Let’s face it. Psoriasis on the nose, cheeks, ears, or forehead is not only irritating, it can be embarrassing. About 20 percent of people with plaque psoriasis on their bodies (the most common form) also develop psoriasis on their faces.

The appearance of red, 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 more sensitive to strong medications. It can also be hard to avoid the picking and scratching that inflames lesions, or to cover up dry, blotchy spots. “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 coverings. Although personal protection masks for COVID-19 safety may also hide unsightly lesions, masks can cause skin irritations. More than 70 percent of people with face psoriasis experience the Koebner phenomenon (a reaction that creates new 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 (AAD).

Psoriasis flares can be triggered by certain medications, cold weather, sun, smoking, and stress. They may also be an indicator of more severe disease. Frequently, scalp psoriasis progresses to facial flares.

Symptoms of Facial Psoriasis

Psoriasis most frequently appears on the forehead, but can also show up on the upper lip, cheeks, and delicate skin around eyes and ears. Symptoms range from mild to severe and can include itching, soreness, skin sensitivity, or burning. “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: hairline psoriasis, sebo-psoriasis, and true facial psoriasis.

Hairline Psoriasis

The most frequent type, hairline psoriasis affects 76 percent of people with facial lesions. It typically appears as an extension of scalp psoriasis, with bright red, thickened plaques on the forehead along the hairline. It can also build up and block the ear canal. One member explained, “Psoriasis behind my ears and the back of my head grew towards my forehead.”

Sebo-psoriasis

Sebo-psoriasis most often affects the eyelids, eyebrows, upper lip, and beard area. Patches are thinner and lighter in color. It 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 member.

True Facial Psoriasis

Red, scaly plaques are characteristic of true facial psoriasis, which can affect any part of the face. It is usually linked to 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.

How Facial Psoriasis Affects Members’ Lives

Although facial psoriasis affects just a small area of the body, it has a huge impact on self-esteem and well-being. Members of MyPsoriasisTeam talk about feeling isolated, ashamed, and depressed by their condition and how it has changed their home, work, and social lives:

• “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 ’cause 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, 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 inhibiting or 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 around 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. Approved for atopic dermatitis, they’re frequently prescribed off-label to treat face lesions. “I get psoriasis on both eyes. Protopic is the only thing that cleared it,” shared one member. “My dermatologist prescribed it for the 'delicate areas' and it works quickly,” agreed another.

Phototherapy

Sun exposure — as well as controlled doses of ultraviolet light — are often effective in treating small spots on the face. Common side effects of phototherapy include redness and itching. Elidel and Protopic can increase sunburn risk. Phototherapy can also increase the risk of skin cancer.

Moisturizers

Moisturizing lotions, creams, and ointments are an important part of facial psoriasis treatment. These over-the-counter products soothe itching, redness, 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 products that are free of alcohol, artificial preservatives, 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 Coverings

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, 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. They include strategies for self-care before, during and after wearing a mask.

Makeup

Covering up dry, red, and 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 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 it over cream foundation.
• Consider a pigment concealer to cover lesions.

Shaving

Removing beard stubble can aggravate facial patches. One member of MyPsoriasisTeam suggested, “A lady’s razor. It helped my husband.” Experts from the National Psoriasis Foundation recommend these practices:

• Switch from electric razors to wet shaving.
• Choose a shave cream for sensitive skin.
• Apply a thin layer of moisturizer before shaving.
• Use a good aftershave moisturizer.
• Don’t shave every day, to reduce skin stress.

Sunscreens

For many people with facial psoriasis, sunscreens can aggravate symptoms. If you will be in the sun, dermatologists recommend physical sunscreens containing zinc over irritating chemical products.

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
• Physiological and social support
• Massage

You Are Not Alone: Finding Support for Facial Psoriasis

By joining MyPsoriasisTeam, the social network and online support group for those living with multiple sclerosis, you gain a support group more than 81,000 members strong. Facial psoriasis is one of the most discussed topics.

Here are some question-and-answer threads about facial psoriasis on MyPsoriasisTeam:

• "Has anyone had breakouts on their faces from wearing masks?"
• "Which makeup products are best for people with psoriasis?"
• “What’s a good face wash and cream for face psoriasis?”

Here are some conversations about facial psoriasis on MyPsoriasisTeam:

• “Not sure what kind of treatment to use on my face.”
• “What can I take over-the-counter to stop patches on my face from hurting?”
• “Psoriasis is spreading to my face.”

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 tips and experiences in a comment below or on MyPsoriasisTeam. You'll be surprised how many other members have similar stories.

References

1. Psoriasis in Special Locations — Reumatologia
2. Psoriasis Causes and Triggers — National Psoriasis Foundation
3. Psoriasis Causes — American Academy of Dermatology
4. Facial Psoriasis — DermNet NZ
5. Psoriasis on the Face — National Psoriasis Foundation
6. Treatment of Psoriasis in Adults — UptoDate
7. Skin Care Through the Ages — National Psoriasis Foundation
8. Use of Cloth Face Coverings to Help Slow the Spread of COVID-19 — Centers for Disease Control and Prevention
9. 9 Ways to Prevent Face Mask Skin Problems — American Academy of Dermatology
10. Face Mask Skin Problems: DIY Treatment — American Academy of Dermatology
11. 4 Tips for Putting on Makeup When You Have Psoriasis on Your Face — Self.com
12. Shaving Tips for Psoriasis on the Face — National Psoriasis Foundation

Laurie has been a health care writer, reporter, and editor for the past 14 years. Learn more about her here.