From healthline.com
Psoriasis is a common chronic skin condition that speeds up the life cycle of skin cells, which causes extra cells to build up on your skin. This build-up results in scaly patches that can be painful and itchy.
These patches — often red with silver scales — can come and go, flaring up for weeks or months before cycling to a less prominent 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 have moderate to severe psoriasis on other parts of their body, as well.
There are several forms of facial psoriasis. They all involve skin that’s itchy, painful, and irritated.
Psoriasis around the eyes can lead to red, crusty eyelids, and eyelashes potentially rubbing against the eye. Psoriasis can also appear inside and around the ear, potentially affecting your hearing.
Scratching psoriasis lesions can also lead to broken skin and, in some cases, infection. Psoriasis can affect your self-image and general quality of life, too.
Plaque psoriasis is the most common form, and it tends to appear as raised, scaly patches. Guttate psoriasis, on the other hand, comes with pink spots that are smaller and less thick.
Erythrodermic psoriasis is rare. It tends to come with a widespread red rash, swings in body temperature, and a potentially increased vulnerability to infection.
Other types of psoriasis may appear alongside facial psoriasis — for instance, scalp psoriasis affects about half of people with psoriasis.
There’s some evidence
The three main subtypes of psoriasis that appear on the face are the following:
Hairline psoriasis
Hairline psoriasis is scalp psoriasis (plaque psoriasis) that’s extended 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
Sebopsoriasis results in symptoms of both psoriasis and seborrheic dermatitis. A chronic form of eczema, seborrheic dermatitis is 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 patches are often thinner, with a lighter colour and smaller scales.
Facial psoriasis
Facial psoriasis can appear on any part of your face and is associated with psoriasis on other parts of your body, including your:
- scalp
- ears
- elbow
- knees
- torso
It can be plaque psoriasis, guttate psoriasis, or erythrodermic psoriasis.
As with psoriasis on other parts of your body, there’s no clear cause of facial psoriasis. Researchers have determined that heredity and your immune system both play a role.
Psoriasis and psoriasis flare-ups can be triggered by:
- exposure to sun and sunburn
- stress
- a yeast infection, like Malassezia
- certain medications, including lithium, hydroxychloroquine (Plaquenil), and prednisone (Rayos)
- cold, dry weather
- tobacco use
- heavy use of alcohol
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 have HIV or other autoimmune disorders like lupus, or who are undergoing chemotherapy.
Skin injuries from scratches to sunburns may also factor in. So too can obesity and certain medications, including lithium, antimalarials, and beta-blockers.
Smoking and alcohol use can also be risk factors for psoriasis.
To diagnose facial psoriasis, a doctor or dermatologist will ask questions about your symptoms, like itchy skin. They may also ask about your family history and whether your close relatives have also had psoriasis.
In addition, they may take a small sample of your skin, or biopsy, to study under a microscope and confirm your diagnosis. You may also get questions about changes in your life too, 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 with other skin conditions from seborrheic dermatitis to ringworm to a drug reaction.
While similarities exist between eczema and psoriasis, the causes differ, as can the treatments. The two can also overlap in some cases. Both can affect the face, and neither’s contagious.
Psoriasis is a chronic condition that leads to an overproduction of skin cells, while eczema is an overreaction to an irritant, like certain clothes, soaps, or animals.
The two have some triggers or risk factors in common, including cold dry weather, but eczema may also stem from encounters with pollen, moulds, or even 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 and redder than with eczema. Silvery scaling also tends to be unique to psoriasis.
Because the skin on your face is very sensitive, facial psoriasis needs to be treated carefully.
Corticosteroids
Your doctor might recommend a variety of treatments, including mild corticosteroids in the form of an ointment, lotion, or cream. These might be applied daily when symptoms are at their worst.
Avoid your eyes when applying any medication to your face. Special steroid medication is made to be used around your eyes, but too much can cause glaucoma and cataracts.
Vitamin D analogues
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
Calcineurin inhibitors stop the action of calcineurin, an enzyme that’s involved in some immune system processes. They can be applied around the eyes. While they won’t cause glaucoma, they may sting for the first few days of use.
Examples include tacrolimus (Protopic) and pimecrolimus (Elidel).
Retinoids
Retinoids like tazarotene (Tazorac) work by slowing the overproduction of skin cells and reducing inflammation.
If retinoid creams and gels aren’t helpful, a dermatologist may prescribe oral or injected medication, including a retinoid in pill form called acitretin (Soriatane). As with topical retinoids, these work by slowing skin cell production.
Phototherapy
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. With sunlight, don’t overdo it. Keep in mind that your risk of sunburn may be higher when using some topical medications.
Along with medication recommended by your doctor, you can take steps at home to help manage your psoriasis.
- Reduce stress. Consider meditation or yoga.
- Avoid triggers. Monitor your diet and activities to see if you can determine the factors that result in flare-ups.
- Don’t pick at your patches. Picking off scales typically results in making them worse or initiating new rashes.
- Use moisturizer. Have your doctor recommend a moisturiser that can help reduce dry skin and scaling on your face.
- Get emotional support. Sometimes, having patches on your face can make you feel self-conscious and even depressed. Your doctor might have a recommendation for a support group or psychologist that can help.
Finding a skin care routine that helps with your facial psoriasis is key, although you may have to experiment a bit with different products to perfect it.
In addition to discussing prescription creams with your doctor, you may find it helps to use an over-the-counter emollient. These soothe the skin and can create a barrier of oil to protect your skin from drying out.
Humectants, like glycerin and aloe vera, can also help hydrate your skin.
You may also want to look for products with salicylic acid, which can help your skin shed psoriasis scales, or coal tar, which can reduce itching and inflammation.
Talk with a doctor to determine the type of psoriasis that’s appearing on your face. They can recommend a treatment plan for 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 have suggestions for managing any self-consciousness about your facial psoriasis.
For example, they may recommend a support group or even types of makeup that won’t interfere with your treatment.
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