Psoriasis on the scalp may initially be mistaken for dandruff, but can extend and form silvery-white patches.
There are several different types of psoriasis that can vary based on the appearance of the scales, as well as where on the body the psoriasis is located.
Psoriasis on the face can cause a variety of symptoms and complications. In addition to physical effects, psoriasis on the face can also cause embarrassment and self-consciousness.
However, there are many treatments available to help reduce these symptoms.
Symptoms and complications
Facial psoriasis is often the result of scalp psoriasis. Lesions will extend from the scalp, and may appear as red, itchy areas. Sometimes, silvery-white scales will form.
Often, a person with facial psoriasis will have dead skin cells in their hair as well. In the first instance, this may be mistaken for dandruff from dry skin or skin sensitivity.
Psoriasis on the face will most commonly affect the following areas:
- skin between the nose and upper lip
- upper forehead
Facial psoriasis can sometimes affect the eyelids, extending even to the eyelashes. This can cause redness, swelling, and crusting of the eyelids.
People can experience psoriasis of the eyes themselves. However, this condition is very rare.
Psoriasis can also appear on the lips, inside the cheek, on the gums, or inside the nose. This is often very uncomfortable and may affect a person's ability to chew and swallow their food.
Causes of psoriasis on the face
Psoriasis occurs due to the overactivity of immune system cells known as T cells in the body. Usually, T cells protect the body from bacteria and other infectious agents.
When a person has psoriasis, the body triggers T cells in the absence of infection. As a result, the T cells cause other inflammatory responses that lead skin cells to develop rapidly.
Psoriasis lesions rarely appear just on the face alone. As well as scalp psoriasis, a person may also have psoriasis on other areas of the body that affects the face as well.
The causes associated with facial psoriasis are the same as those for the other types of psoriasis.
While doctors don't know the exact cause of psoriasis, they theorize that psoriasis is the result of inflammation in the body, which results in the overproduction of skin cells.
Risk factors associated with facial psoriasis include:
- family history of psoriasis
- history of infections of the skin
- injuries to the skin, such as from surgery
A person with facial psoriasis may notice that their symptoms get worse after exposure to ultraviolet radiation, including that from the sun or a tanning bed. Smoking can also worsen facial psoriasis.
Psoriasis on the face can be difficult to treat because the skin is very thin and sensitive.
It is important that a doctor evaluates the skin and makes recommendations to ensure the treatments will not be too harsh for the face.
Sometimes, a person can apply over-the-counter topical corticosteroids, such as hydrocortisone, to the face to reduce the incidence of face psoriasis.
Topical corticosteroid creams may be used sparingly to treat psoriasis on the face.
However, a person should be prepared that application of hydrocortisone may cause a variety of potential side effects, such as:
- thin, transparent skin
- easy bruising
- skin that is more easily torn
A doctor will sometimes recommend using topical steroids as sparingly as possible. They will suggest a dose that makes sure that a person will get results while minimizing side effects.
In addition to steroids, rinsing with a saline solution can also help to reduce discomfort and pain.
Treatments available over the counter include:
- calcipotriene cream or ointment
- scale-removing products
- tazarotene cream or gel
- ultraviolet light
If the skin around the eyes is affected by psoriasis, doctors will advise taking great care when applying medications. Many over-the-counter psoriasis treatments can cause damage to the eyes that can lead to glaucoma or cataracts.
However, the United States Food and Drug Administration (FDA) have approved two drugs for the treatment of psoriasis that may work especially well on the face
These prescription drugs are tacrolimus ointment and pimecrolimus cream. Both creams should be applied very carefully, avoiding the eyes.
Although tacrolimus or pimecrolimus should not cause glaucoma, they can cause uncomfortable side effects, including facial stinging.
In addition to these topical medications, there are several practices a person can do at home to reduce irritation as much as possible. These include:
- using gentle, non-soap cleansers to keep the skin clean
- applying moisturizers regularly
- applying sunscreen on a regular basis to reduce the effects of ultraviolet radiation
Practicing good self-care will help a person control their psoriasis as much as possible.
Tips for living with face psoriasis
Psoriasis on the face can affect more than just a person's skin. The obvious scars and lesions on a person's face may cause psychological concerns, such as anxiety or depression. However, stress and anxiety can often trigger a psoriasis flare-up.
People with facial psoriasis may find the condition particularly challenging. Their face is what the world sees. However, psoriasis is only a small part of a person and should not define them.
Some people find that sharing their feelings with friends and family is helpful, as it can help them understand the daily struggles involved in living with facial psoriasis.
However, if a person does not feel comfortable sharing these emotions with loved ones, they could talk to a counselor, their doctor, or a support group.
An example of an online support group is the TalkPsoriasis forum from the Inspire community.
A person with psoriasis can learn about it and teach others about it. Although some people may be be anxious about someone else seeing their skin up close, it is important that people understand psoriasis. People need to understand that anyone can develop it, and that it is not contagious.
When to see a doctor
If someone is uncertain whether their symptoms are from psoriasis or some other cause, they should see their doctor. A dermatologist will most commonly treat psoriasis. If someone does not have a dermatologist, their primary care physician can often make a referral.
A person should see a doctor if the lesions are extending towards the eyes.
People should see their doctor when:
- areas on the face are painful or causing discomfort
- areas on the face are making it difficult for someone to get through their daily activities
- lesions are extending to or near the eyes
- someone is concerned about their skin's appearance
- someone is experiencing joint problems as well as facial lesions related to psoriasis
People should see their doctor whenever their psoriasis is causing them problems, or to discuss treatment options.
Psoriasis is a chronic medical condition. A person may experience outbreaks of psoriasis, followed by remission of symptoms.
People will often find that certain things make their psoriasis worse. These include stress and seasonal changes that can make the skin drier.
Facial psoriasis is usually associated with more severe symptoms of psoriasis.
Researchers are conducting many clinical trials to identify causes, risk factors, and treatments of psoriasis. As they continue to learn more about the disease, they will, hopefully, develop new ways to treat facial psoriasis.