How to Recognize and Treat Psoriasis on the Face

From verywellhealth.com

What you can do about plaques on this delicate skin 

Key Takeaways

• Psoriasis on the face can cause red or pink sores with silvery-white plaques.
• Treatments for facial psoriasis include creams, oral medicine, and light therapy.
• A dermatologist can help you figure out the best way to treat psoriasis.
• Facial psoriasis can cause red, itchy patches around your eyebrows, ears, and mouth. Learn how to recognize and treat this condition effectively.

What Does Psoriasis on the Face Look Like?

                                                 Reproduced with permission from © DermNet dermnetnz.org 2023.

Psoriasis on the face starts as small, red bumps that develop into red or pink sores, often topped with silvery-white plaques that can flake. The look of facial psoriasis varies by type:

• Plaque psoriasis looks like dry, discoloured, scaly skin on your face.
• Guttate psoriasis appears as small, scaly patches that show up on your skin after you’ve had a strep infection.
• Pustular psoriasis displays as pus-filled bumps on top of dry skin on your face.
• Scalp psoriasis looks like dry patches of skin on top of your head that can hurt.

Types of Facial Psoriasis

True Facial Psoriasis

True facial psoriasis looks like classic psoriasis plaques on the face. The red, scaly plaques are usually the same on both sides (symmetrical) and also appear on other areas of the body. The affected skin is often painful and itchy.

Hairline Psoriasis

Around half of people with psoriasis have scalp psoriasis, which can include the upper forehead.

Scalp and hairline psoriasis can be mild and may look like fine flakes of dandruff. Some people get severe psoriasis with thick plaques covering the hairline and behind the ears. The plaques can be greasy and yellow-coloured. 

Sebo-Psoriasis

Sebo-psoriasis is a combination of facial psoriasis and seborrheic dermatitis.

Sebo-psoriasis causes thin, pink plaques on the face that can be covered in greasy, yellow scales. They can show up on the hairline, eyelids, eyebrows, sides of the nose, and beard area. While the eyebrows, forehead, hairline, and the skin above the lip are the most common places affected by facial psoriasis, the condition can also spread to other parts of the face.  

worklater1 / Getty Images

Symptoms and Complications 

Facial psoriasis that spreads can cause symptoms specific to where on the face it is—for example, near the eyes and the mouth. 

Vision Issues

Psoriasis around the eyes is rare. It may cause dry, red patches of skin. Facial psoriasis that’s too close to the eyes can cause pain or impaired vision.

If you have psoriasis near your eyes, it’s important to work with your dermatologist to find a safe treatment that will not affect your vision. 

Nose Discomfort

Nasal psoriasis can look like peeling, cracked, sore, or scaly skin on your nose or nostrils. It’s very rare to get psoriasis inside your nose, but it can happen.

If you think you have psoriasis near your nose, see a dermatologist to make sure it’s not another more common condition like an infection. 

Hearing Trouble

Facial psoriasis can affect the inner and outer ears. The symptoms include redness, itching, and patches of scaly skin on the ears. The patches may show up on the skin behind the ears, around the ears, or inside the ear canal.

When scales build up inside the ear, it can lead to temporary hearing loss. However, never try to push or remove the scales from your ears yourself. Only your provider should treat psoriasis plaques in your ears. 

Mouth Pain and Bleeding

In rare cases, people with facial psoriasis have psoriasis symptoms in their mouths. You may have redness, burning pain, and bleeding along the gums, tongue, or inner cheeks. The symptoms can make it hard to eat and drink. Mouth psoriasis usually needs to be treated by both your dermatologist and your dentist.

Conditions With Similar Symptoms

There are some skin conditions that can look and feel similar to psoriasis on the face. Certain conditions can cause redness, rashes, and other symptoms that could be confused for psoriasis, such as:

• Eczema (atopic dermatitis)
• Seborrheic dermatitis
• Pityriasis rosea
• Lupus rash
• Rosacea
• Lichen planus
• Shingles (herpes zoster)
• Dermatomyositis
• Ringworm (tinea capitis)
• Intertrigo
• Skin cancer

What Causes Face Psoriasis?

Psoriasis is a chronic autoimmune condition that causes inflammation. With psoriasis, the skin cells grow too fast and pile up. The dead skin cells do not slough off like they’re supposed to, leading to silvery-white skin plaques building up on the skin’s surface.

It’s not totally understood why some people get psoriasis. There is a genetic component and psoriasis tends to run in families. If someone in your family has facial psoriasis or psoriasis elsewhere on their body, you might be more likely to have it, too.

Face Psoriasis Triggers

Certain things can cause a facial psoriasis flare-up including:

• Emotional stress
• Skin injury
• Infections (especially on the skin) 
• Cold, dry weather
• Prescription medications

Spending too much time in the sun and smoking can also worsen facial psoriasis symptoms.

How to Treat Psoriasis on the Face

Psoriasis cannot be cured but there are treatments. Since the skin on and around the face is sensitive, finding the best treatment for facial psoriasis can be challenging. Your provider may suggest several treatments, including topical medications, oral prescriptions, phototherapy, and immune therapies.

Medications and Procedures

The treatment you need will depend on the severity of your symptoms and which parts of your face are affected. Your dermatologist may recommend one or more treatments for facial psoriasis:

• Topical treatments include medicated creams, ointments, and shampoos that treat psoriasis symptoms. First-line treatment often includes a steroid cream. Hairline psoriasis may need to be treated with a medicated shampoo.
• Systemic medications are usually considered when you have psoriasis symptoms all over your body. Medications can include methotrexate, cyclosporine, retinoids, biologics, and others.
• Phototherapy uses ultraviolet light (UV) treatments to help slow skin cell growth and reduce inflammation. This can improve facial psoriasis symptoms over time.

How Can I Treat Facial Psoriasis at Home?

It’s not always possible to prevent psoriasis symptoms, but there are steps you can take to avoid triggers and take care of your skin. 

Skincare

Your skincare routine will be an important part of managing facial psoriasis.

• Choose skincare products carefully and avoid any harsh ingredients. Check the labels to make sure the products do not contain irritating ingredients (e.g., they should say “hypoallergenic,” “fragrance-free,” “for sensitive skin,” “alcohol-free,” and/or “dye free”).
• Use a gentle daily moisturizer, especially after washing your face.
• Do not over-wash your face, even if it feels greasy.

Lifestyle Changes

There are methods you can use to treat facial psoriasis at home:

• Learn your triggers for a psoriasis flare-up and work with your dermatologist to figure out how to avoid them. 
• Find techniques for managing stress, such as mindfulness and physical activity. 
• Avoid smoking and being around those who do.
• Wear quality sunscreen any time you’re in the sun.

Using Medicated Shampoos

If you have psoriasis on your scalp or hairline, talk to your dermatologist about using a medicated shampoo at home. You can also look for an OTC product that contains both salicylic acid and tar. Salicylic acid softens and removes the thick plaques, while tar helps slow skin growth and reduce inflammation.

https://www.verywellhealth.com/psoriasis-on-face-5180877

We Asked a Doctor How to Reduce Psoriasis Flares in the Summer

From verywellhealth.com

Psoriasis can flare at any time of year.     Olena Malik / Getty Images

If you have psoriasis, you might expect the cold, dry winter to be your toughest season. But summer can bring a different set of challenges, from sweat and friction to sunburns.

We asked our chief medical officer, Sohaib Imtiaz, MD, why psoriasis can get worse in warm weather and what you can do to keep your skin calm all season long. 

Q: Why can psoriasis flare up during the summer, and what’s the best way to prevent it?

Imtiaz: Heat-related factors can trigger psoriasis flares in some people. Sweating, friction during exercise, or hot weather can make plaques itch more intensely, leading to an itch-scratch cycle. High humidity can also make psoriasis worse because it alters your skin microbiome, the healthy bacteria that sit on your skin.

While we know that moderate sun exposure is good for psoriasis, sunburn can provoke new lesions, which is another reason psoriasis can flare in the summer. Just be sure to use sunscreen on skin unaffected by psoriasis to allow for controlled UV exposure to your plaques. However, some people with the condition have photosensitive psoriasis, in which any UV exposure will significantly worsen the disease. If this is the case for you, try to avoid the sun.

Other ways to reduce flares in the summer include wearing lightweight, breathable fabrics to minimize friction and sweat accumulation on plaques, showering promptly after sweating, and applying emollients to maintain your skin barrier. And, of course, consistently use any topical therapies that your doctor has prescribed.

Q: Why is psoriasis usually so much worse in colder weather?

Imtiaz: You have less sun exposure and UV radiation in cold weather. Your skin also loses hydration in cold, dry weather. Since psoriasis is a disease of excessive dryness in the skin, your barrier is less functional.

Barrier dysfunction is a major component of psoriasis pathogenesis (how the disease works). Dry winter air increases transepidermal water loss, meaning you lose more water from your skin and it becomes dehydrated. When your skin barrier is disrupted, it becomes more vulnerable, and things that trigger your psoriasis can penetrate the skin.

Q: If someone feels like they’re managing their skin well in the summer, what can they do to replicate that success going into the colder months?

Imtiaz: I would say you want to start prepping your skin with more emollients and moisturizing ingredients to help it maintain hydration. The biggest thing is keeping your skin barrier intact and hydrated.

https://www.verywellhealth.com/we-asked-a-doctor-how-to-reduce-psoriasis-flares-in-the-summer-12032947

Not Just Choose Food: Cooking Methods Are Also Important for Psoriasis

From voi.id

YOGYAKARTA - Choosing healthy foods for psoriasis is not only related to the type of ingredients that go on your plate. The way you cook food can also be a part that needs to be considered, especially when using high temperatures to cook meat. Launching Verywell Health, Thursday, August 6, certain cooking methods can increase the formation of advanced glycation end products (AGEs), compounds known to be related to inflammation and oxidative stress.

Psoriasis is a disease that involves the immune system and causes inflammation on the skin. Therefore, a diet that supports overall health can be part of efforts to maintain body conditions, although food and cooking methods are not a substitute for medical treatment. The relationship between AGEs from food and psoriasis is still being studied, so dietary changes should be made as part of a healthy lifestyle, not as the main therapy.

Why is the cooking method important?

AGEs are formed when sugars react with proteins or fats. This process can occur naturally in the body, but it also increases when foods are cooked at high temperatures, especially through dry heat cooking techniques. Frying, baking, grilling, and using an air fryer are methods that can produce more AGEs, especially in meat-based foods.

Rajani Katta, MD, clinical professor of dermatology at UTHealth Houston, explained that the difference in AGEs levels due to cooking methods is more visible in meat. Cooking with dry heat and high temperatures can significantly increase the formation of AGEs compared to methods that use moist heat. Meanwhile, whole fruits, vegetables, and grains naturally tend to have lower levels of AGEs.

                        Illustration of how to cook healthy food for psoriasis (Freepik/magnific)

Choose a cooking method with moist heat

You don't have to avoid all foods cooked at high temperatures. However, if you want to make a diet more supportive of health, try using cooking techniques with moist heat more often, such as boiling, steaming, or poaching. This method uses relatively lower liquids and temperatures so it can help limit the formation of AGEs, especially when processing meat.

Jaime Uribarri, MD, AGEs researcher and professor of medicine at the Icahn School of Medicine at Mount Sinai, suggests choosing lean meat and avoiding exposure to too high temperatures. Fish, seafood, and chicken breasts can also be protein source choices because they can generally be cooked in a relatively short time. That way, you don't have to eliminate animal protein from the menu, but you can be more careful in choosing ingredients and cooking techniques.

Marinating can also be an option

There is another simple way you can try when cooking meat, which is to marinate first. Acidic ingredients, such as lemon juice or tomato juice, can help reduce the formation of AGEs during the cooking process. A more acidic environment can slow down the reaction that produces the compound.

If you still want to roast meat, keeping it moist can also help. Meat can be wrapped in aluminium foil and cooked at a temperature that is not too high so that it does not get too long in dry heat. Another option is to increase plant-based foods, which naturally tend to contain less AGEs than meat.

There is no need to drastically change your diet

In the end, paying attention to food for psoriasis does not mean you have to make a long list of prohibitions. Simple changes, such as boiling or steaming food more often, choosing fish, using marinades, and reducing the use of very high temperatures when cooking meat, can be a more realistic step. You can also still enjoy your favourite foods by adjusting the ingredients and processing techniques.

Keep in mind, there is no evidence that changing the way you cook alone can control psoriasis. Everyone can also have different triggers and responses to certain foods. So, if psoriasis often recurs or its symptoms are difficult to control, consult your diet and treatment with a doctor or nutritionist so that the changes you make remain in accordance with the body's needs.

Thus, healthy food for psoriasis is not only about choosing nutritious ingredients, but also considering how the food is processed. Cooking with gentler methods can be one of the simple habits that support an overall healthy diet. Most importantly, make these changes a complement to psoriasis treatment, not a substitute for the treatment that your doctor has recommended.

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https://voi.id/en/info-sehat/588470 

Everything You Need to Know About Hair Removal If You Have Psoriasis

From allure.com

By Kara McGrath

We asked dermatologists for tips on how to safely get rid of unwanted fuzz, whether you prefer shaving, waxing, lasers, or tweezing

While psoriasis can come with its fair share of everyday annoyances, hair removal should be a relative breeze as long as you don’t have an active flare-up. “The truth is that most people with psoriasis are not tremendously bothered by gentle hair removal as long as their psoriasis is controlled,” says Shira Y. Wieder, MD, a board-certified dermatologist at Montefiore Einstein Advanced Care in New York City.

Anyone who hasn’t found an effective method to ward off their psoriasis flares should take serious precautions before doing any type of hair removal, as it carries a real risk of triggering new plaques even in areas that weren’t affected before. However, if your psoriasis is well managed by prescription treatments, you’ll likely be able to shave, laser, wax, and pluck almost exactly like anyone else. “The risk of triggering new plaques drops but doesn’t fully disappear,” says Divya Shokeen, MD, a board-certified dermatologist and founder of OSVI Dermatology and Surgical Institute in California. Here are a few precautions to keep in mind to avoid irritating your skin and triggering a flare-up.

Adobe

How Having Psoriasis Can Affect Hair Removal

“It’s one word: Koebnerization,” Dr. Shokeen says of what can make hair removal trickier for people with any inflammatory condition like psoriasis, especially during an active flare. For people with psoriasis, the Koebner effect occurs when trauma stimulates the immune system to develop plaques, Dr. Wieder says. In other words, if your psoriasis is active and you suffer any sort of minor skin injury (like a nick from a razor or a burn from too-hot wax), you could see more psoriasis, especially if it’s close to a psoriatic plaque, Dr. Shokeen says.

She emphasizes that this does not mean your psoriasis is “spreading” because psoriasis is not an infectious disease (meaning it’s not contagious). Instead, these minor injuries can start a new inflammatory reaction anywhere on the body, especially if your psoriasis is not controlled by medication.

In addition to the risk of Koebnerization, people with psoriasis tend to have drier skin, which compromises the skin barrier, Dr. Shokeen says. This means the skin can become irritated fairly easily. As a result, it “tends to develop more redness, stinging, or lingering marks from things that a non-psoriatic patient would tolerate,” she explains.

With all of that in mind, the first step in safe hair removal should be to manage your psoriasis with prescription treatments, many of which can completely eliminate symptoms. This is especially true if you’re taking an injectable medication like the biologics Humira or Skyrizi, says Tracy Evans, MD, a board-certified dermatologist and the medical director of Pacific Skin and Cosmetic Dermatology in California. However, since psoriasis can only be managed and not cured, the risk of Koebnerization from hair removal remains for anyone with the condition, although it’s much lower in those cases.

On the flip side, if you’re still in the process of finding a psoriasis treatment that works for you, Dr. Shokeen says all hair removal methods carry a high risk. “Anything that’s causing repeated, mechanical trauma could potentially trigger your psoriasis.”

The Best Hair Removal Methods for Psoriasis-Prone Skin

If your psoriasis is well managed and the hair removal method is performed correctly, the dermatologists interviewed here agree you’ll likely be fine to use any method as long as you do so carefully. However, they note you should ideally speak with your own doctor before trying anything new. It will ultimately be a matter of trial and error to find which one works best for you, but these are a few safer options to consider.

Shaving

All three dermatologists interviewed for this piece agree that, aside from the risk of accidental cuts that could cause skin trauma, shaving is one of the safest hair removal methods for people with psoriasis. With shaving, “you’re [removing hair] above the follicle, not pulling it out,” Dr. Evans explains.

Dr. Wieder agrees and notes that it’s especially important for people with psoriasis to use a sharp razor and shave in the direction of hair growth rather than against the grain. Both will help ward off the irritation that can trigger Koebnerization. And if you’re trying to navigate around a psoriasis plaque, proceed with caution. “Avoid shaving off the scales because it’ll bleed underneath,” Dr. Wieder says.

Laser hair removal

Laser hair removal might sound like it carries a high risk of causing trauma, but the dermatologists interviewed agree it’s actually one of the safer options for psoriasis patients, as long as it is administered correctly. (Laser burns have the potential to cause, say it with us, Koebnerization.) “Even though you would think [a laser] would be traumatic to the hair follicle, it does seem to be safe,” Dr. Wieder says, pointing to studies on lasers that have shown their potential for treating psoriasis. Dr. Evans echoes this, noting that “heat and light” don’t seem to be an issue for people with psoriasis.

“I do laser hair removal on psoriasis patients all the time,” Dr. Shokeen says. She notes her preference for long-pulsed Nd:YAG lasers (1,064 nm), though she says diode lasers (about 800 to 810 nm) can also work if the settings are dialled down. Either way, it can be a tricky balance to get the levels just right, and the settings will need to be adjusted for each patient.

“If the energy of the device is too low, you’ll actually get hair regrowth,” she says. “It’s complicated to treat a psoriatic patient [with lasers], to say the least.” That’s why she always recommends that people who have psoriasis get laser hair removal in “a physician-supervised, medical-grade setting rather than a standard laser chain. There are more med spas than McDonald’s,” she says, noting her scepticism that all the people employed in those many locations would be fully trained to treat people with psoriasis.

Hair Removal Methods to Approach With Caution

As mentioned above, if your psoriasis is well controlled, you will likely be okay no matter how you remove unwanted hair as long as it’s done carefully. However, these methods carry some extra risks worth considering.

Depilatories

Hair removal creams (depilatories) may be a good option for someone with psoriasis because, like shaving, they don’t cause much trauma to the hair follicles. However, Dr. Wieder notes that these products can be irritating to many people, with or without psoriasis, so she always recommends a patch test beforehand on the areas where you plan to apply the depilatory. If you want to use it on your face, for example, Dr. Wieder recommends trying “some spots under the chin to see if you can tolerate it.”

Waxing

Although people with psoriasis can certainly get waxed, it’s the method that arguably comes with the most risk. “Waxing could pull on the skin and create microabrasions or tears,” says Dr. Evans. She says psoriasis is more likely to develop on areas that have been injured, even if the damage is minor. Dr. Evans also cautions that if the skin is damaged by waxing, new flare-ups could occur even in areas where you didn’t have plaques before.

For this reason, Shailer Carruth, a Vermont-based oesthetician who specializes in Brazilian waxing, says she waxes with her eyes as well as her hands. “The first thing I do if I’m going to wax someone who has psoriasis is check for any broken skin,” she says.

If you’re going the DIY route, Carruth recommends using a hard wax, which adheres only to the hair, not the surrounding skin. A sticky strip wax, on the other hand, is going to exfoliate the top layer of skin, which could further aggravate a psoriatic flare-up.

Tweezing

“Plucking is very traumatic to the hair follicles,” Dr. Wieder says, so you’ll want to tweeze with caution if it is your preferred method. While Dr. Evans notes that it’s relatively uncommon to get psoriasis on the face, it’s not impossible, so you should think twice about plucking if you’re prone to getting plaques there.

What to Do If Hair Removal Causes a Psoriasis Flare-Up

Although hair removal is generally safe for people with controlled psoriasis, if you get any micro-injuries during the process, there is a small risk that it could trigger a flare-up. If that happens, Dr. Evans says you can use your topical prescription medication to treat the area. If the flare persists, reach out to your dermatologist.

Meet the experts:

• Shailer Carruth is a licensed esthetician in Brattleboro, Vermont.
• Tracy Evans, MD, is a board-certified dermatologist and the medical director of Pacific Skin and Cosmetic Dermatology in California.
• Divya Shokeen, MD, is a board-certified dermatologist and founder of OSVI Dermatology and Surgical Institute in California.
• Shira Y. Wieder, MD, is a board-certified dermatologist at Montefiore Einstein Advanced Care in New York City.

https://www.allure.com/story/hair-removal-with-psoriasis