Psoriasis - Specific locations: face

Specific locations: face

On the face

Facial psoriasis most often affects the eyebrows, the skin between the nose and upper lip, the upper forehead and the hairline. You might need a biopsy to confirm that it is psoriasis.

Psoriasis on and around the face should be treated carefully as the skin here is very sensitive.  Occasional use of mild topical steroids, also called corticosteroids, may be effective.  Other treatments include Dovonex, Tazorac, keratolytic products (scale removers) and ultraviolet light. Dovonex and Tazorac can be irritating, so you should work with your doctor to find a way to address this concern.

The U.S. Food and Drug Administration (FDA) has approved two drugs, Protopic and Elidel, for the treatment of eczema which many dermatologists have found work well for treating psoriasis on the face or other sensitive areas.  Medication used to treat facial psoriasis should applied carefully and sparingly; creams and ointments can irritate eyes.  Because facial skin is delicate, prolonged use of steroids may cause it to become thin, shiny and/or prone to enlarged capillaries. Treatment with steroids may be safe if a careful treatment schedule is followed.

Around the eyes

When psoriasis affects the eyelids, scales may cover lashes. The edges of the eyelids may become red and crusty. If inflamed for long periods, the rims of the lids may turn up or down. If the rim turns down, lashes can rub against the eyeball and cause irritation.  Psoriasis of the eye is extremely rare.  When it does occur, it can cause inflammation, dryness and discomfort.  It may impair vision.  Topical antibiotics may be used to treat infection.

In some cases, a special steroid medication made for use around the eyes may be used to treat scaling. Your doctor must carefully supervise the treatment because eyelid skin can be easily damaged. If topical steroids are overused in and around your eyes, glaucoma and/or cataracts may develop, which is the reason doctors suggest having your intraocular pressure checked regularly by an ophthalmologist.

Protopic ointment or Elidel cream won't cause glaucoma and is effective on eyelids, but can sting the first few days of use. Using Protopic or Elidel for eyelid psoriasis may help you avoid the potential side effects of topical steroids.

In the ears

Psoriasis in the ears can cause scale buildup that blocks the ear canal. This buildup may lead to temporary hearing loss. A doctor should remove this scale. Psoriasis generally occurs in the external ear canal, not inside the ear or behind the eardrum.

Prescription steroid solutions can be dripped into the ear canal or applied to the outside portion of the ear canal. Dovonex or Tazorac may cause irritation when used alone and may be best used in combination with a topical steroid. The eardrum is easily damaged. Care should be taken when inserting anything rigid into the ear. Also, impaction of scale already present from psoriasis can occur if medication prescribed for the skin on the ear is not appropriately applied inside the ear canal.

Around the mouth and nose

For a very small number of people, psoriasis lesions appear on the gums, the tongue, inside the cheek, inside the nose or on the lips. The lesions are usually white or gray. Psoriasis in these areas can be relatively uncomfortable. It can cause difficulty in chewing and swallowing food.

For the most part, psoriasis treatments for the mouth and nose involve the use of topical steroids that have been designed to treat moist areas. Improving hygiene and rinsing frequently with a saline solution can help relieve oral discomfort. Low-potency steroids, such as hydrocortisone 1% ointment, may be useful in treating psoriasis on the lips. Protopic and Elidel may also be effective treatment options for psoriasis in and around the mouth.