Treatment for Facial Eczema

First-Line Treatment

The British Medical Journal recommends applying topical corticosteroids as the primary treatment, using the least potent preparation that effectively controls the eczema, for patients with facial eczema 1
For patients with facial eczema, the American Academy of Dermatology suggests using mild to moderate potency corticosteroids due to the thinner skin in this area, which increases risk of side effects 1
The National Institute for Health and Care Excellence advises applying treatment no more than twice daily, as once-daily application of potent corticosteroids is equally effective as twice-daily application, for patients with facial eczema 2
Regular bathing is beneficial for cleansing and hydrating the skin, with emollients applied immediately after bathing to provide a surface lipid film that retards evaporative water loss, as recommended by the American Academy of Dermatology 2
The use of a dispersible cream as a soap substitute instead of regular soaps and detergents that remove natural skin lipids is recommended by the National Eczema Association, for patients with facial eczema 2
Avoiding extreme temperatures and irritant clothing, such as wool, with cotton clothing being preferred, is advised by the American Academy of Dermatology, for patients with facial eczema 2
Keeping nails short to minimize damage from scratching and reduce risk of secondary infection is recommended by the National Institute for Health and Care Excellence, for patients with facial eczema 2

The Infectious Diseases Society of America recommends treating overt secondary bacterial infections with appropriate antibiotics, such as flucloxacillin for Staphylococcus aureus, phenoxymethylpenicillin for β-hemolytic streptococci, and erythromycin for penicillin-allergic patients, for patients with facial eczema 1, 2
For patients with herpes simplex infection (eczema herpeticum), the American Academy of Dermatology advises administering oral acyclovir early in the disease course, and in ill, feverish patients, acyclovir should be given intravenously 1, 2

The American Academy of Dermatology suggests considering ichthammol (1% in zinc ointment) for lichenified eczema, as it is less irritant than coal tars, for patients with facial eczema 1
Coal tar solution (1% in hydrocortisone ointment) is generally preferred to crude coal tar and does not cause systemic side effects unless used extravagantly, as recommended by the National Institute for Health and Care Excellence, for patients with facial eczema 1
Sedating antihistamines can be useful as a short-term adjuvant to topical treatment during relapses with severe pruritus, primarily for their sedative properties, as advised by the American Academy of Dermatology, for patients with facial eczema 1, 2
Non-sedating antihistamines have little to no value in treating facial eczema, according to the National Eczema Association 1, 2

The American Academy of Dermatology recommends considering phototherapy for moderate to severe eczema not responding to first-line treatments, for patients with facial eczema 3, 4
Systemic corticosteroids have a limited but definite role in tiding occasional patients with severe atopic eczema, but should not be considered for maintenance treatment until all other avenues have been explored, as advised by the National Institute for Health and Care Excellence, for patients with facial eczema 3, 5

The American Academy of Dermatology recommends considering referral if there is failure to respond to first-line treatment, extensive disease, or diagnostic uncertainty, for patients with facial eczema 5
Specialists should start with first-line treatment measures again, reinforcing any aspects in which there was lack of compliance, as advised by the National Institute for Health and Care Excellence, for patients with facial eczema 5