Psoriasis on Face (Facial Psoriasis)

Psoriasis on the face is different than on other parts of the body. Your skin there is thinner and may be more sensitive to treatments. In this area, the condition usually affects your:

  • Eyebrows
  • Skin between your nose and upper lip
  • Upper forehead
  • Hairline

You have a lot of options for treating psoriasis in these areas. Work closely with your doctor to find what works best for you.

Symptoms

They vary depending on what part of your face the psoriasis affects:

Eyelids

  • Scales cover the lashes.
  • The edges of your lids may get red and crusty.
  • The rims may turn up or down if they’re inflamed for a long time.

Eyes

  • Dry, inflamed, irritated eyes
  • Trouble seeing

Ears

  • Scales build up and can block your ear canal, causing hearing loss.
  • Usually, psoriasis doesn’t affect the inner ear.

Mouth

You might have white and gray lesions:

  • On your gums or tongue
  • Inside the cheek
  • Inside your nose
  • On the lips

Psoriasis Causes and Risk Factors

Doctors aren’t sure what causes psoriasis, but they know that genes and your immune system play a major role. About 40% of people with psoriasis have a close family member with the disease. Many of the genes linked to psoriasis are those that help run your immune system. In addition to your genes, these things can make you more likely to get psoriasis:

  • Smoking
  • Obesity
  • Medications
  • Infections
  • Alcohol
  • Vitamin D deficiency
  • Stress

Treatments for Face Psoriasis

There are a few main types of treatments specifically for facial psoriasis. The type you use depends on which part of the face is affected.

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Medications

Your doctor may prescribe just one or a mixture of them, including treatments that go on your skin such as:

  • Low-potency corticosteroids, which are ointments, creams, lotions, and sprays that reduce redness and swelling. Doctors usually prescribe them for just a few weeks at a time. If you use them for longer, they can make your skin thin, shiny, and bruise easily or give it stretch marks and new blood vessels.
  • Synthetic  vitamin D , such as calcipotriene (Dovonex, Sorilux) ointment or cream, slows the growth of skin cells. But it can also irritate your face. Calcitriol (Rocaltrol, Vectical) is a newer vitamin D drug for psoriasis that some studies suggest may be better for sensitive skin.
  • Retinoids, such as tazarotene gel (Tazorac), help remove scales and may ease inflammation. But skin irritation is a side effect.
  • Pimecrolimus  (Elidel) and  tacrolimus  (Protopic) are two drugs the FDA has approved for eczema, a different skin condition. Some dermatologists recommend these drugs for psoriasis on the face. But talk to your doctor about whether you need these medicines. The FDA says people should use them only for a short time since some studies have linked the drugs to cancer risks.
  • Crisaborole (Eucrisa) ointment is another topical medicine recently approved by the FDA for eczema that can reduce inflammation. It can cause temporary burning or stinging upon application.
  • Coal tar. Derived from coal, this treatment comes in over-the-counter shampoos, creams, and oils. Prescription-strength products are also available.
  • Lotion, creams, or other moisturizers. They can’t heal psoriasis, but they can make your skin feel better and ease itching, scaling, and dryness.
  • Salicylic acid. Also available over-the-counter and by prescription in shampoos and scalp treatments, this remedy can help get rid of scales. Your doctor might pair it with steroids or coal tar.

If these treatments don't help, ask your doctor if you should take prescription pills or shots for your condition. These include:

Each works differently, but they can be helpful for moderate to severe psoriasis.

Light Treatment

Another option is treatment with ultraviolet (UV) light, called phototherapy, which slows skin cell growth. There are several types:

  • Sunlight. You get ultraviolet rays from sunlight or artificial light.
  • UVB phototherapy. You get UVB rays from an artificial source.
  • Narrow band UVB phototherapy. This is a newer type of UVB treatment.
  • Goeckerman therapy. This mixes UVB treatment with coal tar.
  • Psoralen plus ultraviolet A (PUVA). Psoralen is a medication that makes your skin more sensitive to light. You take it before UVA therapy.
  • Excimer laser. This is a controlled beam of UVB light that treats a small area.

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Treatments for Specific Areas

Eyelids

To treat this area, your doctor may recommend:

  • Special corticosteroids to treat scaling. But don’t overuse them. If they get into your eyes, they can lead to glaucoma or cataracts.
  • The eczema drugs crisaborole (Eucrisa) ointment, pimecrolimus (Elidel), or tacrolimus (Protopic). They don't cause the side effects of steroids. They can sting the first few days you use them.

Be careful when you treat psoriasis around your eyes. The skin on eyelids is delicate and gets damaged easily. Tell your doctor about any problems you have.

Psoriasis in the eye is very rare. If you have it, your eyes can be painfully dry. You may need antibiotics to treat an eye infection if you get one.

Ears

Psoriasis medications can put your eardrum at risk, so be cautious when you apply any inside the ear. Your doctor may recommend:

  • A prescription corticosteroid you can drip in your ear or apply to the outside of your ear canal
  • Calcipotriene or tazarotene usually mixed with a corticosteroid cream or ointment

Mouth and Nose

Your doctor may recommend:

  • Steroid creams or ointments that are made for moist areas
  • Rinsing often with a saline solution to relieve pain
  • Low-potency corticosteroids like hydrocortisone 1% ointment
  • Pimecrolimus or tacrolimus

How to Apply Psoriasis Medication on Your Face

Here are a few basic tips:

  • Use small amounts.
  • Be careful when you apply creams and ointments around the eyes. Some treatments can irritate them.
  • Follow your doctor’s instructions for taking the medication so you can prevent side effects, especially with steroids.
  • Ask your doctor if you can use makeup to conceal the psoriasis on your face. Some products can prevent treatment from working.
  • If your medication doesn’t help or causes too many side effects, work with your doctor to figure out a treatment that will help.
WebMD Medical Reference Reviewed by Debra Jaliman, MD on October 16, 2018

Sources

SOURCES:

The Psoriasis Association: "Psoriasis in Sensitive Areas."

National Psoriasis Foundation: "Specific locations: Face," “Psoriasis on the Face.”

Ortonne, J. Eur J Dermatol, 2010.

Yamamoto, T. European Journal of Dermatology.

FDA: "Elidel (pimecrolimus), Protopic (tacrolimus)," “FDA approves Amjevita, a biosimilar to Humira.”

Mayo Clinic: “Psoriasis

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