Eczema & Dermatitis in Men

Not Just a Childhood Thing

Many men associate eczema with children — and it's true that it often starts in childhood. But around 10-15% of adults in the UK have eczema, and it can appear for the first time in adulthood. Adult-onset eczema is increasingly common and often affects the face, hands, and around the eyes.

Men are less likely to seek treatment for eczema, often attributing dry or red skin to "just the weather" or shaving irritation. This means they often suffer unnecessarily with a condition that responds well to proper treatment.

Types of Eczema Affecting the Face

Atopic Eczema (Atopic Dermatitis)

The most common type. Caused by a combination of genetic factors (a defective skin barrier, often linked to filaggrin gene mutations) and immune system overreactivity. Symptoms include:

• Red, dry, itchy patches — particularly around the eyes, on the cheeks, and on the neck
• Skin that cracks, weeps, or crusts during flare-ups
• Thickened, leathery skin in areas of chronic scratching (lichenification)
• Often associated with asthma, hay fever, or food allergies (the "atopic triad")

Seborrhoeic Dermatitis

Extremely common in men. Caused by an inflammatory reaction to a yeast (Malassezia) that lives naturally on the skin. Symptoms include:

• Red, flaky, greasy-looking patches around the nose, eyebrows, hairline, and behind the ears
• Dandruff (seborrhoeic dermatitis of the scalp)
• Worsens in winter, during stress, or with illness
• Often mild but persistent and cosmetically frustrating

Contact Dermatitis

A reaction to something touching your skin. Two types:

• Irritant contact dermatitis: Direct damage from harsh products — fragranced aftershave, strong soaps, industrial chemicals. The most common type.
• Allergic contact dermatitis: An immune reaction to a specific allergen — nickel (watch straps, glasses frames), fragrances, preservatives (methylisothiazolinone), hair dye ingredients.

Feature	Atopic Eczema	Seborrhoeic Dermatitis	Contact Dermatitis
Appearance	Dry, red, cracked	Red, greasy, flaky	Red, itchy, sometimes blistered
Location	Eyes, cheeks, neck, hands	Nose folds, eyebrows, scalp	Where the irritant contacts
Itch	Intense	Mild to moderate	Moderate to severe
Cause	Genetic + immune	Yeast (Malassezia)	External substance
Treatment	Emollients + topical steroids	Antifungal creams	Avoid trigger + steroids

Treatment

The Foundation: Emollients

Emollients (medical moisturisers) are the cornerstone of eczema treatment. They repair the skin barrier, reduce water loss, and prevent flare-ups. Key points:

• Apply liberally and frequently — at least twice daily, more during flare-ups
• Use as a soap substitute when washing (apply to wet skin, rinse off)
• Choose fragrance-free, simple formulations
• Ointments (e.g., Epaderm, Hydromol) are more effective than creams for very dry skin
• Creams (e.g., Cerave, Aveeno, Diprobase) are lighter and preferred for the face
• Your GP can prescribe emollients — they're free on prescription in the UK if you have eczema

Topical Steroids

Used during flare-ups to reduce inflammation. They are safe when used correctly:

• Mild (e.g., hydrocortisone 1%): Suitable for the face. Apply thinly once or twice daily for up to 2 weeks.
• Moderate (e.g., clobetasone/Eumovate): For stubborn facial patches, short courses only.
• Potent (e.g., betamethasone/Betnovate): Not for the face. Used on the body for severe flares.
• Apply to affected areas only, not healthy skin
• The "fingertip unit" (FTU) guides correct dosing — one FTU covers an area roughly the size of two adult palms

For Seborrhoeic Dermatitis

• Antifungal cream: Ketoconazole 2% cream (Daktarin or Nizoral) applied to affected areas once or twice daily
• Antifungal shampoo: Ketoconazole shampoo (Nizoral) for scalp involvement. Can also be used briefly on the face as a wash.
• Combination treatment: Some flares benefit from a short course of mild steroid + antifungal
• Maintenance: Antifungal shampoo once weekly can prevent recurrence

Advanced Treatments

• Topical calcineurin inhibitors (tacrolimus/pimecrolimus): Steroid-free anti-inflammatory creams. Excellent for long-term facial eczema management. Prescribed by GPs or dermatologists.
• Phototherapy: Controlled UV light treatment. Effective for widespread eczema. Available through dermatology departments.
• Dupilumab (Dupixent): Biologic injection for severe atopic eczema. Life-changing for those who qualify. Available on NHS through dermatology.

Daily Management Tips

• Shower, don't bath. Keep showers short (5-10 minutes) and lukewarm. Hot water strips the skin barrier.
• Pat dry, don't rub. Apply emollient within 3 minutes of drying while skin is still slightly damp.
• Wash clothes with non-bio detergent. Skip the fabric softener — it's a common irritant.
• Change your pillowcase frequently. Dust mites, sweat, and product residue accumulate and worsen facial eczema.
• Keep nails short. Scratching in your sleep is common and causes damage. Short nails minimise the harm.
• Manage stress. Easier said than done, but stress is a major flare trigger. Exercise, sleep, and finding ways to decompress all help.