About Face: Treating Psoriasis From the Neck Up

Even mild psoriasis can be a big problem if it occurs on your face, because it can be tricky to treat, it’s more difficult to hide and it may make you feel less attractive and confident. Mark Lebwohl, M.D., professor and chairman of the department of dermatology at Mount Sinai School of Medicine in New York and chairman of the medical board of the National Psoriasis Foundation, offers advice on the best ways to clear psoriasis and put your best face forward.

Q: How does psoriasis on the face differ from psoriasis on the body?
Plaque psoriasis is the most common type of psoriasis on both the face and the body, but the skin on the face is much thinner. Some treatments that work well on the body are unsafe for use on the face because they may be too irritating or cause too much thinning of facial skin and lead to increased spider veins.

Also, many treatments that work well to treat psoriasis on the body cannot be used around the eyes because they may cause cataracts or glaucoma. On the positive side, medications that don’t work very well on psoriasis on the body can be very effective for treating psoriasis on the face, where they are better absorbed. The most common areas of the face for psoriasis to occur are the eyebrows, the skin between the nose and upper lip, the upper forehead and the hairline, so only small amounts of topical medications are usually needed, and they should be applied carefully.

Q: What are the best treatments for facial psoriasis?
For very mild psoriasis, petroleum jelly and other nonirritating moisturizers can be helpful. Ointments containing a form of vitamin D called calcitriol can work very well on the face, as can tazarotene, a topical vitamin A derivative, although in some people it can be too irritating.

Another option is a category of medications known as calcineurin inhibitors, which include tacrolimus (in Protopic) and pimecrolimus (in Elidel). These medications are not FDA-approved for use in treating psoriasis, but they have been shown in studies to be very effective in some people, and early studies indicate that they do not raise risks for cataracts or glaucoma when used around the eyes. Psoriasis on the face also tends to respond more quickly to sunlight than psoriasis on the body. I tell my patients to go outside without wearing sunscreen for a few minutes—less time than it takes them to burn—and then apply sunscreen and keep it on for the rest of the day. That way you can get the therapeutic benefits of sunlight without the risks of sunburn. Use a gentle cleanser and feel free to wear makeup if you like—most makeup is safe even if a person has psoriasis. Facial psoriasis often occurs in people who have more severe cases of psoriasis overall. If topical treatments don’t clear the psoriasis, systemic medications can be prescribed.

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