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.  

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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

What’s the Best Way to Wash Your Hair if You Have Scalp Psoriasis?

From everydayhealth.com

If you have psoriasis on your scalp, it can cause redness, thick scales or patches, itching, and even pain. It can also cause temporary hair loss. It’s similar to psoriasis on other parts of the body, but hair can trap the scales, causing them to build up more. 

There are a few prescription medications that are commonly used to treat scalp psoriasis. But you can get better results from your medications if you wash your hair with psoriasis-specific shampoo. 

For moderate to serious psoriasis, psoriasis shampoos are not that effective alone, but they can help your medications work better when used in combination with them. 

“These shampoos should be thought of as a complementary therapy,” says Lawrence J. Green, MD, a clinical professor of dermatology at George Washington University School of Medicine in Washington, DC. “They’re not on your hair and scalp for long enough to be a primary treatment.” 

For some people with very mild scalp psoriasis, the shampoos may be enough to keep it under control, says Alix Charles, MD, a dermatologist in Hinsdale, Illinois.

Here’s a breakdown of the different types of shampoos, how to use them, and what else you should be doing to keep your scalp psoriasis under control.

Types of Psoriasis Shampoos

There are two main types of over-the-counter medicated shampoos for psoriasis — those with coal tar, and those with salicylic acid. Both of these ingredients are approved by the U.S. Food and Drug Administration for psoriasis.

Coal tar shampoos can slow skin cell growth, reduce scaling, and help with redness, inflammation, and itchiness. The downside is that they’re a bit messy and can stain clothing, and they tend to have a particular smell.

Shampoos with salicylic acid are used to exfoliate skin and soften and remove the patches. “It makes it easier for any topical medication to penetrate into the scalp,” says Dr. Green. That can make medications more effective. These shampoos typically contain 3 percent salicylic acid. Some salicylic shampoos are recommended by the National Psoriasis Foundation.

Psoriasis shampoos may contain other ingredients that can soothe irritation, reduce itching, and restore moisture to your scalp.

There’s also a prescription shampoo, which contains clobetasol propionate, a type of steroid. But dermatologists try to avoid using steroids when possible, because they can’t be used for more than a few weeks. 

“I don’t use prescription shampoos because they’re not on the scalp long enough to help much, and we have better medications,” says Green.

How to Use Psoriasis Shampoo

We think of shampoo as being for the hair, but it’s important to apply psoriasis shampoo to your scalp as much as possible. Here’s how to do it:

• Apply shampoo to your scalp. Try to separate sections of the hair and apply the shampoo to the scalp.
• Gently massage. After applying the shampoo, gently massage it into your scalp. Don’t vigorously rub your scalp, as that can irritate your skin and make the psoriasis worse. 
• Wait   Leave the shampoo in for five minutes. 
• Alternate between psoriasis-specific and regular shampoo. It’s a good idea to alternate a medicated shampoo with a regular shampoo, so that you don’t dry out your hair and scalp, says Green. If you have thick scales that need to be removed, you can use the salicylic acid shampoo daily until it improves. Use the medicated shampoo at least three times a week.
• Stop when your scalp clears. When the psoriasis clears, you don’t need to use the medicated shampoo anymore. “These are only meant to be used when using medication, not as long-term maintenance therapies,” says Green.
What About Scale Softeners?

If you have very thick scales, you may need a scale softener that stays on your scalp longer. There are gels that you apply to your scalp and leave on. One study found that applying salicylic acid followed by a moisturizer reduced redness and scaling in people with psoriasis. This is used more like a medication than a shampoo, but it may not be necessary. 

“If you’re using one of the prescription medications, you don’t usually need [a scale softener], because you can get enough of the scale off with a medicated shampoo,” says Green.

Conditioning Your Hair
It’s important to use a conditioner whenever you shampoo. Psoriasis shampoos can be very drying to your hair. Using a conditioner on the hair shaft can add moisture back in. 
Some psoriasis shampoos contain ingredients that moisturize your hair, but the additional step of using a conditioner can add extra moisture. You may want to also apply a few drops of hair oil or serum to your scalp to keep it moisturized.
Common Mistakes
When you use a psoriasis shampoo, you need to have a slightly different approach than with regular shampoo. Some common mistakes people make when using psoriasis shampoo may prevent them from getting the full benefit of the shampoo — and in some cases, they can even make the psoriasis worse. Here are few mistakes dermatologists see:
1. Washing your hair not your scalp: Try not to think of shampoos as just being for your hair. It’s important for the active ingredients to have contact with your scalp. Be sure to gently massage it into your scalp.
1. Rinsing the shampoo out too quickly: Make sure the shampoo is in contact with the your scalp for at least five minutes before you rinse it out, says Dr. Charles. Contact time is important for the ingredients to work.
2. Skipping shampoos: It’s helpful to shampoo every day, as it can help clear out the debris and oils that can make psoriasis worse. Just be sure to alternate a medicated shampoo with a regular shampoo. 
3. Scratching or rubbing your scalp: Scalp psoriasis can be very itchy, and shampooing and massaging it may trigger the itchiness. Still, it’s important to avoid scratching or trying to rub away the itch. That can make psoriasis worse and may make your scalp bleed or cause hair loss. 
4. Blow-drying your hair: Scalp psoriasis can make your scalp very dry. Using a blow-dryer with hot air can dry it out even more. Instead, let your hair air-dry or use a dryer on the cool setting.
5. Picking at the scales: Shampoo and medication may help loosen scales, which is the goal. But picking at them can cause psoriasis to flare, may cause bleeding, and can even cause scarring and hair loss.

6. The Takeaway

   • Using a medicated shampoo that contains coal tar or salicylic acid can help to alleviate scaling and itching caused by psoriasis.
   • Apply the shampoo directly to your scalp, gently massage, and leave it in for at least five minutes to give the active ingredients enough time to work.
   • Moisturizing with a conditioner after shampooing can help keep your scalp hydrated and reduce dryness-associated itchiness.
   • Avoid scratching or rubbing your scalp, as it can worsen psoriasis and lead to complications like bleeding and hair loss. Instead, talk to your healthcare provider about additional treatments if symptoms persist or worsen.
7. https://www.everydayhealth.com/skin-conditions/best-way-to-wash-your-hair-with-scalp-psoriasis/