Facial psoriasis can cause painful or itchy plaques on areas of the face, including the forehead, nose, and cheeks. Treatment can include medications and lifestyle practices.
Psoriasis is a common chronic (long-term) skin condition that speeds up the life cycle of skin cells, which causes extra cells to build up on your skin. This buildup results in scaly plaques that can be painful and itchy.
The plaques tend to be pink or red with silvery-white scales if you have a fair or lighter skin tone. On medium skin tones, the plaques can appear salmon-colored with silvery-white scales. The psoriasis plaques could look violet and the scale gray on darker skin tones. Or it can also appear dark brown and difficult to see.
These plaques can come and go, flaring up for weeks or months before cycling to a less noticeable appearance.
Although psoriasis is more likely to affect your elbows, knees, lower back, and scalp, it can also appear on your face. It’s rare for people to have psoriasis only on their face, though.
The majority of people with facial psoriasis also have scalp psoriasis. Some also have moderate to severe psoriasis on other parts of their body.
There are several forms of facial psoriasis. They all involve skin that’s:
Scratching psoriasis plaques can also lead to broken skin. In some cases, it can lead to infection. Psoriasis can affect your self-image and general quality of life, too.
Plaque psoriasis is the most common form of psoriasis and tends to appear as raised, scaly plaques. On the other hand, guttate psoriasis can look like drops with smaller and less thick spots.
Erythrodermic psoriasis is rare. It tends to come with a widespread red rash and may look dark brown or purplish on darker skin tones. It also leads to swings in body temperature and a potentially increased chance of infection. As it heals, the skin will develop dark brown patches. This is known as hyperpigmentation.
The three main subtypes of psoriasis that appear on the face are the following:
Hairline psoriasis is scalp psoriasis (plaque psoriasis) that has spread beyond your hairline onto your forehead and in and around your ears. Psoriasis scales in your ears can build up and block your ear canal.
Sebopsoriasis results in symptoms of both psoriasis and seborrheic dermatitis. A chronic form of eczema, seborrheic dermatitis is a chronic form of eczema. It’s a common skin condition that usually affects the scalp, causing dandruff. It may affect other parts of the body as well.
Sebopsoriasis is often patchy at your hairline. It can appear on:
- your eyebrows
- your eyelids
- your beard area
- the area where your nose meets your cheeks
Even though sebopsoriasis is commonly associated with diffuse scalp psoriasis, the plaques are often thinner with a lighter color and smaller scales.
Facial psoriasis can appear on any part of your face and is associated with psoriasis on other parts of your body, including your:
It can be plaque psoriasis, guttate psoriasis, or erythrodermic psoriasis.
Common triggers of psoriasis and psoriasis flare-ups include:
There are several risk factors that may increase your chances of having psoriasis.
Family history is one example. Having a parent with psoriasis increases your chances of having it too.
A compromised immune system may also be a concern, as psoriasis may particularly affect people who:
Other risk factors may include:
To diagnose facial psoriasis, a doctor or dermatologist will ask questions about your symptoms, such as whether you have itchy skin. They may also ask about your family history and whether any of your close relatives have also had psoriasis.
In addition, they may take a small sample, or biopsy, of your skin to study under a microscope and confirm your diagnosis. You may also be asked questions about changes in your life, like whether you’re under more stress or on new medications.
It’s worth making sure you have the right diagnosis. Psoriasis can be mistaken for other skin conditions, like:
While similarities exist between eczema and psoriasis, the causes and treatments can differ. The two conditions can also overlap in some cases. Both can affect the face, and neither is contagious.
Psoriasis is a chronic condition that leads to an overproduction of skin cells, while eczema is an overreaction to an irritant, like certain:
The two conditions have some triggers and risk factors in common, including cold dry weather, but eczema may also stem from encounters with:
- certain foods
Eczema can be intensely itchy, and while psoriasis may itch too, it can also be painful. Skin affected by psoriasis tends to be thicker than skin with eczema. Silver scaling also tends to be unique to psoriasis.
Because the skin on your face is very sensitive, facial psoriasis needs to be treated carefully.
A doctor might recommend a variety of treatments, including mild corticosteroids in the form of:
- an ointment
- a lotion
- a cream
These medications might be applied daily when symptoms are at their worst.
Vitamin D analogs
Some of the other possible topical treatments are essentially forms of vitamin D. They are:
- betamethasone/calcipotriene (Enstilar, Taclonex)
- calcitriol (Vectical)
- calcipotriene (Dovonex, Sorilux)
Calcineurin inhibitors stop the action of calcineurin, an enzyme that’s involved in some immune system processes.
Calcineurin inhibitors can be applied around the eyes. While they will not cause glaucoma, they may sting for the first few days of use.
Examples include tacrolimus (Protopic) and pimecrolimus (Elidel).
If retinoid creams and gels are not helpful, a dermatologist may prescribe oral or injected medication, such as a retinoid in pill form called acitretin (Soriatane). As with topical retinoids, these work by slowing skin cell production.
Another possibility is phototherapy, or light therapy. This method uses ultraviolet (UV) light in a controlled setting.
Natural sunlight may sometimes help as well, but it’s not the same as prescription phototherapy. For example, going to the beach for sunlight exposure
However, with sunlight, it’s important not to overdo it. Remember that your sunburn risk may be higher when using some topical medications.
Along with taking medication your doctor recommends, you can take steps at home to help manage your psoriasis:
- Try to reduce stress: Consider meditation or yoga to help reduce stress.
- Avoid triggers when possible: Monitor your diet and activities to help determine what triggers cause your flare-ups.
- Do not pick at your plaques: Picking off scales typically results in making them worse or creating new rashes.
- Apply a moisturizer: Consider asking your doctor to recommend a moisturizer that can help reduce dry skin and scaling on your face.
- Consider emotional support: Sometimes, having plaques on your face may make you feel self-conscious and even depressed. Your doctor can recommend supportive resources like scheduling an appointment with a psychologist or providing information about support groups.
Finding a skin care routine that helps with your facial psoriasis is key, although you may have to experiment with different products to get it right.
In addition to discussing prescription creams with a doctor, you may find it helpful to use an over-the-counter emollient. Emollients soothe the skin and can create a barrier of oil to help protect your skin from drying out.
Talk with a doctor to determine the type of psoriasis appearing on your face. They can recommend a treatment plan for specific to your type of psoriasis, including medical and at-home care.
Because psoriasis on your face can be emotionally upsetting for some people, your doctor may also share suggestions for managing self-consciousness about your facial psoriasis.
For example, they may recommend a support group or even types of makeup that will not interfere with your treatment.