Face contact dermatitis

Contact dermatitis on the face can be a reaction to:

  • airborne irritants or allergens (eg perfume, hairspray, air freshener)—suspect an airborne allergen if the eyelids and neck are also involved
  • products directly applied to the face (eg cosmetics)
  • products accidentally transferred to the face (eg hair dye, nail varnish, gloves).

Cosmetics are an uncommon cause of allergic contact dermatitis on the face, but often cause irritation in patients with sensitive skin. Stop all cosmetics and instruct patients to perform the ‘usage test’ to identify the source of irritation.

To reduce inflammation, start treatment with a topical corticosteroid. Unless the skin is dry or atopic, creams and moisturising lotions are usually preferred to ointments because they are less likely to induce acne or block pores, and are more acceptable cosmetically. However, ointments do not contain preservatives and are more moisturising, so can be used if the patient prefers them. Use:

1hydrocortisone 1% cream or ointment topically, once daily until skin is clear (for up to 1 week) hydrocortisone hydrocortisone hydrocortisone

OR

2desonide 0.05% lotion topically, once daily until skin is clear (for up to 1 week). desonide desonide desonide

If the skin is not clear after 1 week, use:

methylprednisolone aceponate (adult, or child 4 months or older) 0.1% cream or ointment topically, once daily for up to 1 week. methylprednisolone aceponate methylprednisolone aceponate methylprednisolone aceponate

If the skin still does not respond, refer for specialist advice. Also see Deterioration or relapse of contact dermatitis.