Diagnosis and Treatment of Facial Psoriasis

Steroids and Immunomodulators Can Treat Facial Psoriasis

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Facial psoriasis, which affects up to 46% of individuals with psoriasis, produces silvery scales, itchy rashes and, in rare cases, open lesions in an area of the body that is difficult to conceal. As a result, those with facial psoriasis confront a distinct set of challenges, involving both treatment and coping methods

Diagnosis of Facial Psoriasis

In its cause and symptoms, facial psoriasis is no different from psoriasis that appears elsewhere. Above all, individuals with facial psoriasis typically experience the same itchy, scaly rash that is characteristic of any type of psoriasis.

The rash most commonly affects the skin above the upper lip, as well as areas around the forehead and eyebrows, and at the hairline. According to one Korean study of 235 patients with facial psoriasis, approximately 74% of study participants had rashes on the upper forehead, and approximately 46% had rashes near the ear. The study also found that most patients first experienced facial symptoms between the ages of 30 to 40.

In order to diagnose facial psoriasis, a physician will examine the patient's skin and will take a personal health history. If the diagnosis is in doubt, a biopsy may be conducted to rule out other skin diseases, such as seborrheic dermatitis.

Treatment Options for Facial Psoriasis

Like standard psoriasis, facial psoriasis generally responds well to moisturizers and petroleum jelly. People with facial psoriasis should also pay close attention to what triggers flare-ups, as these activities or products should be avoided. For example, some individuals report flare-ups after swimming in a chlorinated pool, while other individuals say that the chlorinated water actually improves symptoms.

Many topical steroid treatments approved for psoriasis treatment, such as hydrocortisone creams, may also be effective in treating facial psoriasis. However use of such steroids should be limited, as long-term use can cause skin thinning and other adverse effects. Talk to your physician about steroid treatments and risk factors.

Protopic (tacrolimus), which is an immunomodulator, is used as off-label treatment for severe facial and genital psoriasis. Protopic is an immunosuppressive drug approved to help prevent rejection of transplanted organs. The FDA warns that Protopic should not be regarded as a first-line treatment for psoriasis and its administration should be closely monitored by a knowledgeable physician. The regulatory agency also ordered the manufacturer to include a black box warning noting that the medication is linked with increased risk for skin cancer, lymphoma, and viral infections. A black box warning is the strongest warning label the agency employs.

Protopic, typically applied twice a day, works by blocking the immune response thought to cause psoriasis symptoms. Patients applying Protopic should contact a physician immediately if they experience swollen glands, fever, fatigue, cold sores or oozing or swelling of the skin. Other less serious potential adverse effects include a tingling sensation at the application site, itching, acne, nausea, and headache.

A small 2007 study, published in the British Journal of Dermatology, compared the efficacy of both topical calcitriol and tacrolimus. The six-week study, involving 50 participants with facial or genital psoriasis, found that 60% of patients taking tacrolimus achieved complete or almost complete clearance of psoriasis rash and lesions. However, only 33% of patients using calcitriol experienced comparable improvements.

Self-Esteem Issues and Facial Psoriasis

Because facial psoriasis is not easy to cover or mask, it carries a variety of psychological challenges not faced by those with non-facial psoriasis. Yet these challenges are surmountable, given the right combination of treatment and support.

The Mayo Clinic advises patients to educate family and friends about facial psoriasis and the treatment methods recommended by physicians. This allows them to be a part of the solution. Finding a support group can also be helpful, as can talking to a counselor about emotional issues connected with the disease.

Patients with facial psoriasis can also experiment with various cover-ups. The National Psoriasis Foundation recommends Dermablend, cosmetics designed for people with psoriasis, dermatitis and other skin conditions. However, the foundation advises against applying cosmetics to overly irritated skin or unhealed lesions, as this could result in stinging and possible infection.

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