Facial Psoriasis

Facial psoriasis is a common condition, often with an overlap with seborrhoeic dermatitis, a condition known as sebopsoriasis. It presents as scaly, dry, and red patches along the scalp, nose and cheeks. Given the location, this form of psoriasis can have a significant impact on a patient’s psyche. Effective treatments are readily available at The Psoriasis Institute.

  • Facial psoriasis affects up to half of patients with psoriasis
  • The use of long term steroids is discouraged as this can harm facial skin
  • The use of a simple moisturiser as well as a non-soap cleanser forms the basis of treatment
  • Avoidance of psoriasis triggers is very important
  • Vitamin A, and D creams, along with phototherapy can be safely and effectively used on the face

FREQUENTLY ASKED QUESTIONS

Facial psoriasis most commonly affects the scalp margins, eyebrows and around the nose. Psoriasis involving the head and neck area often affects the ears, and ear canals. Like other forms of psoriasis it presents as a red, scaly, irritating rash. Facial psoriasis usually flares up with dry weather, as well as exercise and long hot showers. Most patients will also have scalp involvement and have dandruff associated with their facial psoriasis. Psoriasis of the face is often misdiagnosed as eczema or dermatitis.

Psoriasis can also affect around the eyes and eyelid margins, and may cause dryness and discomfort in this area.

Psoriasis around the ears can lead to a build up of scale that can block the ear canal, leading to a temporary loss of hearing. Treatments are readily available no matter what the location.

Most patients with facial psoriasis will have involvement elsewhere. In fact it is very rare to have just psoriasis localised to the face. The most commonly involved areas include the scalp.

The most common trigger factors for psoriasis affecting the face is in fact what you do to your skin. Harsh scrubs, and cosmetics account for the number one trigger factor! The use of a simple skin care regime is best.

Other trigger factors for psoriasis of the face include -

  • Stress
  • Trauma
  • Foods
  • Infection
  • Weather, including environmental changes

Simple basic skin care forms the absolute foundation of managing facial psoriasis, this includes the use of soap substitutes and simple moisturisers.

As a guide we recommend the following:

Cleanser - Cetaphil or QV Wash

Moisturiser - QV Intensive, use at night. Cetaphil moisturiser during the day.

Never use a toner, and never, ever exfoliate. Always minimise skin irritation where possible. For example, chlorine may flare up facial rashes, including dermatitis, eczema, and psoriasis is no exception! If you like to swim, rinse off the chlorine off your face, and protect the skin with QV Intensive. Identify and avoid your flare factors where possible. Simple measures can improve facial psoriasis.

The skin around the face can be challenging to treat as it is thinner and more sensitive than other areas, so treating facial psoriasis may take some extra patience and care.

This forms the cornerstone of management. Replace potential irritant such as soaps and fragrance containing moisturiser. Replace with QV wash, Cetaphil wash or Aqueous cream. As a moisturiser, use QV Intensive at night, and a light moisturiser such as Cetaphil during the day.

Anti-inflammatory creams

Topical steroids on your face should be minimised and used with extreme caution. This form of treatment can be used to gain control of your facial psoriasis, however once control has been achieved, steroid use should be cycled, or kept to an absolute minimum. Long term use of corticosteroids on the face can lead to damage to your skin.

Vitamin A creams

This form of cream treatment can be used with excellent results in some patients. Most vitamin A creams can be irritating, and hence the dose will need to be carefully mixed and tailored to your skin sensitivity.

Vitamin D creams

This new form of cream can be highly effective in treating both psoriasis on the face and scalp psoriasis. Vitamin D creams can be formulated as a cream base, or a gel base for the scalp.

Non- steroid creams

There are new compounded creams available in the US and in the UK (not available in Australia), that are called steroid sparing agents. This group of creams and ointments act as anti-inflammatory agents, that limit the use of steroids on the face.

Tablets

This form of psoriasis therapy is considered if creams and phototherapy does not improve your skin condition.

Phototherapy

This method of treating facial psoriasis can be highly successful, especially if there are other areas of psoriasis on the body. Narrowband phototherapy can block the immune cells that cause psoriasis and stimulate vitamin D production. Treatments take less than a minute to perform, and are covered under Medicare.

Facial psoriasis, unlike psoriasis affecting the body, is very hard to cover up, and hence rapid effective treatment is very important. Psoriasis affecting this area can also lead to significant psychological issues. We recommend a range of cosmetic for patients with sensitive skin, including DERMABLEND. Mineral make up can also help hide areas of psoriasis.

We understand the importance of facial psoriasis and the impact of this condition on patients. The area of the face is especially tricky to manage, as the skin is super sensitive, and thinner than other areas of the body. We often use a tailored approach, and individualise a treatment regime for you.

Remember we work as a team, addressing basic skin care, trigger factors and have the option to use Vitamin A and D creams as well as state of the art phototherapy treatments. Rest assured there are many options available for treating psoriasis on your face.

Getting control of this condition is very important to gain patient confidence. I often start patients on a moderate strength steroid topically, such as Advantan Fatty Ointment, this give me quick control of the condition. I review patients at one week, taper the corticosteroid and add either a low concentration of coal tar, sulfur with or without salicylic acid. The importance of general skin care, including quick cool showers cannot be overstressed. Maintaining the barrier function of the skin with a non-irritating moisturiser is important in the treatment of facial psoriasis. Newer creams such as Vitamin A, D and anti-inflammatory formulations can decrease the use of steroids on the face.

Dr Davin Lim -  Consultant Dermatologist

PATIENT TESTIMONIAL

  • Avoiding certain foods in my diet has helped keep my psoriasis under control. Thank you for the insight and guidance.
    - Richard A. Northlakes

Most often patients will have scalp involvement as well as facial disease

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