Causes, Symptoms, and What to Use to Combat Dermatitis on the Face

Types of Dermatitis on the Face

Every effective facial dermatitis treatment plan begins in the same place: an accurate understanding of which condition you are actually dealing with. The three most common types affecting the face each have distinct characteristics, but they can look deceptively similar — particularly during an active flare — which is why misdiagnosis and inappropriate treatment are surprisingly common.

The three main types are:

• Contact dermatitis: An inflammatory reaction triggered by direct skin contact with an irritant (irritant contact dermatitis) or an allergen (allergic contact dermatitis). On the face, common culprits include skincare products, cosmetics, fragrances, hair dye, and nickel in glasses frames or jewellery.
• Seborrhoeic dermatitis: A chronic, relapsing condition caused by an overgrowth of the yeast Malassezia on the skin surface, combined with an inflammatory response. It affects oily areas of the face — particularly the sides of the nose, eyebrows, and the hairline — and is characterised by redness, greasy scaling, and itch.
• Perioral dermatitis: A distinct inflammatory condition presenting as small red papules and pustules clustered around the mouth, chin, and sometimes the nose and eyes. It is frequently triggered or worsened by topical steroid use, heavy moisturisers, and fluorinated toothpaste.

There is also atopic dermatitis (eczema) of the face, which affects many eczema patients and tends to appear on the cheeks, around the eyes, and on the forehead, particularly in children. This shares features with contact dermatitis but is driven by a pre-existing genetic skin barrier dysfunction rather than a specific external trigger.

Getting the right diagnosis matters enormously on the face. Treatments appropriate for one type — such as a potent topical steroid for atopic eczema — can be harmful for another, such as perioral dermatitis, where steroid use is a known causative factor.

Contact Dermatitis on the Face: Causes and Symptoms

Contact dermatitis on the face is extremely common, in part because the face is the area of the body exposed to the widest range of topical products on a daily basis. Moisturisers, cleansers, serums, sunscreens, foundations, mascaras, hair dyes, and fragrances all represent potential triggers — and the more products you use, the more complex the process of identifying the culprit becomes.

Irritant contact dermatitis on the face

Irritant contact dermatitis occurs when a substance physically disrupts or damages the skin barrier without necessarily triggering an immune response. On the face, this is particularly common with:

• Over-exfoliation — excessive use of chemical exfoliants (AHAs, BHAs, retinoids) that strip the skin barrier
• Harsh cleansers with high detergent content or alkaline pH
• Repeated exposure to hand sanitiser that comes into contact with the face
• Certain active skincare ingredients used at too high a concentration or too frequently
• Face masks — both sheet masks containing sensitising ingredients and physical masks causing friction and occlusion

Allergic contact dermatitis on the face

Allergic contact dermatitis on the face involves a true immune-mediated reaction to a specific allergen. Once sensitised, even tiny amounts of the allergen can trigger a reaction. Common facial allergens include:

• Fragrances — found in almost all standard skincare, cosmetics, and hair products
• Preservatives — particularly methylisothiazolinone (MI), methylchloroisothiazolinone (MCI), and formaldehyde-releasing agents
• Hair dye chemicals — para-phenylenediamine (PPD) can cause severe reactions around the hairline, forehead, and ears
• Nickel — from glasses frames, earrings, or necklace clasps that rest against the face
• Sunscreen ingredients — particularly some chemical UV filters
• Rubber or latex — from face masks, goggles, or elastic bands

Symptoms of contact dermatitis on the face

Symptoms typically include redness, swelling, intense itch, dry or flaking skin, and in more severe cases, blistering or weeping. The distribution often follows the pattern of contact — for example, redness across both cheeks from a face cream, or a reaction along the hairline from a hair dye. Eyelid dermatitis — one of the most common and frustrating presentations — is frequently caused by contact allergens in mascara, eye cream, nail varnish (transferred by touching the eyes), or eye drops.

Seborrhoeic Dermatitis on the Face: What You Need to Know

Seborrhoeic dermatitis on the face is one of the most prevalent skin conditions in the UK, affecting an estimated 1–3% of the general population and up to 5% of adults. Despite its prevalence, it is frequently misidentified as dry skin, rosacea, or contact dermatitis — leading to months or even years of ineffective treatment.

The condition is caused by an inflammatory response to Malassezia yeast, which colonises sebaceous (oil-producing) skin. This is why seborrhoeic dermatitis characteristically affects the oiliest areas of the face:

• The sides of the nose and nasolabial folds
• The eyebrows and the skin above and between them
• The hairline and temples
• The ears and behind the ears
• The central chest and upper back (in some patients)

The characteristic appearance is of red, inflamed skin with greasy yellowish or white scaling, often accompanied by itch. Unlike contact dermatitis, the distribution is fairly predictable and symmetrical. Unlike eczema, the skin tends to be oily rather than dry in affected areas.

Key facts about seborrhoeic dermatitis on the face:

• It is a chronic, relapsing condition — it cannot be cured, but it can be managed very effectively with the right treatment
• It is not contagious and is not caused by poor hygiene
• It tends to worsen in cold, dry weather and under stress
• It is significantly more common in people who are immunocompromised, including those with HIV, and in patients with neurological conditions such as Parkinson’s disease
• Antifungal treatments — both topical and, for severe cases, oral — form the cornerstone of management
• Standard emollients and topical steroids alone are insufficient; an antifungal component is essential for meaningful improvement

If you have redness and scaling that keeps returning despite moisturising and gentle skincare, seborrhoeic dermatitis should be on your radar. Get in touch with our team if you would like clinical guidance on next steps.

Perioral Dermatitis: Causes, Symptoms, and Why It Is Often Misdiagnosed

Perioral dermatitis is a condition that causes significant distress partly because of where it appears — in the most visible, central area of the face — and partly because it is so frequently misidentified and mistreated, leading to prolonged suffering that could have been avoided with an earlier accurate diagnosis.

Perioral dermatitis causes are not fully understood, but several factors are consistently implicated:

• Topical steroid use: This is the most commonly identified trigger. Applying topical corticosteroids to the face — even mild ones — can trigger or significantly worsen perioral dermatitis. Many patients develop the condition after being prescribed a topical steroid for an unrelated facial rash, creating a cycle where stopping the steroid initially worsens symptoms, leading to further steroid use.
• Heavy moisturisers and occlusive products: Rich creams, heavy foundations, and occlusive sunscreens appear to worsen perioral dermatitis in susceptible individuals, possibly by occluding follicles and disrupting the skin microbiome.
• Fluorinated toothpaste: A notable proportion of patients report improvement after switching to a non-fluorinated toothpaste, though the evidence base for this is largely observational.
• Hormonal factors: The condition is significantly more common in women of childbearing age, and many patients notice a worsening around hormonal fluctuations.
• Inhaled corticosteroids: Use of steroid inhalers for asthma has been associated with perioral dermatitis in some patients, particularly those who do not use a spacer device.

Symptoms of perioral dermatitis include clusters of small red papules and pustules — sometimes with a fine scaly texture — arranged in a ring around the mouth, typically with a clear zone of unaffected skin immediately around the lip border. The chin and nasolabial folds are also frequently involved. The rash can extend to the nose (perinasal) or around the eyes (periocular dermatitis).

The most important and counterintuitive aspect of perioral dermatitis treatment is this: topical steroids must be stopped, even though stopping them initially causes a rebound flare. This steroid withdrawal phase — during which symptoms temporarily worsen before improving — is one of the main reasons patients abandon treatment prematurely. Clinical support during this phase is invaluable. Complete our online consultation to discuss your symptoms with our prescribing team.

Facial Dermatitis at a Glance: A Comparison

The table below summarises the key differences between the three main types of facial dermatitis to help you identify which condition may be affecting your skin: