For many people, psoriasis on the nose, cheeks, forehead, and ears is not only irritating; it can be embarrassing. About 50 percent of people with plaque psoriasis — the most common type of psoriasis — who develop symptoms on their bodies also develop them on their faces, according to the National Psoriasis Foundation.
The appearance of discolored, scaly patches on your most prominent body part can take a toll on self-esteem and quality of life. “Now that psoriasis has attacked my face, I (literally) can’t face going out,” said one member of MyPsoriasisTeam. “People look at me like I have a disease,” shared another.
Psoriasis is also harder to treat on the face than elsewhere because the skin is thinner, and stronger steroid creams cannot be used there. It can also be hard to avoid picking and scratching the lesions, and covering up dry, blotchy spots can be frustrating. “Any makeup I use sticks to the flaky patches and makes me look a million years older than I really am!” lamented one member.
Facial lesions, like psoriasis elsewhere on the body, are typically caused by an overactive immune system that creates inflammation and overproduction of skin cells, according to the American Academy of Dermatology Association.
Psoriasis flares can be triggered by certain medications, infections, cold weather, sun, smoking, and stress. Flares on the face may also be an indicator of more severe psoriasis overall. Scalp psoriasis can also progress to facial flares.
Facial psoriasis most frequently appears on the forehead, but it can also show up on the upper lip, cheeks, delicate skin around the eyes, and in and around the ears. Symptoms range from mild to severe and can include itching, soreness, skin sensitivity, or burning. The plaques can appear red or pink on lighter skin and brown or purple on darker skin.
“My forehead, scalp, ears, neck, and eyelids are covered and I’m beyond miserable,” lamented one MyPsoriasisTeam member.
There are three types of psoriasis on the face: scalp psoriasis, sebopsoriasis, and true facial psoriasis.
Scalp psoriasis affects between 45 percent and 56 percent of people with psoriasis, according to the National Psoriasis Foundation. It typically appears on the scalp, forehead, hairline, the skin around the ears, and the back of the neck. It can look like dandruff or white scales on top of thickened plaques. The scales can also build up and block the ear canal. One member explained, “Psoriasis behind my ears and the back of my head grew toward my forehead.”
Scalp psoriasis can also be mistakenly identified as another skin condition, seborrheic dermatitis. However, seborrheic dermatitis will present as yellow, greasy plaques. Scalp psoriasis plaques are usually dry and white or silver in tone.
Sebopsoriasis most often affects the eyelids, eyebrows, upper lip, and behind the ears. Patches are thinner and lighter in color, and they can look more like a severe case of seborrheic dermatitis.
Sebopsoriasis can also cover lashes, causing eyelids to redden. If inflamed for long periods, eyelid rims can turn up or down. “With every blink, I feel a rubbing, scratching, bleeding, raw feeling on my eyes,” shared one MyPsoriasisTeam member.
Scaly plaques are characteristic of true facial psoriasis, which can affect any part of the face. It is usually accompanied by psoriasis on other areas of the body. Lesions can also build up in the exterior ear canal.
Psoriasis and skin cancer symptoms can look very similar initially, appearing as crusty or scaly changes to the outer layers of skin most exposed to sun. For that reason, it’s important to get an accurate diagnosis from a dermatologist. A biopsy — which entails removing a small sample of skin for analysis — may be necessary to determine if a scaly area is psoriasis or sun damage.
Facial psoriasis can have a huge impact on a person’s self-esteem and well-being. Members of MyPsoriasisTeam talk about feeling isolated and depressed by their condition:
Although there’s no cure for facial psoriasis, it can be controlled with prescription and over-the-counter medications that are safe for thin, delicate skin. Consult with your dermatologist about treatment options that are right for you. They may include topical treatments, systemic treatments, phototherapy, and moisturizers.
For mild facial psoriasis, dermatologists often prescribe a low-potency topical corticosteroid, such as over-the-counter hydrocortisone 1 percent ointment or prescription-strength 2.5 percent. Steroids help reduce swelling and discoloration by blocking inflammatory responses in the body. They come in various forms and strengths and should be used sparingly on small areas of the body for no longer than three weeks.
Side effects can include skin thinning and changes in pigmentation. Steroid creams should not be used in the eyes because they can cause cataracts and glaucoma.
Topical calcineurin inhibitors, such as tacrolimus (Protopic) and pimecrolimus (Elidel), suppress the immune system to control inflammation and can be used longer than steroids. These creams do not thin the skin like steroid creams and are often a good choice for areas where the skin is thinner. Although these medications are approved for atopic dermatitis (eczema), doctors frequently prescribed them off-label to treat psoriasis face lesions.
“I get psoriasis on both eyes. Protopic is the only thing that cleared it,” shared one MyPsoriasisTeam member. “My dermatologist prescribed it for the ‘delicate areas’ and it works quickly,” agreed another.
Systemic treatments are medications that work throughout the whole body to treat a disease or condition. These can be used to treat psoriasis anywhere on the body, including the face.
Systemics are given as pills or injections, which then enter the bloodstream to take effect wherever they are needed. This helps people achieve skin clearance over the entire body, including the face. Some systemic drugs have been around for decades, while others are newer.
Traditional systemics work in a variety of ways to treat facial psoriasis. Below are a few examples:
Biologics are human-made proteins designed to work against specific parts of the immune system to help control inflammation. Biologics that are approved for treating psoriasis block certain immune cells — such as T cells — or different mediators of inflammation known as cytokines.
Because biologics are proteins, they cannot be taken orally because they would be digested and broken down in the stomach. Instead, they are given as injections or infusions to directly enter the bloodstream and take effect.
There are over a dozen biologics for available for treating psoriasis, including:
Phototherapy is a treatment for psoriasis that uses ultraviolet (UV) light to penetrate the layers of the skin, slowing the growth of skin cells. Phototherapy is typically done under the care of a dermatologist who can monitor the treatments and the amount of UV radiation exposure.
Another option is the excimer laser, which is FDA-approved for treating specific areas of plaque psoriasis. Research shows the excimer laser is effective for treating scalp psoriasis.
Moisturizing lotions, creams, and ointments are an important part of facial psoriasis treatment. These over-the-counter products soothe itching, discoloration, and dry skin, and can help prevent psoriasis from getting worse. They should be applied to the skin at least once a day following a warm bath or shower.
To minimize irritation, choose moisturizers that are free of alcohol, artificial preservatives, dyes, and fragrances. Those that contain ceramides, lipids, and hyaluronic acid help keep the upper layer of skin hydrated and protected.
MyPsoriasisTeam members have used several other strategies to manage face psoriasis. Some are external, like cosmetics and sunscreen. Others involve lifestyle changes, like healthy eating and stress reduction practices.
Covering up dry, discolored, flaky patches on your face can be challenging. Makeup artists offer these tips:
Removing beard stubble can aggravate facial patches, and psoriatic skin may bleed more easily. One member of MyPsoriasisTeam suggested, “A lady’s razor. It helped my husband.”
The American Academy of Dermatology recommends these shaving tips:
You may want to apply a light moisturizer before and after shaving. Use sunscreen and moisturizers daily to protect your skin.
For many people with facial psoriasis, sunscreens can aggravate symptoms. Dermatologists recommend that people with psoriasis who spend time in the sun use mineral sunscreens containing zinc oxide or titanium dioxide instead of irritating chemical products. These products will often be labeled for use on sensitive skin.
Face masks worn to protect against the spread of illness can pose challenges for some people with psoriasis on the face.
“The mask creates issues around my ears where the psoriasis is really bad,” said one MyPsoriasisTeam member. “I clip the end of the mask to my hair, so it doesn’t rub, and try to moisturize as much as possible.”
Another added, “I apply A+D Ointment on my nose, lips, and face before putting on the mask. If it can protect a baby’s butt, it’ll protect your face! It really works!”
The American Academy of Dermatology offers tips for preventing skin problems from prolonged mask use, including:
One way to reduce symptoms of facial psoriasis is to treat it from the inside out. There’s no specific diet for psoriasis, but many physicians recommend eating a healthy balance of fresh fruit and vegetables, fish, and lean meats, and unsaturated fats.
“I stopped sugar, ate green veggies (the darker the better), berries of all kinds, and increased vitamin D3,” said one member. “It took up to six weeks, but that was the answer for me.”
Stress is a common trigger for psoriasis flares. To manage stress levels, the National Psoriasis Foundation advises the following:
Each person’s psoriasis diagnosis is different, and what works for one person may not work for another. You should work with your dermatologist to determine which treatments to try — and which ones to avoid. Be open regarding changes to your condition and whether new treatments are meeting your expectations. Be sure to report unwanted side effects.
MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 112,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.
How does facial psoriasis affect your life? Has your doctor prescribed treatments to manage your symptoms? What helps you look and feel good? Share your experience in the comments below, or start a conversation by posting on your Activities page.