I'm tired of being a lizard
March 7, 2018 8:23 AM   Subscribe

I have adult-onset eczema on my face and neck. If you have facial eczema, what do you do to combat flareups? What sorts of things do you say to your doctor to get help?

My lovely new friend eczema came to me in September and I've had flareups on and off since then. Lately, though, the flareups never clear up. People sometimes stare at me and I'm tired of it.

It's mostly on my temples and cheekbones (near my eyes). I have a patch in the middle of each cheek and two persistent patches on my neck.

My GP and dermalogist weren't helpful when I talked to them about it. I'm looking for a new doctor.

I'm using a non-prescription 1% hydrocortisone cream and CeraVe eczema soothing creamy oil right now. I do about a week on, week off schedule with the hydrocortisone.

I'd love any advice or product recommendations you might have.
posted by marfa, texas to Health & Fitness (17 answers total) 10 users marked this as a favorite
Steroid creams aren't really recommended for use on your face, which I know is no help at all. My GP basically said "use them if you absolutely must, but I don't advise it". A week on, week off thing sounds like a sensible precaution. Also, note that an ointment (oil-based) sometimes works better than a cream (usually water-based). Ointments, if you can get them, stay on longer, and also don't have the drying effect of many creams.

Eczema will only go away when you break the itch/scratch cycle, which is easy to say, but hard to do. I've had a certain amount of success with a couple of different 'anti-itch' creams, such as Eurax, which contains Crotamiton. Definitely keep your nails as short and blunt as you can, and maybe wear scratch mitts if you're prone to scratching at night.

Absolutely the best treatment I ever tried was something called Tacrolimus (branded as Protopic). When first used I remember that it caused a powerful burning sensation, and then it just wiped out my eczema completely in just a few days. I believe it's something you can only get via a dermatologist, as a tried-everything-else treatment.

The key thing for me seems to be keeping the skin from drying out. So many so-called moisturisers do precisely the opposite for me, or are actual irritants. I found that pure shea butter works well as a barrier to moisture loss, despite my initial scepticism.

Hopefully you don't use soap, shower gel or any other cleanser on your face. The best approach seems to be water-only, and then as rarely as possible. Any and all washing will lead to further dryness.

I've been dealing with eczema for 40+ years now, and I'm still trying to get it under control. Best of luck!
posted by pipeski at 8:49 AM on March 7, 2018 [1 favorite]

I had incredible success with narrow-band UV light therapy after trying every prescription cream and remedy in the book. It's a hassle as you have to visit a doc office 3 or so times a week to start, but the relief was absolutely worth it to me. I was effectively cured.

If it's bad enough you can get a doc to prescribe a home unit, although that comes with its own hassle (ensuring calibration, etc.)

What blew my mind about the UV light therapy was that it took literally years for someone to bring it up (this was pre-Dr. Google). As we know, most docs want to immediately go to the script pad rather than suggesting a treatment that might, you know, actually work.
posted by eggman at 9:04 AM on March 7, 2018 [4 favorites]

I should also mention that as the treatment has been proven effective and expanded, many derm or immunology doc offices have their own units, vs. having to go to a hospital clinic. Back when I started the treatment (15 years ago) Mass General Hospital here in Boston was one of, I believe, two light therapy clinics in all of New England.
posted by eggman at 9:07 AM on March 7, 2018

Another option is the mild nonsteroid immune-system suppressant Elidel, though you may have to "fail" another prescription or two before your insurance will pay for it.
posted by praemunire at 9:38 AM on March 7, 2018 [3 favorites]

I had eczema on my face and neck; the derm gave me a steroid cream which did precisely nothing. The only thing that helped me was Eucerin moisturizer for made specifically for eczema (the stuff with colloidal oatmeal in it) applied liberally before bed, and a fairly thick layer of Aquaphor over that. That actually cleared it up. I get occasional flares and the Eucerin and Aquaphor always keep them pretty limited.
posted by holborne at 9:41 AM on March 7, 2018 [2 favorites]

Hi, I have adult facial eczema, although I'm lucky(?) that my neck flares much more frequently than my cheeks, so it's not too visible. I'm surprised that you don't have a topical cortisteroid prescription; contrary to others above, I've seen multiple GP's and multiple dermatologists over the years, none of whom have batted an eye at my cortisteroid prescription for face/neck eczema. I currently use desonide 0.05% cream "as needed," which my doctor says means up to 1-2 weeks at a time (but not continuously, because thinning of the skin is a possible side effect). And it's been working great for years.

In the US, I did have to get the initial prescription from a dermatologist, but since then my GP has been happy to renew the script. Which I rarely need, because just applying the cream for a couple of days will take care of a flare. In my own non-medical-professional opinion, it's better to use a stronger steroid cream for a shorter period of time, than a weaker cream for a longer period of time. The eczema only gets worse if I let it slide for a while and scratch at it.

My other tip, once you get the constant flares under control, is to figure out what your triggers are. For me, my skin is surprisingly resilient to surface irritants, but having a stressful week will inevitably result in a flareup (and if I know to watch for it, I can catch it early at the just-starting-to-itch stage). Right now you're probably stressed by the flares and aesthetic appearance, so you won't be able to tell if stress is a trigger until you and your skin can calm down.
posted by serelliya at 9:46 AM on March 7, 2018

My father and I both have eczema and the thing that has really (really) worked for both of us is a cream called Aveeno. Specifically Aveeno Skin Relief cream.

I used various prescribed creams for a while (Diprobase, for example) and they were all terrible. But Aveeno absorbs quickly for me, stops the itching instantly and has basically reduced my eczema to nearly nothing. I can't recommend it enough. In the UK, you can also get it on prescription.
posted by Happy Dave at 10:18 AM on March 7, 2018 [1 favorite]

I've dealt with recurrent eczema on my hands for about 25 years. For whatever reason, Neutrogena Norwegian Formula Hand Cream (fragrance free) clears it up and prevents it from occurring. I don't know why it works and I haven't found any other OTC product that does - even when I try products with very similar ingredients. In my research I've found that very specific products seem to work for different people (see recommendation for Eucerin eczema moisturizer which was the key for someone above). So consider trial and error with some of these recommended products while you pursue more intensive treatment like steroids, prescription meds or light therapy. Maybe one of them will happen to work for you too. Good luck!
posted by pitseleh at 10:24 AM on March 7, 2018 [1 favorite]

I'm just going to put my story out here, FWIW. I developed psoriasis all over my body in my 40s with zero relief from dermatologists, integrative care centers, and GPs over the course of nine years. Last summer I threw a Hail Mary and went to a Chinese herbalist, who diagnosed with me a "yin deficiency." Every day I drank a tea he composed for me, and after three months, my psoriasis was gone (and hasn't returned). YMMV, of course.
posted by fiery.hogue at 11:52 AM on March 7, 2018 [1 favorite]

I finally got mine under control, and it started with religiously (1) washing my face at night and in the morning (during my shower) with a super gentle facial cleanser -- I had great success with a previous version of Dove Dermaseries face wash, and using only cool or lukewarm water; (2) immediately following with (a) at night, Eucerin redness relief night cream and (b) in the morning, a face lotion with at least SPF 30 sunscreen (I usually use this Eucerin, though I've tried others); and (3) multiple times during the day, using a face-specific moisturizer like Garnier Moisture Bomb. I have followed this routine almost every day and the eczema is finally under control. Flareups usually happen if I stop the routine for a couple days. When the flareup is bad, I use hydrocortisone.
posted by odin53 at 12:36 PM on March 7, 2018 [1 favorite]

I had eczema for about 10 years. All sorts of medicines did not work. Going to the beach and getting a lot of sun (while wearing sunscreen) on a semi-regular basis worked. Completely went away. And it was free.
posted by amodelcitizen at 12:43 PM on March 7, 2018

Vitamin D.

Outside of farmers and lifeguards (and even them, in the winter), most people have suboptimal serum Vitamin D.

Oral Vitamin D (cholecalciferol, or D3) is well tolerated and I take 2000-3000 IU a day (to minimize/keep-at-bay eczema, body acne, and psoriasis).

'Jamieson' is a very dependable brand.

A plausible molecular method of action is that many forms of eczema, acne, and psoriasis - skin conditions - are manifestations of mild (auto)immune dysfunction. Not only are T cells one of the sources of localize inflammation, they sit in a complex web of signal cascades.

T cells don't normally express receptor to Vitamin D, but a subset of (overly) activated T cells will. Upon seeing Vitamin D, in the absence of other overriding signals, they'll settle down, and in turn (eventually) settle down some of the other immune cells that they interact with.

The ELI5 is that skin mononuclear (white blood cell) immune system can get grumpy in some people and can sometimes act out inappropriately to normally innocuous events, Sufficient sunlight exposure, which causes the skin to make Vitamin D, can settle down some of these grumpy immune cells.
posted by porpoise at 1:14 PM on March 7, 2018 [3 favorites]

Seconding Elidel - my GP prescribed it when I told her I was needing non-prescription hydrocortisone to control eczema on my face. Since steroid creams are not great for your face, a GP should be willing to prescribe it. It has weird side effects (stuffy nose, wtf) and is not indicated if you have any skin infection though. If not that, prescription steroid creams are far more powerful than the non-prescription stuff and are worth a try.

As discussed above, make sure you have a good moisturizing routine going on with something that works for you. When I have flareups, I carry around a container of Aquaphor with me to make my skin more comfortable. I slather myself in Vaseline Creamy after every shower. I'm so bad at taking short showers that I sometimes dry my face and apply moisturizer in the middle. If my face is really bad, I put on moisturizer (with petroleum jelly) before showering to keep it from drying out. This all works for me because my primary issue is extreme dryness - ymmv.

My mother, who has awful skin problems, swears by getting sun. Sun is contraindicated with Elidel though.

I keep my nails absurdly short and blunt because I scratch in my sleep like crazy (from uncomfortable dry skin) even when my skin is in good condition.

Just want to say that I feel you - I've had skin problems on my face and neck for a lot of my life and it makes me feel gross and can just feel awful. Sounds like you're already doing everything right and you need to keep pushing your doctors until you find something that works for you.
posted by lookoutbelow at 5:48 PM on March 7, 2018 [1 favorite]

Cortisone creams and Protopic are state of the art for treatment of eczema.

This being said.

1. An MD once said: They call everything eczema when they don't know the problem.
I suspect that the majority of eczema is caused by food (as it was in my case)

2. The only non-steroid cream (besides protopic which has other disadvantages) is a moisturizing creme (with no lanolin) and about 10% evening primrose oil. w/o bases are preferable to o/w based creams.
It helps more if applied topical with a cream then orally.

I used to make the cream myself and tried to market it in the US but nobody bought it. Only ex-girl friend keep nagging me about it.
posted by yoyo_nyc at 2:06 AM on March 8, 2018

Emollient-wise, I swear by Bioderma Atoderm, best moisture-retention cream I ever found. My cheek skin was almost dead from steroid creams before a dermatologist told me to throw out all of them and switch to a thick layer of Atoderm overnight - it both moisturizes and promotes skin regrowth. Apparently in the US it's available in Walmart.
posted by I claim sanctuary at 4:01 AM on March 8, 2018 [1 favorite]

The things that keep my eczema at bay (and I just had an eye flare up that's cleared up this week) is: vitamin D, prescription topical steriods (my doc was totally fine prescribing them), exercise, aquaphor, and jumping on the first sign of a flare. Things that didn't help: changing my diet, lotions only.

I found my first flare was the worst and took a while to get under control. Only starting to swim and stress reduction made that better. Now I have a routine and can stop it before it gets going.

Good luck. I know it is frustrating.
posted by dame at 9:48 AM on March 8, 2018

I have psoriasis and not eczema, but Protopic/tacrolimus has absolutely changed my life. The first few applications can be uncomfortable (my dermatologist recommended mixing it with Vaseline and gradually increasing to full-strength). I had been dealing with a specific outbreak for months with no relief and the first application of tacrolimus cleared it up almost entirely within about twelve hours.
posted by naturalog at 1:45 PM on March 13, 2018

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