Facial and eyelid skin is thin and absorbs topical corticosteroids readily, so atrophy, telangiectasia and perioral dermatitis appear sooner than elsewhere. Use the lowest effective potency for short courses on the face.
Topical calcineurin inhibitors such as tacrolimus do not cause skin atrophy and are a standard steroid-sparing choice for facial and eyelid eczema, including for maintenance. Warn patients that a burning sensation in the first days is common and usually settles.
- Use low-potency topical steroids, in short courses, on the face and eyelids.
- Consider topical tacrolimus for facial eczema needing longer control.
- Warn that early burning with tacrolimus is common and usually settles.
- Check for perioral dermatitis in patients using facial steroids long term.
Why it matters
Facial side effects are the commonest reason patients stop topical treatment altogether.
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