What is the recommended treatment for facial psoriasis?

From the Guidelines

For facial psoriasis, the use of calcipotriene or tacalcitol ointment combined with hydrocortisone is recommended as a first-line treatment, as it has been shown to be efficacious in achieving an Investigator’s Static Global Assessment score of 0 or 1. This recommendation is based on an 8-week double-blind RCT with 409 patients, which found that the combination of calcipotriene and hydrocortisone was more effective on the face than calcipotriene alone 1. The treatment can be applied once or twice daily, and it is essential to use it cautiously on the face due to the risk of skin thinning.

Some key points to consider when treating facial psoriasis include:

• The use of combination treatments with vitamin D analogues and potent topical corticosteroids can be more effective than either agent alone for the treatment of psoriasis 1
• Topical calcipotriene has displayed greater efficacy than 6% coal tar or salicylic acid but less efficacy than liquor carbonis detergens (LCD) 15% solution 1
• The application of vitamin D analogues twice daily on weekdays in conjunction with high-potency topical corticosteroids twice daily on weekends can be considered for maintenance treatment for psoriasis 1
• Simultaneous use of salicylic acid with calcipotriene should be avoided because the acid pH of salicylic acid will inactivate calcipotriene and reduce its effectiveness 1

It is also important to note that facial psoriasis requires special care because facial skin is thinner and more sensitive than other body areas, making it more susceptible to both irritation and treatment side effects. Therefore, gentle cleansing with non-soap cleansers and regular use of moisturizers can help prevent irritation and reduce scaling. If these topical treatments fail, phototherapy or systemic medications may be considered under dermatologist supervision.

From the FDA Drug Label

Plaque Psoriasis (Ps) (1. 7): treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate. Plaque Psoriasis or Adult Uveitis (2.5): Adults: 80 mg initial dose, followed by 40 mg every other week starting one week after initial dose.

The recommended treatment of psoriasis on the face is not explicitly stated in the label. However, for plaque psoriasis, the label recommends an initial dose of 80 mg, followed by 40 mg every other week.

• Key points:
  • Dosage: 80 mg initial dose, followed by 40 mg every other week.
  • Indication: Moderate to severe chronic plaque psoriasis.
  • Candidate patients: Those who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate. 2

From the Research

Treatment Options for Psoriasis on the Face

• Topical therapy is the gold standard for mild psoriasis cases and is also recommended in addition to UV and systemic therapy in cases of moderate to severe psoriasis 3
• The combination of topical corticosteroids and vitamin D analogues has proven to be the therapy of choice for the initial phase of treatment 3
• Fixed combination therapy is recommended once or twice a week for maintenance therapy 3
• Topical vitamin D analogues, such as calcipotriol, have been shown to be effective in treating psoriasis, including on the face 4
• The choice of formulation is important, and patient preferences and experiences should be taken into account to increase adherence 3, 5

Recommendations for Topical Treatment

• Topical treatments combining corticosteroids and vitamin D analogues are well-established first-line treatments in mild-to-moderate psoriasis 5
• The clinical effectiveness, fast onset of action, tolerability, cosmetic acceptability, and practicability of topical therapy are important for optimising patient adherence and maximising efficacy 5
• Good physician-patient communication is also important for optimising patient adherence and maximising efficacy 5
• Simple but detailed practical guidance is provided to assist GPs with the optimal use of topical agents based on efficacy, tolerability, disease severity, site of psoriasis, patient lifestyle and preferences, and intended duration of treatment 5

Special Considerations for Facial Psoriasis

• Facial psoriasis requires special consideration due to its sensitive location 3, 6
• Topical agents should be chosen carefully to minimize side effects and maximize efficacy 3, 6
• The Tuscany Consensus Group on Psoriasis provides recommendations for the use of topical therapies in psoriasis, including on the face 6