One of the most annoying and humiliating dermatologic conditions is a facial rash. Can you imagine jumping out of bed in the morning, looking in the mirror, and realizing that you have a massive, red patch across your cheeks, forehead, nose or all of the above?
Facial rashes are one of the most complex diagnoses to make, even for seasoned dermatologists. To prevent further flaring up your rash, be sure to obtain a proper diagnosis from your PCP or dermatologist before trying out any new products or treatments.
In this blog post, I’ll discuss some of the most common facial rashes, also known as “facial dermatoses.” I’ll also recommend a few of my favorite products that you can trial to soothe symptoms and use as an adjunct to your doctor’s prescribed regimen (e.g. topical steroids, topical calcineurin inhibitors, and so forth).
Most Common Facial Dermatoses/Rashes
Allergic contact dermatitis
Allergic contact dermatitis, also known short-hand as ACD, is a common hypersensitivity reaction caused by an allergen. The most common allergens include: dust, house mites, poison ivy/oak, nickel, latex, polyester, fragrances, dyes, and many others. People with sensitive skin or skin conditions are generally more likely to develop ACD. For example, out of 100 kids with atopic dermatitis (a common form of eczema), about ⅓ will have some form of allergy and 17% had an allergic reaction relevant to the skin .
ACD symptoms come on 48-72 hrs after an exposure, NOT immediately. Allergic contact dermatitis on the face typically presents as weepy, red, vesicles (tiny little blisters) which are extremely itchy! Common sites for ACD are the eyelids.
Diagnosis is usually clinical (which means your doctor takes a look at it, listens to your history, and is able to put the two together). Sometimes, you may be referred to an allergist or allergy-trained dermatologist for patch testing. This is a form of diagnostic testing that involves putting small patches with tiny amounts of different allergens on the skin to see if there is a reaction.
Treatment of ACD is simple: soothe the symptoms and avoid the responsible substance! Mild to moderate cases are usually treated with over the counter emollients, topical steroids, and possibly a topical antibiotic if there is an infection going on concurrently. ACD will typically settle down within a few days with the proper treatment and allergen avoidance. Please note that contact allergies typically originate from external contact to something rather than an internal contact with the gut (like a food allergy!).
Since ACD is very itchy, below are some of our most soothing, cooling, and itch-fighting products and moisturizers that you can try at home:
Remedywear™ Eye Mask- Available for adults and kids, this eye mask is the perfect natural treatment for eyelids or eczema around eyes. Made with TENCEL and embedded with anti-inflammatory zinc, it helps soothe irritated or puffy eyes. Store in the fridge between uses for an extra cooling overnight treatment.
Organic Aloe Vera for Eczema Skin Soothing Spray – The non-greasy formula of this aloe vera spray makes it perfect for spraying anywhere on the body – including the face! Calm your itchy, red skin with this soothing, refreshing facial spray.
Irritant contact dermatitis
Irritant contact dermatitis (ICD) is a form of direct and IMMEDIATE injury to the skin by a caustic substance, force, or material. Some common causes of ICD are cold, harsh chemicals or detergents, make-up products, adhesives, friction against a surface, or even over-exposure to water. Basically, the irritant breaks down the outer skin layers which contain insulating fatty acids and moisturizing “natural moisturizing factor,” leading to a leaky barrier and inflammation. The skin is unable to rapidly repair itself due to continuous or repeated irritant exposure. Believe it or not, we commonly see ICD in children due to saliva hanging out on their face! We call it “dribble rash.”
Another common presentation is ICD within minutes of application of a make-up product. For example, you will start putting on a cream or eye shadow and notice tingling, redness, and/or itching right way. This is different from allergic contact dermatitis, an allergic process, which will flare up 48-72 hours after the application. Treatment of ICD is removal of the offending agent(s) and repair of the damaged epidermal barrier.
Below are some of our favorite treatments that may assist in bringing hydration to dry, damaged skin after ICD:
Remedywear™ Balaclava for Kids – This balaclava rash is a great way to prevent dribble rash and protect the skin from scratching. Featuring moisture-wicking sweat control, it’s comfortable to wear all not without any chafing or sweaty irritation.
Organic Manuka Skin Soothing Cream – Made with just six ingredients – including Manuka honey – this oil-based balm is a calming treatment for facial rashes. It’s safe to use anywhere on the body – even delicate areas like the lips and eyelids. Your skin will love its soft, buttery texture!
Seborrheic dermatitis is a form of eczema that occurs in areas on the body with a lot of sebaceous glands – the face, axillae, trunk (inframammary), groin. It is thought that little yeasts that live on the skin naturally known by the name Malessezia overproliferate within the sebaceous gland oil. The byproducts of their rapid metabolism are highly inflammatory and irritating to the skin. We find that patients with other known skin conditions, especially psoriasis, immunologic disorders including cancers and HIV, and neuropsychiatric disorders (Parkinson’s, Alzheimer’s, depression…) are more prone to developing seborrheic dermatitis, and seborrheic dermatitis likes to flare up in the winter. The common scalp condition “dandruff” is actually a mild, uninflamed version of seborrheic dermatitis.
On the face, seborrheic dermatitis likes to occur within the eyebrows, on the eyelids, around the nose or within folds/creases. It tends to look like a greasy red-yellow patch with marked skin flaking. Skin biopsy or scrapings are rarely needed for diagnosis. Usually a clinician is able to tell by the appearance and backstory.
Treatment of seborrheic dermatitis involves application of a topical antifungal medicine such as ketoconazole or ciclopirox. More severe cases may require prescription topical steroids, calcineurin inhibitors, antibiotics, or oral antifungal medications.
Remedywear™ (TENCEL + Zinc) Hat – Made with hypoallergenic materials and featuring allergy safe dyes, this scalp treatment for adults and kids was designed to soothe and protect your skin. Wear throughout the day to prevent scratching or overnight as a healing remedy for scalp eczema.
Remedywear (TENCEL + Zinc) Balaclava for Adults – If you’re suffering from mouth, scalp, ear or facial eczema, check out this protective balaclava. Worn overnight as a dry wrap treatment, it protects the skin from unintentional scratching and boosts the healing process.
Periorificial dermatitis (POD) is a chronic facial rash that presents with small flesh-colored to red bumps (we call them papules in the derm world!) in a circle around the mouth (~70% of cases). The nose (43%) and eyes (25%) are also possible sites, but they are less often affected . Typically, the rash will only have mild symptoms, if any! Two clinical variations of POD exist – classical and granulomatous (more common in dark-skinned persons, Arican-Americans). Doctors are unsure about the cause of this condition, but we do know that recent corticosteroid use is linked to POD. The classical treatment is oral antibiotics (however, dermatologists use a very low dose that is anti-inflammatory in its mechanism, and much less anti-bacterial). Kids under the age of 8 years may require a topical antibiotic.
Demodicosis is caused by overproliferation of Demodex follicularum and/or brevis. Demodex are small parasites which colonize hair follicles and sebaceous glands. Studies also suggest that they love the dry, alkaline skin of patients with eczema!  It is thought that when Demodex die on the skin, they release a toxin that sets of an inflammatory cascade on the skin surface.
Demodicosis can show up in a variety of patterns on the face. It frequently mimics rosacea or folliculitis (inflamed hair follicles), often targeting the nose and periocular areas. The diagnosis can be confirmed by skin scraping the affected area and looking under a microscope (you can actually see the parasites!). Evidence for the treatment of demodicosis remains sparse and is largely based on case reports. The treatment of choice for this condition is a prescription medicine called ivermectin.
If you think that list was exhaustive, think again! Different variations of acne (vulgaris), steroid acne, rosacea/steroid-induced rosacea, impetigo (a superficial skin infection caused by the organism Streptococcus), airborne contact dermatitis, and tinea faceii can also exist on the face! This is why seeing a dermatologist can be incredibly important to kick-start you on the path to getting the best treatment. Each of these conditions has a different root cause, and knowledge of that root cause will guide appropriate treatment and action.
**If you need to wait a few days or weeks before you are able to get in to see a local dermatologist, here are some helpful general tips to try at home:
- Take a PHOTO of your rash at its worst. Feel free to take a photo every morning (make-up free) if things are changing day-to-day.
- Hold off on using a wide range of make-up and beauty products. Yes – this may mean going cold turkey on your AM beauty regimen. Instead, choose a single, simple cleanser and moisturizer, and use that daily.
- Avoid ANY fragrance or essential oil-containing items. These are frequently culprits for Allergic Contact Dermatitis (ACD) on the face.
- Check the humidity in your home, and address as needed.
- Write down any triggers as well as the TIMING of your rash and/or symptoms on your phone. We call this a “symptom diary,” and it can be extremely helpful to make a diagnosis. Or try an app made for this purpose like EczemaLess.
Dr. Joanna "Asia" Jaros, MD
Dr. Joanna "Asia" Jaros is a current Dermatology resident at Cook County Hospitals and Health System (CCHHS). Dr. Jaros is committed to providing compassionate, equitable, and evidence-based care for all of her patients. Her special research interests include eczema, chronic urticaria, and diet and lifestyle modifications in dermatology.