This is a series focused on facial eczema, with the privilege of having Dr Lynn Chiam, of Children & Adult Skin Hair Laser Clinic, to help explain further the type of facial rashes, its treatment options and daily facial care. Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Singapore. Apart from paediatric dermatology, her other subspecialty interests include adult pigmentary conditions and laser dermatology. More on Dr Lynn can be found here.
What can I do about the rashes on my face?
Treatment options for the face may differ slightly from the rest of the body due to the thinner skin and higher concentration of superficial blood vessels found in the face. Before Dr Lynn helps with the treatment specific for facial eczema, let’s run through good skin care routine that’s applicable for the whole body.
1. Moisturizing – Dry skin needs moisturizing and as there is a high concentration of sebaceous glands on the face, it will be good to choose a product that is non-comedogenic. A non-comedogenic product does not lead to the formation of whiteheads or blackheads. As always, choose one that does not contain an ingredient that you are allergic to and always choose one that has been clinically tested. Read this post for the top allergens and here for a better understanding of product label. For the face, you may also want to use a sunscreen that protects your face and not irritate it, read here for sunscreen selection.
2. Cleaning – As with the body, you will have to clean the face. Choose a facial cleanser that works for you, without abrasive materials. There’s no need to exfoliate your face more than how it is naturally exfoliating on its own. Moisturize after cleaning. Pat dry your face, do not rub and always avoid hot water.
3. Cold Presses – If you have an itchy rash on your face, you can apply a cooling pack on the area to reduce the itch. Dr Lynn advises not to use a hot pack as this may make the rash and itch worse. A cooling pack can be placed to temporarily reduce the itchiness on the face.
4. Avoiding Irritants and Allergens – Avoid harsh soap, common allergens which you are sensitive to.
Dr Lynn’s Advice on Facial Eczema Treatment
Question: Help! I have more than one type of eczema on my face! How do I treat both atopic dermatitis and seborrhoeic dermatitis? What if I have both irritant contact and atopic dermatitis?
Dr Lynn: It is not uncommon to see patients with eczema also having seborrhoeic dermatitis. These two conditions can be treated with similar creams. A thin layer of low-to mid potency steroid cream can be applied to the rash for a limited amount of time. Alternatively, a steroid-sparing cream like calcineurin-inhibitors (Tacrolimus or Pimicrolimus) can also be used. It is important to use moisturizer regularly together with the steroid cream/ Tacrolimus as it will help improve the barrier function of the skin. In order not to over-dry the skin, use a gentle soap and avoid facial scrubs.
Atopic dermatitis makes an individual more susceptible to irritant contact dermatitis. This is because people with atopic dermatitis have a suboptimal skin barrier which makes them more sensitive to chemical and physical agents. It is important to identify which substances/products are responsible for the irritant contact dermatitis. It is advisable to see your dermatologist. Avoidance of the irritant product and application of a suitable steroid cream and moisturizer are needed to treat both the irritant contact dermatitis and atopic dermatitis. Sometimes, if the dermatitis is severe, a course of oral steroids may be required.
Question: Help! I’m told to use only mild steroids but the eczema on my face isn’t getting better! Are there other treatment options?
Dr Lynn: In general, only low to mid potency steroids should be used on the face for a limited amount of time (1-2 weeks). There are certain mid-potency steroids with minimum side effects that can be used on the face. I will advise starting with a mid-potency steroid cream if the eczema is persistent then tailing down to a low potency steroid once the rash is better. Another alternative is to use topical Calcineurin- Inhibitors like Tacrolimus and Pimicrolimus. This is a group of creams that have similar effect as steroids but without the steroidal side effects. They can be used for a longer period of time compared to steroid creams. It is important to see your dermatologist to decide on which cream is suitable for you. The regular use of a good moisturizer and gentle soap is also important.