How Is Facial Psoriasis Classified?

Researchers are learning more about facial psoriasis and have found new subtypes. Facial psoriasis is one of the most severe forms of the condition. Researchers have also discovered that having psoriasis on specific areas of the face could signal serious illness. This information could help you and your doctor find treatments that work well to ease symptoms.

About 20 percent of people with psoriasis have it on their face. Typical areas affected include:¹

• Upper forehead
• Lower forehead
• Ears
• Cheeks

Most people with facial psoriasis also have it on their scalp. It will also sometimes appear on the smile or laugh lines, eyelids, and around the mouth.¹

Researchers have found that people with facial psoriasis tend to get it earlier in life than other types. Flare-ups also happen over a more extended period and need more intense treatment.²

Facial psoriasis is a sign that your disease is serious. You are more likely to have a higher Psoriasis Area and Severity Index (PASI) score. This score shows whether psoriasis is mild, moderate, or severe.^1,3

Types of facial psoriasis

There are 3 main subtypes of psoriasis that appear on the face:^1,4-6

Hairline psoriasis

This type of scalp psoriasis spreads beyond the hairline onto the skin of the face. You may notice patches that are thick, discolored and have white scales. The skin in this area may be extremely dry, cracked, and bleeding.

Sebopsoriasis

Sebopsoriasis is a combination of seborrheic dermatitis (a chronic form of eczema) and psoriasis, where you have symptoms of both conditions. Flare-ups happen along the hairline, eyelids, eyebrows, smile or laugh lines, and beard area. Patches in these areas are more spread out, thinner, and lighter.

Facial psoriasis

Facial psoriasis can affect any part of the face. It is linked to the condition on other parts of the body, like the genitals, scalp, elbows, knees, and torso. Plaques may look discolored and scaly and have defined boundaries.

Understanding the causes and symptoms

Like other areas of the body, facial psoriasis happens when an overactive immune system speeds up the growth of skin cells. While normal skin cells grow and shed in a month, this process occurs in a few days with psoriasis. Instead of falling off, cells pile up on the skin’s surface.^4,7

Experts link psoriasis to stress, infection, injury, certain medicines, and a family history of the disease. It can worsen with exposure to the sun or other UV light, smoking, and yeast that lives on the skin. Facial psoriasis causes itchy, sore, and sensitive skin.^4,7

Classifications & diagnosis

While some research studies have found that facial psoriasis on its own is a sign of serious disease, others say there is more to this idea. One small study found that the location of facial psoriasis plaques also plays a role in disease severity.

Researchers examined people with facial lesions on the upper forehead and ears and the nose and cheeks. They found that nose and cheek lesions:⁸

Are less common than in other areas

• Signal a higher PASI score
• Need more intense treatment
• Are more likely to happen earlier in life
• Have a stronger link to psoriasis on the rest of the body

Considering the location of facial psoriasis could help doctors to develop effective treatment plans.

Unpacking the impact

Having psoriasis in a highly visible area like the face can create challenges in your day-to-day life. You may feel judged, ashamed, alone, have low self-esteem, depression, and overall lower quality of life. This form of psoriasis could mean difficulties with intimacy, at work, and in your social life.¹

If you are struggling with mental health issues due to psoriasis, consider joining a support group for people with the condition. It can help to share your challenges with those who know what it is like to have a chronic illness. Ask your doctor to suggest a support group or find one online.