What to know about psoriasis on the face

Facial psoriasis often develops from scalp psoriasis.

Lesions extend downward from the scalp and may appear as red or purple itchy areas. On occasion, silvery-white scales can form.

A person with facial psoriasis will often have dead skin cells in their hair. At first glance, this may resemble dandruff from dry skin or skin sensitivity.

Psoriasis on the face will most commonly affect the following areas:

• the eyebrows
• the hairline
• the skin between the nose and upper lip
• the upper forehead

Facial psoriasis can sometimes affect the eyelids, extending to the eyelashes. This can cause red or purple discoloration, swelling, and crusting of the eyelids.

As a result, a person’s eyelashes may turn upward or downward. Eyelash rims that turn downward may place further stress on the eye and cause inflammation.

In very rare circumstances, a person might experience psoriasis of the eyes.

Psoriasis can also cause symptoms on the lips, inside the cheeks, on the gums, or inside the nose. These are often very uncomfortable and may affect a person’s ability to chew and swallow food.

Although further research is necessary to confirm the exact cause of psoriasis, some scientists theorize that psoriasis is the result of inflammation in the body. This may result in the overproduction of skin cells and the buildup of plaques on the skin.

Psoriasis occurs due to the overactivity of T cells in the immune system. This type of cell usually protects the body from bacteria and other infectious agents.

When a person has psoriasis, however, the body triggers T cells in the absence of any infection. The T cells then activate different inflammatory responses that cause skin cells to develop too rapidly.

Psoriasis lesions rarely develop only on the face. For example, a person may have both face and scalp psoriasis, or they may have lesions on different areas of the body that also happen to form on the face.

Risk factors

Although the causes are unclear, certain factors can increase the risk of developing facial psoriasis. These include:

• a family history of psoriasis
• a history of infections of the skin
• injuries to the skin, such as from surgery
• stress

A person with facial psoriasis may notice that their symptoms get worse after exposure to ultraviolet (UV) radiation, such as 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 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

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.

Developing psoriasis on the face can have psychological effects, such as anxiety or depression. These are both possible triggers and future complications of psoriasis and tend to resolve once symptoms clear up.

People whose psoriasis affects a visible part of their body may find the condition particularly challenging. However, psoriasis is only a small part of a person and should not define them.

Some people with psoriasis find that sharing their feelings with friends and family is helpful, as it can help their support network understand the challenges of living with facial psoriasis.

If a person would rather talk to people outside of their personal network, they could speak with a counselor, their doctor, or a support group.

One online support group is the Talk Psoriasis forum, from the Inspire community.

Although some people may be anxious or self-conscious about another individual seeing their skin up close, it is important that people understand psoriasis.

It is also vital to understand that anyone can develop psoriasis, and that it is not contagious.

When to see a doctor

If a person is uncertain about whether psoriasis or a different health condition is causing their symptoms, they should see a doctor.

A dermatologist, or skin specialist, will most commonly treat psoriasis. A primary care physician can refer a person to a dermatologist.

People should see their doctor about facial psoriasis symptoms when:

• areas on the face are painful or uncomfortable
• the discomfort makes it difficult to get through the day
• lesions are extending toward the eyes
• they have concerns about their skin’s appearance
• they are experiencing joint problems as well as facial lesions

Generally, people should see their doctor whenever their psoriasis is causing them problems or when they wish to discuss treatment options.

Psoriasis is a chronic medical condition. A person may experience flares of psoriasis followed by remission of symptoms.

People may find that certain things make their psoriasis worse. Such triggers include stress and seasonal changes that can dry out the skin.

Those with psoriasis symptoms on the face have usually had it for longer, have a family history of psoriasis, or have a more severe manifestation of the condition.

However, treatments have progressed to a stage where biologic medications can reduce the activity of the condition at the root cause rather than purely soothing the lesions and improving comfort.

Research into a full cure continues. Although facial psoriasis is a disruptive form of the condition, effective treatments are becoming more widely available.