Oftentimes, having a red face means a person is either super embarrassed or deeply sunburnt. But people with eczema know that there’s another possible explanation for their tell-tale flush: atopic dermatitis on the face.
Atopic dermatitis—one of the most common types of eczema—is an inflammatory skin condition, Tiffany Jow Libby, MD, director of Mohs micrographic and dermatologic surgery at Brown Dermatology in Rhode Island, tells Health. In the simplest terms, that means people with atopic dermatitis have immune systems that overreact to things that aren’t irritants to most people. They also often have compromised skin barriers, making it easier for potential skin irritants to get through the skin and into your body. This can cause patches of angry, itchy, discolored skin.
Atopic dermatitis can show up anywhere on the body. On adolescents and adults, it most commonly shows up on the wrists, ankles, elbows, and knees, according to the US National Library of Medicine (MedlinePlus). But the chronic skin condition can affect the face, too. Here, dermatologists explain what you need to know about atopic dermatitis—what it looks like, which symptoms are associated with it, what causes it—and how you can prevent and treat the issue.
What is atopic dermatitis on the face?
Atopic dermatitis is a chronic inflammatory skin disease that can occur anywhere on the body, says Dr. Libby. When atopic eczema affects the face, it typically occurs on the cheeks and folds of the neck in children, and around the eyes in adults.
Dr. Libby says that atopic dermatitis on the face can often be confused for other skin conditions because of how itchy and rashy it is. For example, babies often get contact dermatitis—a type of eczema caused by direct contact with an irritant—around their mouths because of drool or introduction to certain foods. Psoriasis and fungal infections such as ringworm, both of which can cause itchy, scaly patches on the body, can also be mistaken for atopic dermatitis. Despite their similar appearance, these conditions have different causes and thus require different treatment.
What are the symptoms of atopic dermatitis on face—and what does it look like?
There are a few key indications that what you’re experiencing on your face is likely atopic dermatitis:
- Very dry skin: On its own, dry skin might be just that. But if combined with some of the other symptoms, you’re likely dealing with eczema.
- Extremely itchy skin: This is the hallmark of atopic dermatitis, no matter where it occurs.
- Discolored patches on your cheeks or around your eyes: In lighter-skinned people, atopic dermatitis makes the skin look red. In darker-skinned people, the rash can be more subtle and look reddish brown, grey, or purple-grey, says Dr. Libby. (Per the National Eczema Association, darker-skinned people may also experience temporary pigment changes once their eczema heals that last for a few months.)
What causes atopic dermatitis on the face or are there any risk factors?
Atopic dermatitis is caused by a few different factors, no matter where it flares up on your body. Genetics can play a role, says Dendy Engleman, MD, FAAD, a board-certified dermatologist—if your parents have it, that makes you more likely to develop it. Some (but not all) people with atopic dermatitis also have genetic mutations that affect their skin’s ability to protect itself, per MedlinePlus.
The most common risk factors of atopic dermatitis generally are:
- Existing allergies or asthma problems: Thank the “atopic triad” for this one. People who have allergies and/or asthma are also more likely to have atopic dermatitis, or vice-versa.
- A change in seasons: Changing humidity and temperatures in the spring and fall are a common eczema trigger, adds David Kim, MD, a board-certified cosmetic dermatologist.
- Life stress: Stress can also trigger eczema flare-ups if you have the condition, says Dr. Libby.
- Other environmental factors: Per the National Eczema Association, some research suggests that the air pollution, temperature and humidity in a person’s environment may influence their risk of getting atopic dermatitis or trigger flare-ups in people who already have it.
What are treatment options for atopic dermatitis on the face—and how can you prevent it?
All three dermatologists interviewed for this piece say steroids are the most common route for treating atopic dermatitis. However, the skin on the face is very thin and delicate, making treatment a bit different.
“When you’re treating the face or the arms, you want to be a little more cognizant of the skin, and you try to stay away from using the most potent steroids,” says Dr. Kim. That’s because thinner skin absorbs more of the steroid—increasing a person’s risk of experiencing side effects like thinning skin, discoloration, and stretch marks.
When treating atopic dermatitis on the face, Dr. Libby often prescribes either a very low-dose of topical steroid cream or resorts to non-steroidal topicals. Examples include Elidel (pimecrolimus), Protopic (tacrolimus), or Eucrisa (crisaborole). These drugs all work to fight itching, inflamed, discolored skin.
To reduce the risk of flare-ups, “maintaining a healthy skin barrier is going to be key,” says Dr. Libby. Translation: Bust out that moisturizer. Moisturizer keeps your skin hydrated and ensures proper functioning of your skin’s barrier (keeping the good stuff in and the bad stuff out). She recommends looking for a product with ceramides, a type of lipid that protects the skin barrier and is often deficient in people with eczema. (It also naturally declines as you age, Dr. Engelman adds, so adding it back into your skin through moisturizer is extra important.)
You’ll also want to keep your skin-care routine simple and gentle, Dr. Engelman says. Avoid harsh active ingredients like alpha-hydroxy acids (such as glycolic acid), beta-hydroxy acids (such as benzoyl peroxide), and retinoids, especially during flare-ups. If you’re hoping to also address acne or signs of aging, talk to your dermatologist for help putting together a routine that’s effective but won’t aggravate your sensitive skin. “Options like bakuchiol [a retinol alternative] are probably way better tolerated,” she says as an example.
Atopic dermatitis on the face can seem like an itchy, frustrating nightmare. But with guidance from your dermatologist and the right treatment, you can tamp down a flareup in no time.