

Eyelid eczema can also be an allergy to a product. If your eyelids are often red or swollen, a clinician may suggest patch testing.

Tips for eyelids

• Remove eye makeup gently. Choose fragrance-free products, or stop using eye makeup while the skin heals.
• Do not rub your eyes. Cold compresses can calm itch.
• Wash your hands before you touch the area.
• Keep nail polish off your fingers if you touch your eyelids often.

Other conditions that look like eczema

Several skin problems look like eczema on the face. These include seborrheic dermatitis, rosacea, perioral dermatitis, allergic contact dermatitis and, less often, a fungal or a viral infection. A clinician can tell them apart. Do not guess, because the wrong cream can make things worse.

When to message your clinician

Message your Care Team if:

• your eczema does not improve after a week or two of gentle care;
• you have been using a steroid for more than a short course and the rash returns when you stop;
• your eyelids are swollen, painful or you have vision changes;
• you see yellow crusts, pus, blisters or sores, which may mean an infection;
• your skin burns a lot after you apply a cream;
• you are pregnant or breastfeeding and need a treatment.

Go to emergency if your face or lips swell fast or you have trouble breathing.