For many people, psoriasis on the nose, cheeks, forehead, and ears is not only irritating but also 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.

What Causes Facial Psoriasis?

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.

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.

Symptoms of Facial Psoriasis

Facial psoriasis most frequently appears on the forehead, but it can also show up on the upper lip, cheeks, and delicate skin around the eyes, as well as 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,” one MyPsoriasisTeam member said.

There are three types of psoriasis on the face: scalp psoriasis, sebopsoriasis, and true facial psoriasis.

Scalp 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

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.

True Facial Psoriasis

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.

How Facial Psoriasis Affects MyPsoriasisTeam Members’ Lives

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:

• “Every day I get asked what’s wrong with my face.”
• “I’m trying to find a job, but my face is flared up all the time. When people stare, it makes me more anxious.”
• “I have psoriasis on my forehead and scalp. I get so embarrassed, I stay home most of the time.”
• “During exercise class, I sweated off all the makeup covering my red, sore forehead! Mid-class, a woman shouted at me, ‘What’s wrong with your head?’ I went to the gym to de-stress and ended up crying alone in the toilet!”

Treatments for Psoriasis on the Face

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. Ask your dermatologist about treatment options that are right for you. They may include topical treatments, systemic treatments, phototherapy, and moisturizers.

Topical Steroids

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 should be used sparingly on small areas of the body for a short duration.

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.

Nonsteroidal Topicals

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 (the most common type of eczema), doctors frequently prescribe them off-label to treat psoriasis face lesions.

Systemic Treatments

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

Traditional systemics work in a variety of ways to treat facial psoriasis. Below are a few examples:

• Acitretin (sold as Soriatane) is a retinoid that is similar to high doses of vitamin A. It is taken as a pill and helps control cell growth and shedding.
• Cyclosporine is traditionally used as an immunosuppressive medication given to people receiving an organ transplant. However, it can also be used to help dampen the immune system in people with psoriasis.
• Methotrexate is used to treat severe psoriasis. It works by blocking an enzyme that makes skin cells grow quickly, which can help stop the formation of plaques.

Biologics

Biologics are human-made proteins designed to work against specific parts of the immune system to help control inflammation. Biologics 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:

• Adalimumab (Humira)
• Certolizumab pegol (Cimzia)
• Etanercept (Enbrel)
• Golimumab (Simponi)
• Risankizumab-zara (Skyrizi)
• Secukinumab (Cosentyx)

Phototherapy

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 approved by the U.S. Food and Drug Administration (FDA) for treating specific areas of plaque psoriasis. Research shows the excimer laser is effective for treating scalp psoriasis.

Moisturizers

Over-the-counter moisturizing lotions, creams, and ointments can be an important part of managing facial psoriasis. 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.

Skin Care Tips for Facial Psoriasis

Caring for itchy, dry skin on your face can pose several challenges. Below are some tips to make it easier to care for your skin.

Makeup

Covering up dry, discolored, flaky patches on your face can be challenging. Makeup artists offer these tips:

• Use creams, not drying gels.
• Choose a liquid or cream foundation, not a dry powder.
• Apply foundation with a dabbing or stippling technique, using a clean fingertip or a sponge (not a brush that can irritate skin).
• Don’t apply makeup to open, raw psoriatic lesions.
• Consider a pigment concealer to cover lesions.

Shaving

Removing beard stubble can aggravate facial patches and cause bleeding. The American Academy of Dermatology recommends these shaving tips:

• Be gentle and take your time while shaving.
• Use high-quality razors that are clean and have not been used more than five to seven times.
• Moisten your skin before shaving.
• Choose a shave cream or oil for sensitive skin.

You may want to apply a light moisturizer before and after shaving. Use sunscreen and moisturizers daily to protect your skin.

Sunscreens

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

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:

• Using gentle cleansers on your skin
• Applying moisturizer before and after wearing the mask
• Avoiding wearing makeup under the mask
• Washing cloth masks regularly

Talk to Your Doctor About Your Specific Diagnosis

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.

Find Your Team

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 123,000 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.