Eczema on the Face and Neck: Triggers and Treatment - Everyday Health

Of all the places on the body to have itchy, inflamed patches of atopic dermatitis (also called eczema), the face and neck are among the most visible — and bothersome.

"It's not uncommon for people to have eczema on the face or neck, and sometimes it's a little more prevalent in certain groups," says Joy Wan, MD, a dermatologist and assistant professor of dermatology at Johns Hopkins Medicine in Baltimore. Children are especially prone to eczema on the face and neck, often starting on the cheeks, she says.

Atopic dermatitis impairs the skin's ability to serve as a barrier, making it less able to retain water. On top of that, some people with eczema may also have allergic skin reactions, known as contact dermatitis. "That can cause more of a facial or neck presentation for their eczema as well," says Dr. Wan.

Here Wan outlines 10 key facts to know about eczema on the face and neck, with info on common triggers, strategies to minimize flares, and the best and safest treatments.

1. Eczema Can Sometimes Look Different on the Face and Neck Than It Does Elsewhere on the Body

A person can have eczema on their face that appears very different from the eczema they have on other areas of their body. "Some people may have very typical dry, scaly eczema on their arms or their trunk, but then on their face perhaps they have more of an oozing or weeping form of eczema, or vice versa," Wan says.

For other people, face and neck eczema can look very similar to eczema on other parts of their body. "It tends to be scaly, pink patches on the face, similar to what you may see on the arm or the trunk," Wan says. (She notes that pink or red tones may be obscured in people of color with highly pigmented skin.)

Finally, Wan says, "There's no one specific way that eczema on the face and neck looks," and the appearance can vary significantly from person to person.

2. Symptoms of Eczema on the Face and Neck May Be Especially Severe Because of Increased Exposure to Allergens and Other Irritants 

"A lot of symptoms of eczema on the face and neck can be similar to those of eczema on other parts of the body — there's still often a lot of itch and it may be scaly," says Wan. But for some people, the symptoms of eczema on the face and neck can be particularly severe, which could be due to a combination of external triggers.

"Unlike other parts of the body, the head and neck are always exposed to the environment, which may contain allergens that could potentially irritate the skin," says Wan. "These are also areas of the body where a person might use more products — lotions, hair products, makeup, etc. — which can also irritate the skin."

3. Diagnosing Eczema on the Face and Neck Can Sometimes Be Difficult

If the face and neck are the first places a person ever gets a patch of eczema and there are no other areas of involvement, diagnosis may be challenging, says Wan. A person's age and the eczema pattern may provide some clues.

"For example, young children are known to often have facial involvement of eczema, and sometimes it just starts on the cheeks with weepy or dry eczema patches, and it may be limited there," says Wan.

The challenge in adults is differentiating between eczema and a rash caused by an allergen or irritant. "Trying to distinguish if there's some sort of external trigger is really critical in situations like that," Wan says.

More than 15,000 substances can cause an allergic skin reaction, according to the American Academy of Dermatology. A dermatologist might perform something called a patch test to determine whether contact dermatitis is responsible for a rash on your face or neck.

Two things to keep in mind in this situation: First, some allergens can cause a delayed reaction — so your rash may be due to something that touched your skin a while ago. Second, it's possible to develop an allergic reaction to a product you've used for years, so don't rule those things out.

4. People With Seasonal or Environmental Allergies Are More Likely to Have Eczema on the Neck and Face

"Facial and neck involvement is sometimes an issue for people who have significant seasonal or environmental allergies [such as pollen, pet dander, or dust mites], because the face and neck are so exposed to the environment," says Wan.

Wan makes sure to ask her patients about how well they are managing any seasonal allergies. For some people, taking care to avoid triggers and minimizing allergic reactions with medication can be part of an overall plan for treating eczema on the face and neck, she says.

5. Eczema on the Face and Neck Poses Special Treatment Issues

"If we're talking about topical treatments such as creams or ointments that we are applying to eczema, we do have to be mindful that the skin on the face and neck is much thinner than the skin on other parts of the body," Wan says.

Potent topical corticosteroids can cause skin thinning if applied too frequently and for a long time without a break, according to the National Eczema Association. In some people, topical steroids used on the face can cause tiny bumps and acne.

For these reasons, "We often have to limit the duration of time that we might be able to use stronger corticosteroid creams or ointments," Wan says. "For example, a steroid cream that we could use for two weeks on one part of the body, we might only use for a week on the face."

If the eczema on the face and neck is a chronic issue, a dermatologist is likely to prescribe steroid-sparing treatments. "These are not the typical steroid-based creams and ointments and so they can be more safely used on the face and neck in a continuous manner," she says.

The nonsteroid cream ruxolitinib (Opzelura), for instance, is a relatively new option for adults and children 12 and up with mild to moderate atopic dermatitis.

6. Facial Eczema Worsened by Environmental Triggers May Require a Special Washing Regimen

Although experts often recommend that patients with eczema limit the frequency of bathing or showering, the advice might be different for people who have patches on their face and neck that are worsened by seasonal or environmental allergies.

"For these patients we sometimes suggest that they take a shower or bath every day to wash these areas so as to remove external triggers that may have found their way to the skin," Wan says.

7. The Moisturizer You Use for Your Body May Not Be Right for Your Face

Moisturizing is key for easing eczema, but occlusive moisturizers like petroleum jelly and Aquaphor — which form a physical barrier on skin to prevent water loss — might not be the best choice for the face. "You may need to use moisturizers that are less occlusive on your face compared to what you can tolerate on other parts of the body," Wan says.

She adds, "Those types of moisturizers may actually worsen eczema on the face, especially if you sweat."

8. Test Out a Personal-Care Product Before Applying It All Over

For anyone with eczema-prone skin, the right facial moisturizers, makeup, and sunscreen can reduce the risk of an allergic reaction. It's a good idea to test every new product you use on a small area of skin before applying more generously. "It's trial and error," Wan says.

While there is no hard-and-fast rule about which products are safest, those that are fragrance-free and alcohol-free tend to be less irritating, she says.

9. Shave Carefully

Shaving can be a frictional trigger that can sometimes aggravate atopic dermatitis on the face and neck. "Use shaving cream or some other kind of barrier when shaving to limit that irritation," Wan says.

10. Avoid Bacterial or Viral Infections

"Because the face is a high exposure area, we worry about infectious complications. You can get a bacterial infection on top of a patch of eczema," Wan says.

For instance, there may be a higher risk of infection from the herpes simplex virus (which causes cold sores on the lip or around the mouth), because the face is a "higher touch" part of the body, says Wan.

In rare cases, a person with atopic dermatitis who is infected with the herpes simplex virus can develop a dangerous condition called eczema herpeticum. Steps you can take to stay safe include avoiding direct contact with a person who has a cold sore and not sharing utensils, lip balm, or other products that touch another person's mouth.