Psoriasis on the Face

• About half of people with plaque psoriasis on their bodies also develop psoriasis on the face.
• Psoriasis on the face can affect self-esteem and well-being, causing some people to feel embarrassed and depressed.
• Facial psoriasis can be treated with topical treatments, systemic treatments, phototherapy, and moisturizers.

Let’s face it, 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 form) on their bodies also develop psoriasis on their faces.

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.

Yet another wrinkle: face masks. Masks worn to protect against COVID-19 can cause skin irritation for some people. According to some research, more than 70 percent of people with facial psoriasis experience the Koebner phenomenon (a reaction that creates new psoriasis lesions from skin injuries like scratches or sunburn).

“When I wear a mask for work — or in public for just a half-hour — I break out even more,” explained 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, 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

Scalp psoriasis affects between 45 percent and 56 percent of people with psoriasis. 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 scale on top of thickened plaques. The scale 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 may be necessary to determine if a scaly area is psoriasis or sun damage.

How Facial Psoriasis Affects MyPsoriasisTeam Members' Lives

Facial psoriasis has a huge impact on self-esteem and well-being. Members of MyPsoriasisTeam talk about feeling isolated and depressed by their condition:

• “It gives us low self-esteem.”
• “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.”
• “Sometimes I don't want to go to work because it’s very stressful. Is there a disability benefit for psoriasis?”
• “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 of 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. Consult with 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 redness 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.

Nonsteroidal Topicals

Topical calcineurin inhibitors, such as Protopic (tacrolimus) and Elidel (pimecrolimus), 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. While these medications are approved for atopic dermatitis, they’re frequently prescribed 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

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. There are two main types of systemics — traditional systemics and biologics.

Traditional Systemics

Traditional systemics work in a variety of ways to treat facial psoriasis. Soriatane (acitretin) 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. It is the only oral retinoid approved by the U.S. Food and Drug Administration (FDA) for treating psoriasis. Soriatane can affect the liver and lipid levels, so these must be monitored periodically by a doctor during treatment.

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. Treatment with cyclosporine requires close monitoring from a doctor, as it can affect blood pressure and the kidneys.

Methotrexate is a chemotherapy drug that is also FDA-approved for treating severe psoriasis. It works by blocking an enzyme that makes skin cells grow quickly, which can help stop the formation of plaques. Methotrexate can affect the liver, so close monitoring of liver enzymes is necessary during treatment. Sometimes a doctor will perform a liver biopsy to make sure the liver is not being harmed.

Otezla (apremilast) is a newer oral medication approved for psoriasis. This medicine does not suppress the immune system.

Biologics

Biologics are human-made proteins designed to work against specific parts of the immune system to help control inflammation. These are different from systemics, which affect the entire immune system. 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.

FDA-approved biologics for treating psoriasis include:

• Cimzia (certolizumab pegol)
• Cosentyx (secukinumab)
• Enbrel (etanercept)
• Humira (adalimumab)
• Ilumya (tildrakizumab-asmn)
• Orencia (abatacept)
• Remicade (infliximab)
• Siliq (brodalumab)
• Simponi (golimumab)
• Skyrizi (risankizumab-rzaa)
• Stelara (ustekinumab)
• Taltz (ixekizumab)
• Tremfya (guselkumab)

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.

There are a few types of phototherapy that can be used depending on the location and severity of your psoriasis. Ultraviolet light B (UVB) is found in sunlight and is effective in reducing inflammation in psoriasis. UVB phototherapy exposes the skin to artificial UVB light for a certain amount of time on a repeated schedule.

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.

Moisturizers

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. Apply to 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.

Many MyPsoriasisTeam members swear by coconut oil as well. “During the day I wear it under my makeup. At night, I apply a tea tree oil/lavender/coconut oil combo. It feels amazing, helps you sleep, decreases inflammation, and heals the skin. It’s literally the only thing I have found that works,” shared one member.

Skin Care Tips for Facial Psoriasis

There are several other strategies MyPsoriasisTeam members have used to manage face psoriasis. Some are external, like cosmetics and sunscreen. Others involve lifestyle changes, like healthy eating and stress reduction practices.

Face Masks

Wearing a face mask is important to protect yourself and others during the COVID-19 pandemic. But for people with psoriasis, problems can arise from masks that rub on the skin or contain irritating and allergenic material.

“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 gentle skin cleansing, applying moisturizer before and after wearing the mask, avoiding wearing makeup under the mask, and washing cloth masks regularly.

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 put makeup on open, raw psoriatic lesions. If necessary, apply makeup over a cream foundation.
• Consider a pigment concealer to cover lesions.

Shaving

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.” Experts from the European Academy of Dermatology and Venereology recommend these tips:

• Be gentle and take your time while shaving.
• Use high quality razors.
• Choose a shave cream or oil for sensitive skin.
• Make sure blades are clean in between shaves and not clogged with skin flakes, hair, or soap.
• Apply a thin layer of moisturizer before shaving.
• Use a good aftershave moisturizer.
• Apply sunscreen and moisturizers daily to protect your skin.

Sunscreens

For many people with facial psoriasis, sunscreens can aggravate symptoms. If you will be in the sun, dermatologists recommend physical sunscreens containing zinc oxide or titanium dioxide over irritating chemical products. These products will often be labeled for use on sensitive skin.

Diet

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, 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 Management

Stress is a common trigger for psoriasis flares. To manage stress levels, experts from the National Psoriasis Foundation advise the following:

• Meditation and deep breathing
• Exercise, including tai chi and yoga
• Psychological and social support
• Massage

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 100,000 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 MyPsoriasisTeam.