What is Facial psoriasis?

Facial psoriasis is a chronic skin condition in which there are one or more, persistent, thickened, red and dry patches on the face.

Psoriasis is a common chronic inflammatory skin disease that may affect any skin site. Facial involvement occurs at some time in about half those affected by psoriasis. Although it is usually mild, facial psoriasis is occasionally very extensive involving the hairline, forehead, neck, ears and facial skin.

It is extremely rare to have psoriasis occurring solely on the face. Most patients also have scalp psoriasis and they may also have moderate to severe psoriasis at other sites.

Patients with facial psoriasis often suffer from psychosocial problems due to the presence of unsightly red, scaly plaques on highly visible areas

Facial involvement presents as a therapeutic challenge because facial skin is thin, sensitive and more complicated to treat

What are the clinical features of facial psoriasis?

Facial psoriasis has various clinical presentations. There are three main subtypes:

• hairline psoriasis
• sebo-psoriasis
• true facial psoriasis

Hairline psoriasis

• An extension of scalp psoriasis beyond the hairline onto facial skin
• Bright red, thickened plaques with variable white scale

Sebo-psoriasis

• Patchy involvement of hairline
• Often affects eyelids, eyebrows, nasolabial folds and beard area
• Salmon pink, thin plaques with bran-like scale
• Usually associated with diffuse or patchy scalp psoriasis
• Psoriasis may or may not be present at other sites

True facial psoriasis

• Sharply demarcated, red, scaly plaques
• May affect any part of face
• Tends to be symmetrical
• Associated with psoriasis at other sites including ears, genitals, scalp, elbows, knees, trunk
• Can be part of plaque psoriasis, guttate psoriasis or erythrodermic psoriasis

Symptoms of facial psoriasis

• Mild to intense itch
• Soreness and skin sensitivity, which are usually mild

What causes facial psoriasis?

The causes of facial psoriasis are the same as for psoriasis in general. Psoriasis is associated with inappropriate activation of the immune system resulting in inflammation and increased proliferation of skin cells. There is a genetic predisposition, but environmental influences are important, including stress, infection, injuries and certain medications.

Facial psoriasis may also be aggravated by:

• ultraviolet radiation - some patients have photosensitivity, i.e. the psoriasis is aggravated by exposure to the sun
• skin flora, particularly the yeast malassezia smoking.

What is the management of facial psoriasis?

There is no cure for facial psoriasis, but satisfactory control of the disease is possible for most patients using topical therapy. General skin care may include:

• Gentle non-soap cleansers
• Moisturisers
• Sunscreens, if required.