(LifeWire) - Facial psoriasis, which affects up to 46% of individuals with psoriasis, produces silvery scales, itchy rashes and, in rare cases, open lesions in an area of the body that is difficult to conceal. As a result, those with facial psoriasis confront a distinct set of challenges, involving both treatment and coping methods
In its cause and symptoms, facial psoriasis is no different from psoriasis that appears elsewhere. Above all, individuals with facial psoriasis typically experience the same itchy, scaly rash that is characteristic of any type of psoriasis.
The rash most commonly affects the skin above the upper lip, as well as areas around the forehead and eyebrows, and at the hairline. According to one Korean study of 235 patients with facial psoriasis, approximately 74% of study participants had rashes on the upper forehead, and approximately 46% had rashes near the ear. The study also found that most patients first experienced facial symptoms between the ages of 30 to 40.
In order to diagnose facial psoriasis, a physician will examine the patient's skin and will take a personal health history. If the diagnosis is in doubt, a biopsy may be conducted to rule out other skin diseases, such as seborrheic dermatitis.
Like standard psoriasis, facial psoriasis generally responds well to moisturizers and petroleum jelly. Patients should also pay close attention to what triggers flare-ups, as these activities or products should be avoided. For example, some individuals report flare-ups after swimming in a chlorinated pool, while other individuals say that the chlorinated water actually improves symptoms.
Many topical steroid treatments approved for psoriasis treatment, such as hydrocortisone creams, may also be effective in treating facial psoriasis. But use of such steroids should be limited, as long-term use can cause skin thinning and other side effects. Talk to your physician about steroid treatments and risk factors.
The US Food and Drug Administration approved the use of Protopic (tacrolimus) for severe facial and genital psoriasis. Protopic is an immunosuppressive drug first used to help prevent rejection of transplanted organs. The FDA warns that Protopic should not be regarded as a first-line treatment for psoriasis. The regulatory agency ordered the manufacturer to include a so-called black box warning noting that the medication is linked with increased risk for skin cancer, lymphoma and viral infections. A black box warning is the strongest warning label the agency employs. However, the American Academy of Dermatology released a paper stating that the organization disagreed with the FDA's decision and believes the drug to be safe when used properly.
Protopic, typically applied twice a day, works by blocking the immune response thought to cause psoriasis symptoms. Patients applying Protopic should contact a physician immediately if they experience swollen glands, cold sores or oozing or swelling of the skin. Other less serious potential side effects include a tingling sensation at the application site, itching, acne, nausea and headache.
A small 2007 study, published in the British Journal of Dermatology, compared the efficacy of both topical calcitriol and tacrolimus. The six-week study, involving 50 participants with facial or genital psoriasis, found that 60% of patients taking tacrolimus achieved complete or almost complete clearance of psoriasis rash and lesions. However, only 33% of patients using calcitriol experienced comparable improvements.
Coping with Self-Esteem Issues
Because facial psoriasis is not easy to cover or mask, it carries a variety of psychological challenges not faced by those with non-facial psoriasis. Yet these challenges are surmountable, given the right combination of treatment and support.
The Mayo Clinic advises patients to educate family and friends about facial psoriasis and the treatment methods recommended by physicians. This allows them to be a part of the solution. Finding a support group can also be helpful, as can talking to a counselor about emotional issues connected with the disease.
Patients with facial psoriasis can also experiment with various cover-ups. The National Psoriasis Foundation recommends Dermablend, cosmetics designed for people with psoriasis, dermatitis and other skin conditions. However, the foundation advises against applying cosmetics to overly irritated skin or unhealed lesions, as this could result in stinging and possible infection.
"American Academy of Dermatology Responds to FDA Decision on Eczema Medications." American Academy of Dermatology. 19 JAN 2006. American Academy of Dermatology. 23 Jun 2008 <ttp://www.aad.org/media/background/press/eczema_medications.html>.
"Calcipotriene Topical." MedlinePlus Drug Information. 2008. National Institutes of Health. 23 Jun 2008 <http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a608018.html>.
"Calcitriol." MedlinePlus Drug Information. 2007. National Institutes of Health. 1 May 2008. <www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682335.html>.
Fortune, D.G., H.L. Richards, C.J. Main, and C.E.M. Griffiths. "Patients' Strategies for Coping with Psoriasis." Clinical Dermatology. 27. 3. May 2002. 177-184. 31 Apr. 2008. <www.blackwell-synergy.com/doi/abs/10.1046/j.1365-2230.2002.01055.x>.
"Hydrocortisone Topical." MedlinePlus Drug Information. 2007. National Institutes of Health. 1 May 2008. <www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682793.html>.
Liao, Y.H., H.C. Chiu, Y.S. Tseng, and T. F. Tsai. "Comparison of Cutaneous Tolerance and Efficacy of Calcitriol 3 Microg g(-1) Ointment and Tacrolimus 0.3 mg g(-1) Ointment in Chronic Plaque Psoriasis Involving Facial or Genitofemoral Areas: A Double-Blind, Randomized Controlled Trial." The British Journal of Dermatology. 157. 5. Nov. 2007. 1005-12. 31 Apr. 2008. <www.ncbi.nlm.nih.gov/pubmed/17935517?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>.
"Living with Psoriasis: Camouflage and Cover-ups." National Psoriasis Foundation: Camouflage and cover-ups. 2008. National Psoriasis Foundation. 1 May 2008. <www.psoriasis.org/about/living/social/camouflage.php>.
Mayo Clinic Staff. "Psoriasis: Coping Skills." Mayo Clinic.com. 20 Mar. 2007. Mayo Clinic. 1 May 2008. <www.mayoclinic.com/health/psoriasis/DS00193/DSECTION=10>.
"Patient Information Sheet: Tacrolimus Ointment ." Center for Drug Evaluation and Research. May 2006. Food and Drug Administration. 5 May 2008. <www.fda.gov/CDER/Drug/InfoSheets/patient/protopicPT.htm>.
"Psoriasis on Specific Skin Sites: Psoriasis on the Face." National Psoriasis Foundation: Psoriasis on the Face. Oct. 2005. National Psoriasis Foundation. 1 May 2008. <www.psoriasis.org/about/psoriasis/sites/face.php>.
Van de Kerkhof , P.C., G.M. Murphy, J. Austad, A. Ljungberg, F. Cambazard, and L.B. Duvold. "Psoriasis of the Face and Flexures." The Journal of Dermatological Treatment. 18. 6. 2007. 351-360. 31 Apr. 2008. <www.ncbi.nlm.nih.gov/pubmed/17907013?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>.
Yoon, H.S., J.Y. Park, and J.L. Youn. "Clinical Study of Facial Psoriasis." Korean Journal of Dermatology. 44. 12. Dec. 2006. 1397-1402. 31 Apr. 2008. <www.koreamed.org/SearchBasic.php?RID=374046&DT=1&QY=age+%5BALL%5D+onset+%5BALL%5D+facial+%5BALL%5D+psoriasis+%5BALL%5D.>