Psoriasis of the face

Medications

Your doctor may prescribe just one or a mixture of them, including treatments that go on your skin such as:

  • Low-potency corticosteroids, which are ointments, creams, lotions, and sprays that reduce redness and swelling. Doctors usually prescribe them for just a few weeks at a time. If you use them for longer, they can make your skin thin, shiny, and bruise easily or give it stretch marks and new blood vessels.
  • Synthetic vitamin D , such as calcipotriene (Dovonex, Sorilux) ointment or cream, slows the growth of skin cells. But it can also irritate your face. Calcitriol (Rocaltrol, Vectical) is a newer vitamin D drug for psoriasis that some studies suggest may be better for sensitive skin.
  • Retinoids, such as tazarotene gel (Tazorac), help remove scales and may ease inflammation. But skin irritation is a side effect.
  • Pimecrolimus (Elidel) and tacrolimus (Protopic) are two drugs the FDA has approved for eczema, a different skin condition. Some dermatologists recommend these drugs for psoriasis on the face. But talk to your doctor about whether you need these medicines. The FDA says people should use them only for a short time since some studies have linked the drugs to cancer risks.
  • Crisaborole (Eucrisa) ointment is another topical medicine recently approved by the FDA for eczema that can reduce inflammation. It can cause temporary burning or stinging upon application.
  • Coal tar. Derived from coal, this treatment comes in over-the-counter shampoos, creams, and oils. Prescription-strength products are also available.
  • Lotion, creams, or other moisturizers. They can’t heal psoriasis, but they can make your skin feel better and ease itching, scaling, and dryness.
  • Salicylic acid. Also available over-the-counter and by prescription in shampoos and scalp treatments, this remedy can help get rid of scales. Your doctor might pair it with steroids or coal tar.

If these treatments don’t help, ask your doctor if you should take prescription pills or shots for your condition. These include:

Each works differently, but they can be helpful for moderate to severe psoriasis.

Facial psoriasis

What is facial psoriasis?

Facial psoriasis is a chronic skin condition in which there are one or more, persistent, thickened, red and dry patches on the face.

Psoriasis is a common chronic inflammatory skin disease that may affect any skin site. Facial involvement occurs at some time in about half those affected by psoriasis. Although it is usually mild, facial psoriasis is occasionally very extensive involving the hairline, forehead, neck, ears and facial skin.

It is extremely rare to have psoriasis occurring solely on the face. Most patients also have scalp psoriasis and they may also have moderate to severe psoriasis at other sites.

Patients with facial psoriasis often suffer from psychosocial problems due to the presence of unsightly red, scaly plaques on highly visible areas.

Facial involvement presents as a therapeutic challenge because facial skin is thin, sensitive and more complicated to treat.

What are the clinical features of facial psoriasis?

Facial psoriasis has various clinical presentations. There are three main subtypes:

  • Hairline psoriasis
  • Sebo-psoriasis
  • True facial psoriasis.

Hairline psoriasis

  • An extension of scalp psoriasis beyond the hairline onto facial skin
  • Bright red, thickened plaques with variable white scale
Psoriasis affecting hairline

Sebo-psoriasis

  • Patchy involvement of the hairline
  • Often affects the eyelids, eyebrows, nasolabial folds and beard area
  • Salmon-pink, thin plaques with bran-like scale
  • Usually associated with diffuse or patchy scalp psoriasis
  • Psoriasis may or may not be present at other sites
Sebopsoriasis

True facial psoriasis

  • Sharply demarcated, red, scaly plaques
  • May affect any part of the face
  • Plaques tend to be symmetrical
  • Associated with psoriasis at other sites including ears, genitals, scalp, elbows, knees, and trunk
  • Can be part of chronic plaque psoriasis, guttate psoriasis or erythrodermic psoriasis

See more images of facial psoriasis …

Symptoms of facial psoriasis

  • Mild to intense itch
  • Soreness and skin sensitivity, which are usually mild

What causes facial psoriasis?

The causes of facial psoriasis are the same as for psoriasis in general. Psoriasis is associated with inappropriate activation of the immune system resulting in inflammation and increased proliferation of skin cells. There is a genetic predisposition, but environmental influences are important, including stress, infection, injuries and certain medications.

Facial psoriasis may also be aggravated by:

  • Ultraviolet radiation — some patients have photosensitivity where the psoriasis is aggravated by exposure to the sun
  • Skin flora, particularly the yeast Malassezia
  • Smoking.

What is the treatment for facial psoriasis?

There is no cure for facial psoriasis, but satisfactory control of the disease is possible for most patients using topical therapy. General skin care may include:

  • Gentle non-soap cleansers
  • Moisturisers
  • Sunscreens, if required.

Corticosteroid creams

Mild or moderate strength topical steroids reduce inflammation and relieve itching. Side effects of corticosteroids restrict the potency and duration of use on the face. These include:

  • Periorificial dermatitis (spotty acne-like rash around the mouth, nose and eyelids)
  • Easy bruising and tearing of the skin
  • Thin, transparent skin especially if the eyelids are treated
  • Telangiectasia (enlarged blood vessels)
  • Rarely, increased hair growth (hypertrichosis)
  • Risk of glaucoma and cataracts from long-term use of potent steroid creams around eyelids.

Hydrocortisone is generally safe. More potent topical steroids are best used on the face for only a few days each month.

Topical calcineurin inhibitors

The topical calcineurin inhibitors pimecrolimus cream and tacrolimus ointment may be prescribed off-label for facial psoriasis and can be very effective. They are particularly useful on eyelid skin. In New Zealand, these preparations are not currently subsidised by PHARMAC (February 2019).

Other topical preparations

  • Salicylic acid is a descaling agent found in many over-the-counter creams.
  • The vitamin D analogues, calcipotriol/calcipotriene and calcitriol tend to irritate facial skin. Cream or gel formulations may be tolerated, especially in combination with topical steroids.
  • Coal tar creams may cause staining and irritation.

Phototherapy

Sun exposure or prescribed phototherapy is often helpful for facial psoriasis.

It is unwise if there is photosensitivity or significant sun damage, such as solar/actinic keratoses or skin cancer.

Systemic treatment

Severe facial psoriasis sometimes warrants treatment with tablets or injections such as methotrexate, ciclosporin, acitretin or biologic agents. Patients should be under the care of an experienced dermatologist and should be carefully monitored.

What is the prognosis?

Facial psoriasis tends to persist, although its severity may vary with season, stress and other factors. It may be a marker of more severe disease with early onset, long duration and more extensive plaques.

What to know about psoriasis on the face

Psoriasis on the face can be difficult to treat because the skin is thin and sensitive.

It is important that a doctor evaluates the skin and makes recommendations to ensure that the treatments will not be too harsh or irritating for the facial skin.

Some treatment options for facial psoriasis include:

Biologics

People with moderate to severe psoriasis and those whose symptoms do not respond to topical or steroid treatments might choose to take biologic medications.

These disease-modifying therapies can halt the progression of the condition and reduce the number of flares. They work by blocking specific proteins or cells in the immune system that trigger inflammation.

Doctors administer the biologics through injection or infusion. This action tackles psoriasis at its root cause: immune activity. Although it is not a full cure, it can slow the progress of psoriasis and reduce the risk of flares.

Corticosteroids

Share on PinterestCorticosteroid cream may help relieve psoriasis symptoms.

People can apply over-the-counter (OTC) topical corticosteroids, such as hydrocortisone, to the face. This might help reduce the incidence and severity of facial psoriasis. However, people should only use OTC topical steroids short-term.

Hydrocortisone may cause a variety of potential side effects, such as:

  • thin, transparent skin
  • easy bruising
  • skin that is easier to tear

A doctor will sometimes recommend using topical steroids as sparingly as possible. They will suggest a dosage that increases the chance a person will see results while minimizing the risk of side effects.

OTC treatments and home remedies

In addition to using steroids, rinsing the facial skin with a saline solution can also help reduce discomfort and pain.

Available OTC treatments include:

  • scale-removing products
  • tazarotene cream or gel, an off-label treatment that currently has approval for treating acne
  • UV light, which a person should only use under a doctor’s supervision

If psoriasis affects the skin around the eyes, a doctor will advise taking great care when applying medications to the area. This is because many OTC psoriasis treatments can cause damage to the eyes that may lead to the development of glaucoma or cataracts.

That said, doctors sometimes recommend two off-label eczema treatments that may work especially well for treating psoriasis on the face.

These prescription drugs are tacrolimus ointment (Protopic) and pimecrolimus cream (Elidel). People using these medications should apply them very carefully and sparingly, being sure to avoid the eyes.

These medications are unlikely to cause glaucoma. However, using them may lead to uncomfortable side effects, such as a stinging sensation.

In addition to using these topical medications, there are several precautions a person can take to reduce irritation as much as possible. These include:

  • using gentle, non-soap cleansers to keep the skin clean
  • applying moisturizers often
  • regularly putting on sunscreen to reduce the effects of UV radiation

Practicing frequent and thorough self-care can help a person control their facial psoriasis as much as possible.

Here, learn more about whether essential oils can help treat psoriasis.

Psoriasis and sensitive areas

However, make-up could interfere with the effectiveness of your topical psoriasis treatments and this is something that should be considered very carefully and discussed with your doctor. It is likely that make-up can be applied following treatment if enough time has reasonably elapsed.

The treatments used for facial psoriasis should be used carefully and sparingly as creams and ointments can irritate the eyes and mouth areas. They should always be used under the guidance of your doctor. If you are unsure about using over-the-counter products such as make-up and moisturisers then, again, you should consult your doctor or your pharmacist. This is because facial skin is delicate and irritation can easily occur. Using steroid medication, for instance, may cause facial skin to thin, appear shiny and be prone to spider veins.

If your eyelids are inflamed, washing the edges of the eyelids and/or eyelashes gently with a solution of water and sensitive shampoo could help, but be careful to avoid shampoo entering the eye as this may sting. If this happens, flush the eye with clear water immediately. Cotton buds or non-irritating cotton pads can be useful for gently rubbing the lids to remove excess scales. After cleansing, depending on severity, corticosteroids may then be applied in accordance with your doctor’s advice.

Good oral hygiene can aid and relieve oral discomfort for the nose and mouth region. Your doctor or dentist will be best placed to advise you on the most effective methods to treat your psoriasis in and around the mouth

Remember: if any topical steroids or other medication are overused in the eye region, glaucoma and/or cataracts may develop. It is always best to have your intraocular (fluid inside the eye) pressure checked by an ophthalmologist during regular eye tests. It should be said, however, that psoriasis of the eye is rare, but if it does occur it can cause inflammation, dryness and discomfort and possibly some vision impairment. Any infections can be treated with topical antibiotics. Treatment of psoriasis in this area should always be carried out under the supervision of your doctor.

Similarly, always consult your doctor if you are having any problems with your ears. Your doctor will know best how to remove the excess scale build-up that may affect the ear canal. You should bear in mind that the eardrum can easily be damaged, so care should be taken when inserting anything into your ear. Impaction (blockage) of scales can also occur inside the ear canal if existing medication prescribed for the ear region is not used correctly.

General advice

When visiting healthcare providers for other, seemingly unrelated, symptoms such as ear/hearing problems, it is always worth mentioning that you currently have or have had psoriasis in the past . This additional information can help in making diagnoses that might not be obvious without the connection.

This article is adapted from the Psoriasis and sensitive leaflet.

Download Psoriasis and sensitive areas leaflet as a pdf

Always consult a doctor or your healthcare provider

What to Do for Psoriasis Around the Eyes

By

Evelyn Creekmore Was this helpful? (35)

It’s natural to be concerned if psoriasis appears near your eyes. Take a deep breath and know effective treatments are available. Face psoriasis usually appears at the hairline, on the upper forehead, around the eyebrows, or between the nose and lip. Psoriasis around the eyes is rare, but it deserves special attention because left untreated, it can affect your vision and lead to eye disorders.

Remember, psoriasis is caused by a disconnect in the immune system that makes skin grow faster than it should and build up in patches. You can’t help having psoriasis or where it appears on your body, but you can do something about it.

Signs of Psoriasis Near Eyes

Flaky, scaly psoriasis patches or plaques can form on your eyelids and cover your eye lashes, affecting your ability to see. The edges of your eyelids may become red and crusty, making them turn inward or outward. Your eyes may feel irritated, dry, or swollen. Try to resist the urge to rub or scratch your eyes, which could make them feel worse or lead to infection. Instead, talk with your doctor as soon as you can.

Psoriasis can be a challenging diagnosis, but with the right support and a positive mindset, you can stay in control.

Medical Reviewers: William C. Lloyd III Last Review Date: 2018 Dec 20

2019 Healthgrades Operating Company, Inc. The content on Healthgrades does not provide medical advice. Always consult a medical provider for diagnosis and treatment. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

Transcript open 5 Tips For People With Psoriasis From People With Psoriasis Be as active as you can. Exercise relieves stress and helps you feel your best! – Alisha B. Finding the right doctor can be like dating. Don’t stop until you find a dermatologist who really listens to you. – Summer S. Keep a journal to track your meals, mood, and symptoms. Knowing the details will help you stay in control. – Lorenzo B. Self-care is essential. Listen to your body and take time to relax. – Summer S. Stay positive. If one thing doesn’t work, another might! – Alisha B. Turn to Healthgrades to connect with the right dermatologist for your psoriasis.

Treating Psoriasis Near Eyes

The skin around the eyes is sensitive and needs to be handled with more care than other parts of your body such as your feet. Topical medication must be applied delicately to this area to avoid irritating parts of the eye. Your doctor may apply a topical corticosteroid near your eyes to help reduce scaling. Don’t use a topical corticosteroid for psoriasis near eyes without your doctor’s supervision. Using too much or using even a little for too long can lead to glaucoma, which damages the optic nerve, or cataract, which clouds the lens of your eye.

If the skin near your eyes has become infected, your doctor may prescribe a topical antibiotic. He or she may also recommend a moisturizer appropriate for the eye area. Before you use make-up or cover-up, ask your doctor if it will cause further irritation or infection. It’s understandable if you feel self-conscious about your skin’s appearance, but your eye health should come first.

The Risk of Eye Disorders With Psoriasis

If you have psoriasis, be sure to include regular appointments with an ophthalmologist in your healthcare routine. This can help you stay ahead of the following eye disorders that are more common in people with psoriasis, whether or not psoriasis appears near eyes:

  • Uveitis is swelling in the front, middle, or back of your eye. At its most severe, uveitis can involve all three layers.
  • Conjunctivitis (often called “pink eye”) is an inflammation of the moist tissue covering the white of the eye and the inside of eyelids.
  • Blepharitis is redness or swelling of the eyelids caused by bacteria and flaking at the eyelid base.

Having psoriasis doesn’t automatically mean it will appear near your eyes, that it will persist in the area, or that it will cause complications. But knowing the possibilities can help you get the right help right away in managing the condition.

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