Psoriasis on the face

Psoriasis can affect any part of the body. The disease is especially often found on the elbows, under the knees, in the groin and armpits, on the head. Psoriasis on the face is relatively rare, but it causes a lot of discomfort to the patient - primarily psychological. You can't hide the rash on the face: they are visible to everyone. And few people know that the disease is not contagious and is not transmitted to others.

What do you need to know about psoriasis affecting the face? How can you fight the pathology?

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Epidemiology

Psoriasis on the face can manifest itself at any age, but most often it is diagnosed before the age of 30. In women, the pathology is often detected between the ages of 15 and 55, and in men – between 28 and 55.

In 70% of cases, this disease is also present in other family members (relatives).

In our country, the incidence of psoriasis is less than 1%. The disease is more common in northern countries.

Psoriasis on the face can occur equally often in female and male patients.

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Causes facial psoriasis

There is no generally accepted explanation for the development of psoriasis on the face. The main cause of the pathology is considered to be a disorder of metabolic processes. However, specialists still do not have a unified opinion on the origin of the disease. Only theories are put forward, which are considered assumptions:

• the causes may be autoimmune disorders, including those of genetic origin, transmitted as a recessive or autosomal dominant trait;
• Other possible causes include metabolic and autoimmune disorders caused by nervous tension, eating disorders, infectious diseases, climate conditions, and alcohol consumption.

All scientific researchers and doctors are unanimous in their opinion: psoriasis on the face is a polyetiological pathology that cannot have any one cause. Often, the disease is preceded by a whole combination of various factors.

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Risk factors

• Chronic inflammation, infectious diseases.
• Metabolic function disorders.
• Endocrine system failure.
• Immune disorders.
• Hormonal disorders (puberty, pregnancy, menopause, long-term use of contraceptives).
• Trauma and damage to the facial skin.
• Digestive disorders.
• Regular and long-term stress.
• Effect of cold, frostbite of the face.
• Chronic poisoning.
• Taking medications (ACE inhibitors, β-blockers, NSAIDs, antiviral drugs).
• Alcoholism, excessive consumption of alcoholic beverages.

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Pathogenesis

According to the theory of the autoimmune origin of the disease, psoriasis on the face is the result of a specific reaction of the body to certain irritants, which leads to excessive development and proliferation of cells on the surface of the skin.

The average duration of the cell division cycle is usually about 25 days. In psoriasis on the face, division occurs faster, and the period is shortened by 20 days. As a result, the previous cellular structures do not have time to peel off, and coarsening and layering of cells (proliferation) is observed, which leads to the onset of an inflammatory reaction. Inflammatory areas look like light pink bumps, on top of which there are characteristic whitish crusts of dead surface tissue.

As the symptoms increase, the tubercles merge with each other and become large pinkish spots of various shapes.

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Symptoms facial psoriasis

The first signs are small inflamed spots on the skin of the face, which over time increase and merge, turning into small, compacted nodules of a reddish-pinkish color. These nodules are nothing more than psoriatic papules, which are considered the main manifestation of psoriasis.

The nodules become covered with scaly silver-colored crusts in a very short time. They can be easily scraped off the surface of the spot.

In medicine, it is customary to pay attention to three main and characteristic signs of psoriasis on the face:

• The symptom of stearin stain is the appearance of pliable, light-silver scales on the surface of the nodules, which are gently separated when scraped off;
• a symptom of film formation is the exposure of a glossy red surface when trying to scrape off the scales;
• The symptom of pinpoint hemorrhage ("bloody dew") is the result of the above-mentioned signs, when after the scales are removed and the psoriatic film appears, pinpoint bleeding appears.

The nodules tend to grow quickly and join with other papules, forming plaques – spots that protrude on the surface of the skin.

The main localization of the rash is the wings of the nose and the nasolabial triangle, eyebrows and superciliary areas, eyelids, lip border, and frontal area.

Stages

Stages of development of psoriasis on the face:

• Initial stage – rashes appear on the face, which gradually increase in size and look like round plaques, pinkish in color, covered with light scales.
• Stationary stage (1-4 weeks from the onset of the disease) – plaques become light, papules become round, scales become silver.
• The fading stage – the plaques become barely noticeable and practically merge with the skin, the itching subsides, a dense keratinized border forms around the papule. This stage can last on average 2-6 months.

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Forms

Forms of psoriatic rashes on the face:

• pustular (annular or generalized);
• non-pustular (classical, or erythroderma).

Types of psoriasis on the face:

• common (aka vulgar) - accompanied by the appearance of pink papules, a sensation of itching and burning;
• with exudation - manifested by papules covered with yellow crusts, upon removal of which a yellowish liquid is released;
• follicular - characterized by the formation of miliary papules with a funnel-shaped depression in the center;
• atypical – accompanied by the appearance of papules in places that are not typical for psoriasis;
• plaque-like - characterized by the appearance of papules in the form of reddish plaques covered with light scales;
• drop-shaped - accompanied by the appearance of drop-shaped pustules, which over time merge with each other;
• spotted - characterized by the presence of erythema, in some cases with mild infiltration.

Degrees of psoriasis on the face:

• mild degree;
• severe degree.

Types of psoriasis according to seasonality:

• year-round;
• summer;
• winter;
• demi-season.

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Complications and consequences

Unfortunately, it is almost impossible to completely cure psoriasis on the face - this disease is considered chronic, which occurs with periodic outbreaks of activity. Often, patients experience significant psychological discomfort: trying to cure the disease, they fall into depressive states, get fixated on the problem and avoid social contacts. But this does not solve the problem - if you do not carry out treatment, much more serious consequences may appear - generalization of the psoriatic process:

• inflammatory reaction in the joints – arthritis;
• inflammatory reaction in the kidneys - glomerulonephritis;
• inflammatory changes in the liver – psoriatic hepatitis;
• metabolic disorder.

In addition, in some patients, psoriasis on the face occurs in the form of erythroderma, spreading to the hair follicles.

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Diagnostics facial psoriasis

At the initial stage, the doctor conducts an extensive diagnosis in order to confirm the diagnosis of psoriasis on the face and assess the extent of its spread.

Standard diagnostic procedures include examination and questioning of the patient:

• listening to complaints;
• examination of psoriatic lesions;
• verification of data on other background diseases.

The main symptoms that a dermatologist will pay special attention to are:

• stearin stain symptom – the appearance of easily removable light silver crusts on the nodules, which can be scraped off without any problems;
• a symptom of psoriatic film is the appearance of a glossy hyperemic surface when trying to scrape off the crust;
• The symptom of pinpoint hemorrhage ("bloody dew") is a consequence of the above-mentioned signs, if after scraping off the scale and the appearance of the psoriatic film, a pinpoint drop of blood is found.

The fading stage of the disease is determined by the presence of Voronov's symptom - this is the formation of a light border along the edge of the spot and healthy skin.

Tests are prescribed to clarify the diagnosis:

• microexamination of scales scraped from pathological tubercles;
• skin biopsy followed by histology.

Instrumental diagnostics may be necessary only if adverse consequences appear.

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Differential diagnosis

Differential diagnostics are prescribed:

• if dermatitis is suspected;
• to rule out rosacea;
• to rule out lichen planus;
• if dermatomyositis is suspected, etc.

In most cases, psoriasis on the face is distinguished from dermatitis, as well as from such a rare disease as asbestos lichen. This type of lichen is one of the varieties of streptoderma. The disease is accompanied by the appearance of large scaly elements, resembling asbestos in appearance.

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Treatment facial psoriasis

At the first suspicion of psoriasis, you should immediately visit a dermatologist. Early treatment will help to "curb" the disease faster and transfer it to a stable stage of attenuation of the process.

Oral medications are usually prescribed for long-standing psoriasis, in advanced and complex cases of the disease. The following groups of drugs are usually the drugs of choice:

• cytostatic agents – slow down the proliferation of epithelial cells (methotrexate);
• immunosuppressants – weaken autoimmune processes (cyclosporine A);
• aromatic retinoids – inhibit proliferative processes in epithelial cells (analogues of vitamin A);
• glucocorticosteroid hormonal agents – suppress the development of the inflammatory process (prednisolone, dexamethasone);
• Biologically active agents – block the growth and development of cells (alefacept, avastin).

Systemic drugs are prescribed by a doctor and only in extreme cases, when external action on psoriatic rashes does not bring the expected effect, and the disease continues to spread. Self-administration of the listed drugs is strictly contraindicated.

Methotrexate
Dosage of the drug	Take 5 to 25 mg of the drug orally, once a week.
Side effects	Depression of bone marrow function, erosions and ulcers, headaches, baldness.
Special instructions	Methotrexate is prescribed only for severe cases of psoriasis.

Cyclosporine A
Dosage of the drug	Taken orally from 3.5 to 6 mg/kg of body weight per day.
Side effects	Heaviness in the stomach, hypertension, menstrual irregularities in women.
Special instructions	It is important to avoid excessive suppression of the immune system.

Retinol
Dosage of the drug	Adults are prescribed from 50 thousand to 100 thousand IU per day.
Side effects	Drowsiness, apathy, facial flushing, dyspepsia.
Special instructions	Use with caution in patients with impaired renal function.

Dexamethasone
Dosage of the drug	In the acute period, it is permissible to administer 4-10 mg of the drug per day, divided into 3-4 doses.
Side effects	Menstrual cycle disorders in women, pancreatitis, heart rhythm disturbances, edema, allergies.
Special instructions	To reduce the severity of side effects, you can take potassium supplements.

Alefacept
Dosage of the drug	The dosage is strictly individual.
Side effects	Shortness of breath, facial swelling, itching, hypotension.
Special instructions	Individual reactions may occur: if your temperature rises sharply, you should immediately consult a doctor.

Ointments and creams for psoriasis on the face are prescribed first, and only if they are ineffective does the doctor proceed to prescribing the above-mentioned systemic drugs.

For psoriasis on the face, the following topical medications can be used:

• External glucocorticoid ointments – stop inflammation at any stage of the process (lorinden A, prednisolone ointment).
• External products with vitamin D normalize metabolic processes in damaged epidermal cells (daivonex, daivobet).
• Keratolytics and keratoplastic agents soften the keratinized layer of skin (salicylic ointment, salicylic-zinc ointment).

As additional treatment the following is prescribed:

• antihistamines that help eliminate itching and discomfort (fenkarol, erius, etc.);
• sedatives that improve the psycho-emotional background (valerian drops, motherwort);
• vitamins that improve the properties of the skin and create additional protection against damage to cellular structures (vitamins A and E, a successful combination of which is presented in the drug Aevit);
• antibiotics that prevent the development of secondary infection in psoriasis lesions (macrolide group drugs).

Physiotherapy treatment

Against the background of drug treatment of psoriasis on the face, physiotherapy is actively used. Depending on the indications, various useful procedures may be prescribed:

• Electrosleep is a procedure with a sedative effect, normalizing the psyche of a patient whose disease is provoked by stress and periods of severe anxiety. The session lasts 20-60 minutes, every day, or once every two days. The minimum number of sessions is 8 pcs.
• UFO therapy is a procedure of narrow-band medium-wave irradiation.
• Phototherapy is one of the types of UFO, which is prescribed at the stage of attenuation of the process to extend the period of remission.
• PUVA therapy is ultraviolet irradiation with oral administration of photosensitizing agents (eg, psoralen). Two courses of treatment are usually performed: cleansing and anti-relapse treatment.
• X-ray therapy is irradiation of the affected skin with X-rays. The session is repeated once every 5-6 days.
• Laser therapy is a safe procedure that uses a laser to treat areas with psoriatic lesions.

As additional treatment, spa treatment, balneotherapy, and pelotherapy are welcomed.

Folk remedies

How to relieve psoriasis symptoms using folk remedies? Indeed, folk methods can sometimes help to achieve a persistent cessation of the painful process. For example, you can try to help a patient with psoriasis on the face using the following methods:

• two to three times a week, apply compresses to the face area with the following composition: sea salt and warm water, in a ratio of 1:3;
• apply cotton pads soaked in coconut oil, juniper oil, jojoba oil, or lavender oil to the affected areas for 5-6 minutes;
• lubricate the affected areas with 5% sea buckthorn oil, and also take it internally - 2 ml in the morning daily.

In addition, it is recommended to eat more plant foods, especially orange and red fruits and vegetables. Preference should be given to carrots and pumpkins, as they contain large amounts of vitamin A.

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Herbal treatment

Based on medicinal herbs, you can prepare external ointments for daily application to areas of the face affected by psoriasis.

1. Prepare a mixture of 50 g oak ash, 50 g rosehip ash, 20 g dry ground celandine herb, raw egg white, 200 g solid oil. Mix the mixture well and leave at room temperature for 2 weeks. It is better to store the resulting ointment in the refrigerator.
2. Prepare a mixture of 10 ml of Kalanchoe juice, 30 ml of eucalyptus oil and 10 ml of natural honey. Keep it in a dark, cool place for three nights.
3. Prepare a mixture of 100 g birch tar, 40 g rosehip ash, 40 g castor oil and 20 g natural honey. Keep in the refrigerator for 3 days and use.

If you prepare such ointments and use them every day, then a positive result will appear within a month after the start of use.

Homeopathy

Homeopathy for psoriasis on the face is prescribed simultaneously with conservative drug treatment.

The following homeopathic remedies may be recommended:

• Arsenicum Iodatum dilution 3, 6, 12 and 30;
• Cardum Marianus – dilution 3, 6;
• Chelidonium - dilution 3, 6;
• Sulfur – dilution 3, 6, 12, 30.

Good remedies include PsoriNokheel and the external remedy Psoriaten, which can be purchased in pharmacies without a prescription. Such drugs have a minimal set of side effects (very rarely - allergies), and can be prescribed almost without restrictions.

• PsoriNoheel – drink 10 drops 3 times a day before meals.
• Psoriaten – apply to affected areas 3 times a day.

Surgical treatment

Surgical treatment of psoriatic rashes on the face – plastic surgery – does not guarantee that the disease will not recur, since the pathology is considered chronic, with an autoimmune etiology. For this reason, the use of surgical intervention for psoriasis on the face is considered unpopular and inappropriate.

Prevention

You can prevent the development of psoriasis on the face, as well as reduce the frequency and severity of relapses, by following these simple tips.

1. Regularly moisturize and cleanse the skin on your face and body.
2. Avoid overdrying and chapping of the skin, protect your face from the cold.
3. Protect your skin from mechanical damage, do not use aggressive facial scrubs. The use of a razor is also questionable.
4. Avoid stress, conflicts and nervous breakdowns.
5. Strengthen the immune system to resist infectious diseases in a timely manner.
6. Stop drinking alcohol and smoking.
7. Do not take any medications without a doctor's prescription (the doctor must be informed that the patient has psoriasis).
8. Do not use unfamiliar and untested facial products, as they may cause allergies and worsen the condition of the skin.

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Forecast

Psoriasis on the face is recognized as an incurable pathology, with a chronic course, with periods of remission and worsening of the condition. The prognosis, by the way, often depends on how often the disease relapses.

It is generally accepted that the most favorable course of psoriasis is the common, classical form, which is not complicated by infections and only occasionally worsens at certain times of the year.

Considerable discomfort is created by the unaesthetic appearance of the face, which is often perceived by other people with apprehension. Unfortunately, many do not know that psoriasis on the face and other parts of the body is not a contagious disease and cannot spread and be transmitted to other people. As a result of mental stress and constant worries, patients with psoriasis everywhere experience depressive states, neuroses and nervous breakdowns.