Psoriasis is a rare skin condition with several different types. One area of the body where you may experience psoriasis symptoms during an outbreak is the face. There are many treatment options for facial psoriasis that can help alleviate symptoms such as red, itchy plaques that may form. Management of the emotional toll of this cosmetic form of the disease is essential. Below, we discuss the different types of facial psoriasis that exist, what causes it, and the treatment options available.
Overview of Psoriasis
Psoriasis is an incurable autoimmune skin condition that is characterized by red, itchy plaques (patches) that form on the person’s skin. These patches are caused when the life cycle of skin cells is sped up, which results in excess cells building up on your skin. People who have psoriasis may not even know they have it as it often is asymptomatic until an outbreak occurs.Read More
Common symptoms associated with psoriasis:
- Small scaling spots
- Swollen or stiff joints
- Burning, itching, or soreness of the skin
- Small scaling spots
- Cracked and dry skin that may itch or bleed
- Ridged or thickened nails
- Red patches of skin covered with silvery scales
The different types of psoriasis that may present:
- Plaque psoriasis- This is the most common type of psoriasis that may occur, causing itchy and tender, raised, dry skin patches.
- Nail psoriasis -affects the toenails and the fingernails and may even cause the nails to loosen from the nail bed.
- Guttate psoriasis Young adults and children are normally affected by this disease, it is typically caused by an infection such as strep throat.
- Inverse psoriasis The skin folds such as areas in the buttocks, groin, and breasts are mainly affected in this type of psoriasis. Sweating and friction in these areas may cause psoriasis to worsen.
- Psoriatic arthritis This type of psoriasis affects the person’s joints, as they become painful and swollen.
- Pustular psoriasis- This is a rare type of psoriasis that is characterized by the formation of patches of pus-filled blisters throughout the body.
- Erythrodermic psoriasis- This is another rare type of psoriasis that covers the entire body with a peeling, red rash that may have an intense burning sensation or be itchy.
Psoriasis On the FacePsoriasis is more likely to occur on the affected person’s knees, elbows, scalp or lower back, but it can present on a person’s face. Most clinicians believe psoriasis rarely involves the face, however studies have shown that up to 50% of psoriasis patients attending psoriasis clinics have facial involvement. Facial psoriasis is characterized by one or more persistent, dry, red, scaly (thickened) patches on the face.
Symptoms of facial psoriasis
In the rare cases that facial psoriasis presents, there are several forms of facial psoriasis that all cause skin that is itchy, irritated, and painful. The most common symptoms of facial psoriasis include a mild to intense itch and mild skin sensitivity and soreness.
The types of facial psoriasis
There are three main subtypes of facial psoriasis that may present:
- Hairline psoriasis is an extension of scalp psoriasis beyond the affected person’s hairline, with clinical presentations of thickened, bright red plaques that has a variable white scale.
- Sebopsoriasis is involved in the hairline and commonly affects the patient's eyebrows, eyelids, beard area, and nasolabial folds. The thin plaques are a salmon-pink color and have a bran-like scale. Sebopsoriais is typically associated with patchy or diffuse scalp psoriasis and may or may not present on other sites of the body.
Facial psoriasis known as true facial psoriasis, is characterized by scaly plaques that are red and sharply demarcated. These plaques may affect any part of a person's face, with the plaques typically being symmetrical in their presentation. Facial psoriasis can present as part of guttate psoriasis, chronic plaque psoriasis, or erythrodermic psoriasis. Other areas that facial psoriasis may present include the ears, scalp, knees, trunk (torsos), elbows, and genitals.
Causes of facial psoriasis
There are no clear causes of facial psoriasis, as with psoriasis that occurs on other parts of the affected person’s body. As psoriasis is an autoimmune disorder that is, it is associated with the disproportionate activation of the immune system- this results in increased proliferation (formation) and inflammation of the skin cells. Although there is a genetic predisposition to psoriasis, environmental factors such as stress, medications, injuries, and infections can also be the cause of psoriasis.
Diagnosis of facial psoriasis
A doctor or dermatologist will make the diagnosis of facial psoriasis based on clinical presentations, such as red and itchy skin, and based on your family history and your answers to the questions that they will ask. A small sample of your affected skin (biopsy) may be taken to confirm your psoriasis diagnosis. These steps are important in diagnosing psoriasis, and this disease can often present as similar conditions such as ringworm and seborrheic dermatitis.
How to treat psoriasis on the face
While there is no cure for facial psoriasis, there are treatments that can help control or alleviate the symptoms that present. Treatments for psoriasis on the face are determined by the severity and type of your psoriasis and the area that it is affecting. There is a vast range of treatments available; it will be important to communicate with your doctor about the treatment options that you may feel are not working appropriately for you. Treatment options can be grouped into three categories:
- Topical ointments and creams that are applied to the skin
- Systemic– injected or oral medications that work throughout the body
- Phototherapy– the affected skin is exposed to specific types of ultraviolet light
Corticosteroids: These are mild (moderate) strength topical steroids that relieve the itching sensation and reduce the inflammation caused by psoriasis. Corticosteroids are available in the form of a cream, ointment or lotion and can be applied daily when the patient is experiencing psoriasis symptoms. It is important when applying corticosteroids to avoid your eyes; your doctor will suggest a special steroid medication that is made specifically to be applied in moderation around your eyes. If you apply too much corticosteroid around your eyes, you can run the risk of causing cataracts or glaucoma.
Topical Calcineurin inhibitors: work to stop the action of an enzyme called calcineurin, which is involved in some of the mechanisms of the immune systems. Calcineurin inhibitors can be applied around the eyes without the risk of causing glaucoma. Upon application of calcineurin inhibitors such as pimecrolimus (Elidel) and tacrolimus (Protopic), you may experience a stinging sensation for the first few days.
Other topical preparations that can be used to treat facial psoriasis include:
- Vitamin D analogues calcipotriene (Dovonex, Sorilux), calcitriol (vectical), and betamethasone/calcipotriene.
- Coal tar creams may cause added irritation and staining to the skin.
- Salicylic acid is an over-the-counter descaling option.
Phototherapy: Another treatment option for facial psoriasis is phototherapy or light therapy, which makes use of light such as ultraviolet (UV) light. Phototherapy works to slow the reduction of and reduce psoriasis plaques by inhibiting DNA. Your doctor will prescribe the best phototherapy options for you based on the severity of your psoriasis, your previous treatments, your skin type, and your overall health.
Systemic treatments: For those suffering from prolonged and severe facial psoriasis, treatment option in the form of oral medication and injectables can be used. Systemic treatments will and should only occur under the surveillance of your medical professional, as these medications require prescriptions. Examples of systemic treatments for facial psoriasis include ciclosporin, biologic agents, methotrexate, and acitretin.
Managing the emotional burden of having psoriasis on the Face
Another important aspect of treating facial psoriasis is the management of the patient’s overall mental wellbeing. Survivornet has a great resource that provides information, and practical advice on how to manage the stigma that is often associated with cosmetic diseases such as psoriasis. It is perfectly normal to be self-conscious, have lower self-esteem and be embarrassed about your psoriasis. It is important to note that you are not alone and having a doctor that understands and is knowledgeable in depression and anxiety will help hugely.
"So while psoriasis is on the skin, it can carry or be associated with a significant emotional burden. Especially if it’s in an area of the body that’s visible," Dr. Saakshi Khattri, a dermatologist/rheumatologist at Mount Sinai Health System, said in a previous interview with SurvivorNet. "And you can have sort of irreversible damage from which there’s no turning back if there’s a delay in diagnosing or if it’s not diagnosed on time.
“So, all of this can have an emotional impact, a functional impact. It can certainly impact interpersonal relationships… and quite frankly, it can make patients that have psoriasis and psoriatic arthritis depressed. So certainly there is a burden of this disease that’s beyond what is just visible on the skin and/or in the joints."
Questions to ask your Doctor:
- How do I get rid of psoriasis on my face?
- Will I permanently have to live with psoriasis outbreaks on my face?
- Can I use multiple topical creams and ointments together?