Why is my facial eczema worse in summer?

What is eczema?

Eczema, sometimes called dermatitis, is a condition that causes your skin to become inflamed. This results in red rashes and dry, flaky skin.

It also causes itchiness that leads you to scratch the area, which often breaks the skin and causes temporary bleeding, sores, and sometimes scars.

Not everyone experiences eczema on the face, but those who do can find it especially painful and uncomfortable, because the skin on your face is more sensitive.

What does eczema look like on the face?

Facial eczema is most common on the cheeks and forehead. It may appear as red, purple, or white bumps, depending on your skin tone, and can also show up as a rash, dry flaky patches, or blisters.

Types and causes of facial eczema

The cause of eczema is not fully understood, but both genetics and the environment have a role to play. While there's no cure, symptoms tend to flare up for weeks at a time, go away, and then return.

As well as creams and medications, eczema on the face can be improved by knowing the environmental triggers that can kick-start your symptoms, and then taking steps to avoid or limit them.

Dr Mia Jing Gao, a skin specialist at the Cadogan Clinic, says: "some of the most common environmental triggers include fragrance, food, cosmetics, over-exfoliating, and using skincare that is too harsh."

Patient picks for Eczema

Skin, nail and hair health

What causes eczema?

Eczema is a very common skin condition. Although the term eczema is used to describe a few different conditions, when people say eczema they usually mean the condition called atopic dermatitis or atopic eczema. In eczema, the skin becomes dry and more vulnerable to inflammation and infection. People with eczema are also likely to have asthma and hay fever. All three of these are called atopic conditions. In atopic conditions, the immune system response is activated by otherwise-harmless things - allergens. Eczema is not contagious. It can't be passed from person to person.

by Dr Doug McKechnie, MRCGP

Skin, nail and hair health

Atopic eczema

Eczema is sometimes called dermatitis which means inflammation of the skin. There are different types of eczema, but most are chronic conditions. The most common type is atopic eczema. In this type of eczema there is a typical pattern of skin inflammation which causes the symptoms. Moisturisers (emollients) and steroid creams or ointments are the common treatments. About 2 in 3 children with atopic eczema grow out of it by their mid-teens.

by Dr Doug McKechnie, MRCGP

1. Atopic dermatitis

Atopic dermatitis is the most common form of eczema. The word atopic means this eczema is an allergy, and if you have this condition, you're also more likely to have other allergen sensitivities, such as asthma and hay fever. Symptoms of atopic dermatitis on the face tend to show up around the forehead, cheeks, and eyes.

2. Seborrheic dermatitis

This is the most common type of facial eczema, and it also frequently appears on the scalp and chest. It's caused by an overgrowth of yeast on the skin, called Malassezia. If you have seborrheic dermatitis on your face, it's likely this appears around your hairline, eyebrows, and ears.

3. Contact dermatitis

There are two types of contact dermatitis:

1. Allergic - where the facial eczema is triggered by the immune system as an allergic reaction to certain ingredients in skincare products or make up applied to the face, or even nail varnish on your nails if you touch your face afterwards.

2. Irritant - a non-allergic sensitivity to certain ingredients in these products. The immune system isn't involved, but the direct contact of a substance on the skin causes irritation.

4. Light sensitive eczema

Light sensitive eczema is also known as photosensitive eczema and sometimes as sun allergy. In rare cases, the UV light emitted by the sun directly causes eczema. The skin usually reacts within minutes or hours, causing sunburn-like redness as well as well-defined rashes.

How to treat eczema on the face

Managing your facial eczema at home

Dermatologist Dr Gao has these tips:

• Use a gentle soap substitute to gently cleanse the skin.

• Don't chop and change your skincare too much as that is likely to cause more irritation.

• Avoid harsh skincare products - choose fragrance-free products which are suitable for eczema-prone skin.

• Moisturise regularly - eczema skin tends to be very dry so it's important you keep it well hydrated with fragrance-free moisturiser.

• Don't use hot water - ensure its lukewarm and don't vigorously scrub the skin.

• Identify the triggers so you can avoid or minimise contact - keeping a journal is advisable to help monitor flares and identify triggers.

Medications and therapies

There are a range of over-the-counter moisturising creams with eczema-friendly ingredients, as well as cortisone cream to stop itching and inflammation. Cortisone cream is a steroid cream and should not be used on the face without discussing with a doctor first. Some steroid creams can make facial eczema worse.

If you find that over-the-counter ointments aren't doing enough to soothe your irritated skin, or if your facial eczema isn't responding to self-treatment, your doctor can recommend prescription medications or refer you to a specialist for other forms of treatment. This could include:

• Prescription steroid creams.

• Prescription antihistamines.

• Tacrolimus and pimecrolimus creams to suppress the immune system for atopic eczema.

• Biologics.

• Light therapy.

Can you prevent facial eczema?

Eczema is an ongoing long-term condition, and you cannot completely prevent eczema on your face or anywhere on your body.

"Yet there are lots of things we can do to help treat it," says Dr Gao. "Consult a dermatologist for expert advice on treating eczema and to develop a management plan. They will also be able to help you establish a suitable skincare regime tailored to your personal needs."

Further reading

1. Bosma et al: Children with atopic eczema experiencing increased disease severity in the pollen season more often have hay fever at a young age and a dark skin type.

2. Kaneko et al: Usefulness of sweat management for patients with adult atopic dermatitis, regardless of sweat allergy.

3. Ludriksone and Elsner: Adverse reactions to sunscreens.

4. Araya et al: Clinical characteristics and quality of life of seborrheic dermatitis patients in a tropical country.

5. Keyes et al: Potential allergenicity of commonly sold high SPF broad spectrum sunscreens in the United States; from the perspective of patients with autoimmune skin disease.

6. ScienceDirect: Plant dermatitis.

7. Rutt et al: Photosensitive atopic dermatitis exacerbated by UVB exposure.