How to Manage Facial Psoriasis: Effective Strategies for Healthy Skin

The chronic skin condition psoriasis commonly affects specific areas of the body, including the knees, elbows, hands, feet, and scalp. Sometimes, however, the disease can have a highly visible effect, when its scaly plaques show up on the face.

“Skin diseases that are on the face, in my clinical experience, can really impact patients’ everyday life and how they feel about themselves,” says Ronda Farah, MD, a dermatologist and an associate professor at the University of Minnesota Medical School in Minneapolis.

Psoriasis in general can lead to emotional problems. “We do know that in patients with psoriasis, the prevalence of depression may be as high as 50 percent,” Dr. Farah says. But she suspects that depression may be even more common among people who develop psoriasis on their face. “It’s there for everyone to see, and this bothers some people more than others,” Farah says.

The good news is there are effective treatments for and ways to manage facial psoriasis.

When psoriasis shows up on your face, it typically affects the following areas:

• Hairline Scaly patches can develop on your upper forehead and around your hairline. This may be isolated or an extension of scalp psoriasis.
• Inside the Ears If psoriasis scales build up in your ears, they can block your ear canal and affect your hearing. Be sure to tell your doctor if this happens.
• Around Your Eyes Psoriasis scales can form on the sensitive skin of your eyelids and may cover your lashes. Areas around the eyebrows are also common sites for facial psoriasis.
• Between the Nose and Upper Lip This area is often sensitive. If scales form around your mouth, they may affect how you chew and swallow food. Rarely, psoriasis lesions can also surface inside your mouth, such as on the gums and tongue, or in the nose.

• Plaque psoriasis causes dry, scaly patches of discolored skin.
• Guttate psoriasis causes small spots that are scaly and dry, and often occurs after a strep infection.
• Pustular psoriasis produces small, pus-filled bumps on dry, scaly skin.

Researchers still don’t know exactly what causes people to develop psoriasis, but a combination of genetics and environmental triggers are likely at work.

• Stress
• Infections
• Reaction to certain medications
• Injury to your skin (scrapes, cuts, bug bites, tattoos, piercings, sunburn)
• Smoking
• Dry, cold weather

Not everyone has the same triggers. It’s important to identify what brings on or worsens your psoriasis flares.

To diagnose facial psoriasis, a doctor or a dermatologist will perform a physical exam to look at your skin. They'll also ask about your symptoms and your family and medical history.

If you develop facial psoriasis, you may feel anxious to find effective treatments. Don’t hesitate to reach out to your healthcare provider.

“Tailoring the treatment options to a patient and their needs is really important with psoriasis,” Farah says. “That’s really something we work with patients on. We’re always asking, ‘How much does this bother you?’”

“The treatment options for psoriasis have rapidly expanded,” Farah says, for both children and adults. “For those who have not seen a dermatologist in the recent past, it's a good idea to revisit seeing us.”

She adds that psoriasis care has now expanded to teledermatology, making access potentially much easier. “As a physician, dermatologist, and mother, I know that skin disease can be devastating for some, and I want patients to know that we are there to support them every single step of the way.”

Topical Treatments

Typically, doctors will start with topical treatments for psoriasis. Facial skin is more sensitive, so long-term use of corticosteroid creams may cause skin thinning, shininess, or enlarged capillaries. Your doctor will consider these factors and might alter your treatment plan or prescribe a low-potency steroid cream.

Nonsteroidal topical treatments include:

• Nonsteroidal creams such as roflumilast (Zoryve) and tapinarof (Vtama) have been approved to treat psoriasis.
• Topical calcineurin inhibitors (TCIs), including tacrolimus (Protopic) and pimecrolimus (Elidel), are approved by the U.S. Food and Drug Administration (FDA) for treating eczema, but may work well for treating psoriasis on the face or other delicate areas.

  [7]

• Topical vitamin D analogues such as calcipotriene slow skin-cell growth, and in cream forms may be less irritating and more easily tolerated in the facial area.

  [8]

• PDE4 inhibitors like crisaborole (Eucrisa) has been shown to be effective for facial psoriasis.

  [8]

  and may be used off-label, as it’s not FDA-approved for plaque psoriasis.
• Over-the-counter creams and moisturizers designed for psoriasis that include ingredients like salicylic acid to prevent flaking can be used on the face.

  [2]

Phototherapy

Phototherapy effectively suppresses the immune overactivity that causes excess skin cell growth and inflammation. There are two main types of phototherapy for psoriasis: NB-UVB (narrow band ultraviolet B) and PUVA (ultraviolet A combined with a medication called psoralen.)

One downside when it comes to the face: Light therapy can accelerate photoaging, or premature aging of the skin, including freckling and dryness of the skin.

Systemic Medications

For psoriasis that doesn’t respond to topical treatments or phototherapy, systemic drugs that work through the entire body may be prescribed.

Some medicines approved by the FDA to treat psoriasis include:

• acitretin (Soriatane), an oral medication which slows the rate of skin cell proliferation
• apremilast (Otezla), an oral PDE4 inhibitor that suppresses immune response
• deucravacitinib (Sotyktu), a TYK2 (allosteric tyrosine kinase 2) inhibitor that reduces inflammatory proteins, given by injection
• methotrexate, an immunosuppressant given by injection
• cyclosporine, also an immunosuppressant given by injection

Biologics

Biologics work by blocking the action of a certain type of immune cell and proteins in the part of the immune system that is overactive. Unlike other systemic therapies that broadly suppress the immune system, biologics target specific molecules associated with psoriasis. They’re generally administered either by an injection into the skin or via intravenous (IV) infusion and are usually prescribed for moderate to severe psoriasis.

Biologic medications for psoriasis include:

IL-12/23 Inhibitors

• ustekinumab (Stelara)

IL-17A Inhibitors

• brodalumab (Siliq)
• ixekizumab (Taltz)
• secukinumab (Cosentyx)

IL-17A and IL-17F Inhibitor

• bimekizumab (Bimzelx)

IL-23 Inhibitors

• guselkumab (Tremfya)
• risankizumab (Skyrizi)
• tildrakizumab (Illumya)

TNF-Alpha Inhibitors 

• adalimumab (Humira)
• certolizumab pegol (Cimzia)
• etanercept (Enbrel)
• infliximab (Remicade)
• golimumab (Simponi)

Sticking to a gentle yet effective skincare routine and making certain lifestyle modifications can help you manage facial psoriasis.

Daily Skincare Routine

Talk to your doctor about products that could help.

Be careful not to pick at psoriasis scales with your finger nails. Just as with psoriasis on other parts of the body, manual removal of the scaly patches on your face can worsen them or lead to infection.

You can safely use makeup to cover up psoriasis patches but there are a few things to keep in mind. Don’t apply cosmetics to irritated skin or open lesions. And while foundation and concealer can mask discoloration, they can’t camouflage scaly texture and may actually draw more attention to it.

Lifestyle Modifications

Making some lifestyle changes — from what you regularly eat to how you handle stress — can help calm psoriasis symptoms.

• Consider your diet. While there’s no special “psoriasis diet,” an anti-inflammatory diet — full of foods rich in omega-3 fatty acids, vitamin D, and antioxidants — may benefit you. Avoid red meat, alcohol, and processed foods, which can aggravate symptoms.
• Avoid triggers. Try to identify what factors cause your psoriasis flare-ups so you can avoid them. Keep a journal of your symptoms to figure out what’s triggering your psoriasis.
• Prioritize stress management. Stress is known to increase your risk of a psoriasis flare. Try to lower your stress levels with yoga, deep breathing, or meditation.
• Get support. A support group may help you cope emotionally with your psoriasis symptoms. The NPF offers an online support group on their website.

Sun Protection

• Dealing with psoriasis on facial skin can be overwhelming, emotionally, and psoriasis can be painful in sensitive areas like the face. But there are medical treatments and lifestyle adjustments you can explore for relief.
• It's crucial to understand your psoriasis triggers and work closely with your healthcare provider to personalize a treatment plan that helps you feel like yourself again.
• Practicing self-care and stress-reduction strategies can help you manage facial psoriasis.