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Burning cheeks, dry skin. Does this sound like face infection, sensitive skin or eczema?

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Practicing since : 2003
Answered : 304 Questions

I have been dealing with burning cheeks on and off for about 3 months now. My face feels dry, tight, burning and sometimes itchy. Sometimes it looks a little red because it is irritated but it does not get too red often. Sometimes in the morning it feels very hot to the touch and is burning. I will look in the mirror and it only looks mildly pink.

My dermatologist prescribed me a locoid cream and I am in the process of tapering off of it. He said that I just have sensitive skin and is probably worsened by the dry, cold weather. He ruled out rosacea and a very nice and helpful Dr. on this site believes that I may be dealing with Atopic Dermatitis. I cannot seem to get rid of this burning sensation and the hotness on my cheeks. It really hurts. My skin also looks and feels very dry so I figured that my skin is just irritated from the dryness.

I have limited insurance so I can't just run to the doctor every time I have a problem. I am also on elidel cream to help me taper off of the locoid. I am having trouble getting off of the locoid as my symptoms are flaring up. I also use ice packs on my face and when I take them off, my face tingles. I am just so confused at to what is happening to me.

I also want to add that I have hyperlinear palms, dark circles under my eyes, hyperpigmented eyelids and lines under my eyes.
My nose will get flushed at times but I think that is allergies. Sometimes before I am about to cry, my nose gets very hot and burns. The skin on my nose will also burn for awhile after I cry and inside nose burns.

I attached some photos but my skin pretty much looks normal. It will only get mildly pink at times. The worst problem is the face stinging and tight feeling. I do not flush when changing temperatures or with exercise. I do with emotion and wind seems to worsen the burning sensation.

I just want my life back as this has been going on too long. Does it sound like an infection on my face, sensitive skin, intolerant skin, eczema?

Please help!

Posted Thu, 19 Apr 2012 in Skin Hair and Nails
Answered by Dr. Rohit Batra 26 minutes later

Thanks for your query and a detailed history and photographs- which were a real help in diagnosing your problem.

You are having diffuse erythema all over your face and hence rosacea is ruled out which presents like a rash in a butterfly pattern involving nose and surrounding cheeks.

Your history and symptoms fit more into atopic dermatitis which is not a serious but chronic condition.

Your skin barrier function is mainly faulty - the skin breaks easily, though only superficially and hence anything that comes in contact irritates it.
•     The first and the foremost priority is to protect your skin - apply gentle, non irritating bland moisturisers. Those containing ceramides would be the most helpful.
•     Don’t use excessive hot or cold water to wash your face.
•     Use a moisturising soap or face wash in daily routine.
•     Avoid going out unprotected in dry winters, especially on a chilly day.
•     Direct contact with woollen garments on a dry skin can lead to exacerbation of the symptoms.
•     Dry fruits, eggs, canned foods can also increase symptoms.

Coming to the treatment part, topical mild steroids like yours and calcineurin inhibitors like elidel form the routine prescription. Long term use of these creams don’t cause any serious side effects but then topical steroids should be tapered down as slowly their effect starts decreasing and we need to shift patients to a more potent one.
In case we stop a topical steroid or apply intermittently, the symptoms are also kept at bay and their effect is also maintained.
Don’t panic and keep applying the prescribed creams, with the precautions and routine application of moisturisers. The condition will definitely improve.
I hope I have answered all your questions to your satisfaction.
Please accept my answer if you no more follow up queries.


Dr.Rohit Batra
Above answer was peer-reviewed by
Follow-up: Burning cheeks, dry skin. Does this sound like face infection, sensitive skin or eczema? 44 minutes later
Dr. Batra,

Thank you for your fast response. In regards to not having rosacea, that is a good thing. Sometimes I do flush over my nose and cheeks but it is fleeting and I get it when emotional and it's hardly noticeable. My nose will burn after crying for awhile and stay red for a little. It will be hot and sting but then I am ok. Actually it seems to burn more on the inside, is this blood vessels? Many doctors say no to rosacea but these crazy symptoms keep occurring. Mainly my cheeks can look a little blotchy but more towards my hairline.

What causes atopic dermatitis and can it come and go? Can it make my face feel tight and burn like this? I suppose it can as that is what you said I have. What causes it to flare? I have read online that atopic dermatitis causes more itchy symptoms, why are mine burning symptoms?

My dermatologist told me not to use the locoid for longer than a month and it has been 35 days. I have begun tapering but every time I try to get off of them, my symptoms flare. I continue to use the elidel but am not sure if it is helping. My symptoms do not seem to be under control.

Sometimes when I apply moisturizers my face burns. The burning is very often and I rely on icepacks to relieve my pain. The burning is so horrible.

Any idea on why I wake up to burning and flushed face? Is atopic dermatitis the same as eczema?

I have severe nasal allergies. Could this be the cause of the burning sensation and redness of nose when I get upset or come in contact with an allergen?

I am trying not to panic but this is disrupting my life.

Also, this did not start until the weather changed to cool/cold as my skin became very dry and taut. Is this common in winter?

Thank you, XXXXXXX
Answered by Dr. Rohit Batra 5 hours later

Thanks again for writing back.

I have tried to answer all your questions in the first main itself. Well let me clarify few points which I hope would answer your queries.

1.     Any sort of dermatitis is eczema. However that’s not something to worry about.
2.     Atopic Dermatitis increases, rather a new episode usually starts in winters. Cold weather predisposes skin to develop this condition.
3.     Atopic Dermatitis does come back again and again similar to any sort of allergy of skin. It is very common to have recurrent episodes in people with atopic dermatitis.
4.     Nasal allergy and even generalized body allergy i.e. itching - urticaria is common with atopic dermatitis.
5.     Apart from face, flexures of skin like arms and legs can also show redness and itching.
6.     Though the usual symptom is itching, this condition can have mixed presentation in some people.

I would suggest you to try mixing the steroid with your cold cream. That will prevent the burning that you experience when you apply a moisturizer and at the same time will decrease the strength of topical steroid.

Avoiding dryness and irritating products like other creams, face wash, wool and chilly winds is a must in decreasing / preventing these symptoms.

Hope this clarifies your doubts. Please accept my answer if you do not have any follow up queries.

Wish you good health.


Dr.Rohit Batra
Above answer was peer-reviewed by
Follow-up: Burning cheeks, dry skin. Does this sound like face infection, sensitive skin or eczema? 42 minutes later
Dr. Batra,

Thank you for writing back.

1. The only reason that I have doubts that I am suffering fromm AD is because of the near constant face burning. If you think that can be to the AD then I will believe you.

2. You mentioned that my "history and symptoms fit more into atopic dermatitis..?" Are you referring to my hyperpigmented eyelids, hyperlinear palms, dark circles, etc.

3. The tightness in my face is common with atopic dermatitis? My face feels so dry and almost stretched across my face.

4. Does my skin look red to you in the pictures?

5. I use ice packs on my face to calm down the burning itch. Could this be worsening the problem? ie: drying out the skin more, causing chapping, etc?

5. I do have dermographic urticaria.

6. Is flushing common with atopic dermatitis? Although I don't really flush.

7. What do you think causes me to wake up with red, burning cheeks? Could this be dry skin? This is really bothersome and I am having trouble understanding why that is occurring.

I appreciate your help!

Thanks so much, XXXXXXX
Answered by Dr. Rohit Batra 21 minutes later

Thanks for writing back.

Here are your answers:

1. Burning can occur in AD (Atopic Dermatitis) especially after applying anything as the skin barrier function is compromised.

2. Hyperpigmented eyelids, hyperlinear palms, dark circles, etc. are common presenting skin conditions in patients of AD.

3. Dryness causes tightness and irritation of face in AD. Dryness is related to excessive damage in skin leading to breaking of skin layers and scaling.

4. Yes your skin is diffuse red in all your pictures.

5. Wet wraps are recommended in AD patients as they are soothing. Ice packs and cold wraps can be damaging.

6. Flushing is not common in AD, its a sign of Rosacea.

7. Redness and burning can occur in AD because of irritation, in your case it might be due to irritation of bed linen or blanket or excessive dryness in room if you use a room heater.

Hope I have answered all your questions , if you are satisfied with the answer and do not have follow up queries, please accept my answer.

Wish you good health.


Dr.Rohit Batra
Above answer was peer-reviewed by
Follow-up: Burning cheeks, dry skin. Does this sound like face infection, sensitive skin or eczema? 52 minutes later
Dr. Batra,

I appreciate your time in helping me. Just a few last questions and clarifications.

1. Just to clarify, by the look of my skin you would say that I have atopic dermatitis?

2. Do my pictures show the hyperpigmented eyelids and dark circles do you think?

3. Not sure if you can answer this, or if it's related, but lately my nose has felt a burning sensation inside and also a sensation of water up in my nose. It worsens when I bend over or lie down. Is this sinus?

4. Sometimes the difuse redness gets darker and more noticeable. I wouldn't call it flushing, I guess just is more irritated. For example, if I am outside in the cold and go inside, I notice it more but then it goes back to "normal redness" which isn't even really that red. Is this common in AD?

5. Are there any particular foods that you would recommend me avoiding such as gluten or dairy?

6. I am sorry for all of the questions but this is really upsetting me and starting to take over my life. When I don't have the symptoms as much, I feel better but am still worried about it. I just want to feel better. This has been going on for almost 3 months. It's getting quite old! Can stress worsen the problem?

7. How can I rebuild the moisture barrier? I tried cerave but it burns my skin.

8. Is it likely that my skin will improve once there is more humidity in the air?

9. Thank you and have a nice day!
Answered by Dr. Rohit Batra 15 hours later

Here I go again.

1. Yes, your symptoms and look fit into Atopic Dermatitis (AD).

2. There is definitely pigmentation around eyes.

3. AD is a type of skin allergy and so any sort of allergy like food allergy, nasal allergy can be associated with it or AD can result from the allergy.
Those who are prone to allergies manifest the whole spectrum of allergies in the body.

3. Nasal drip or running nose is a common symptom of sinus infection.

4. Redness of face can occur due to change in temperature and is more common when the skin barrier is compromised.

5. Skin barrier function can be refurbished with repeated applications of moisturizers, protection from irritants and extreme temperatures.

6. Yes, AD improves in summers and deteriorates in winters.

Hope, you have got all your answers this time round.

Please accept the answer if satisfied.


Dr.Rohit Batra
Above answer was peer-reviewed by
Follow-up: Burning cheeks, dry skin. Does this sound like face infection, sensitive skin or eczema? 17 hours later
Hi Dr. Batra,

Thanks for answering my questions. The reason I am writing again as I am experiencing more difficulties.

This morning I woke up with my face blotchy and flushed. It was hot and burning. After I washed my face, the redness went away but the burning stuck around.

I want to add that I slept with an ice pack on and off my skin because of the burning. I did not use any different products and my pillowcase was clean from being washed in hypoallergenic detergent.

I had dry patches behind my ears and neckline. They are not itchy.

What do you think is happening? This tends to occur a lot, I wake up blotchy and flushed looking. Does AD cause this? I am at my wits end.

I am sorry to bother you again.


I want to add that my face feels very sore, it tingles and burns.
Answered by Dr. Rohit Batra 6 hours later

Thanks for reverting.

I would suggest that you visit a Dermatologist as soon as possible, as the symptoms are worsening and you need to be put on some oral medicines like steroids, cyclosporine, methotrexate etc. though only for a short time period.


Dr. Rohit Batra
Above answer was peer-reviewed by
Follow-up: Burning cheeks, dry skin. Does this sound like face infection, sensitive skin or eczema? 34 minutes later
Dear Dr. Batra,

Thank you for the message. I can't get in to see the dermatologist until next week, unfortunately.

Could you please view my new pictures from today? Still atopic dermatitis?

Answered by Dr. Rohit Batra 5 hours later

Thanks for writing again.

I have gone through your pictures and the condition in pictures show worsening of condition.

Dermatitis- erythema and scaling alongwith burning symptoms of yours, point out at Atopic Dermatitis.

Avoid harsh climates, irritant substances and apply topical steroidal creams to prevent further damage.

Hope, this helps to answers your query. Please accept my answer in case you have no further queries.

Happy Healing

Dr.Rohit Batra
Above answer was peer-reviewed by
Follow-up: Burning cheeks, dry skin. Does this sound like face infection, sensitive skin or eczema? 14 hours later
Hi Dr. Batra. Thanks for looking at those pictures. This should be my last question. What makes it flare up- one day I look pretty normal and the next day I have more redness? Today I do not have much redness but it still burns.

I thought with atopic dermatitis, my skin has to come in contact with something but I guess not. My skin just feels very tight and irritated. Can stress worsen this?

I guess I have a hard time grasping what's going with my skin because I don't understand the logistics of it all.

I had mentioned to you that the corners of my nose are real red and flaking. You responded that I have sebhorreic dermatitis in that area. Is it possible that I have it all over my face?

I also have a dry pimply rash under my ear and on the nape of my neck.

Does atopic dermatitis cause tingling too?

Thank you again, XXXXXXX
Answered by Dr. Rohit Batra 5 hours later

Thanks again,

Tingling, burning, itching - they all result from irritation and can occur in Atopic dermatitis (AD). Seborrhic Dermatitis is also a part of AD and hence can occur at the same time too.

The symptoms of AD can increase and decrease and hence if you are in a irritating environment at one time and a better one after few hours , the symptoms might show increase or decrease. Also after applying creams the symptoms decrease and as the effect wanes away the symptoms start to come again.

Rash of seborrhic dermatitis can occur in retro auricular area and can show erythema, scaling and pustules too.

Hope my answer is satisfactory and I have cleared all your doubts. Please accept my answer if you do not have any further queries.


Dr.Rohit Batra
Above answer was peer-reviewed by
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