What is the treatment for psoriasis on the eyelids?

From the Guidelines

Treatment for psoriasis on the eyelids typically involves gentle, low-potency topical corticosteroids such as hydrocortisone 1% or desonide 0.05% cream, applied sparingly once or twice daily for short periods (usually 1-2 weeks). For maintenance therapy, calcineurin inhibitors like tacrolimus 0.03% or pimecrolimus 1% ointment are preferred as they don't cause skin thinning and can be used longer term 1. Patients should apply these medications carefully, avoiding contact with the eyes. Eyelid psoriasis treatment requires special care because the skin in this area is thin and sensitive, making it more susceptible to side effects like skin atrophy from stronger steroids. Some key points to consider in the treatment of psoriasis on the eyelids include:

• Mild cleansers and fragrance-free moisturizers should be used daily to reduce irritation and maintain the skin barrier.
• If these topical treatments don't provide adequate relief, a dermatologist may consider systemic treatments or phototherapy, especially if psoriasis is widespread on other body areas.
• Patients should also identify and avoid triggers that worsen their condition, such as stress, certain skincare products, or environmental factors. The use of combination treatments with vitamin D analogues and potent topical corticosteroids has been shown to be effective for the treatment of psoriasis, but the specific treatment regimen should be tailored to the individual patient's needs and preferences 1. It's also important to note that the choice of vehicle can significantly alter the use and penetration of the medication, and different vehicles are indicated for different body sites 1. Overall, the goal of treatment for psoriasis on the eyelids is to reduce symptoms, prevent complications, and improve quality of life, while minimizing the risk of adverse effects.

From the FDA Drug Label

Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis

• The hydrocortisone (TOP) drug label mentions psoriasis as one of the conditions it can temporarily relieve itching for.
• However, it does not explicitly state that it is safe for use on the eyelids.
• Given the sensitive nature of the eyelid area, it is recommended to use this product only under the advice and supervision of a doctor 2.

From the Research

Treatment Options for Psoriasis on Eyelids

• Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, have been studied for the treatment of psoriasis, including facial and intertriginous areas 3, 4, 5.
• These agents have shown efficacy in treating psoriasis, especially in sensitive areas such as the eyelids, without causing cutaneous atrophy 3, 5.
• The Tuscany Consensus Group on Psoriasis recommends the use of topical agents, including corticosteroids, vitamin D analogs, keratolytics, and calcipotriol/betamethasone propionate compound, for the treatment of mild psoriasis 6.
• However, it is essential to note that the treatment of psoriasis on the eyelids requires careful consideration due to the delicate nature of the area and the potential for ocular complications 7.

Ocular Complications and Considerations

• Psoriasis can be associated with ocular manifestations, including lesions of the eyelids, conjunctiva, and uveitis 7.
• The treatment of uveitis, a potentially serious eye condition, is controversial and requires careful management 7.
• Regular eye examinations are crucial for patients with psoriasis, especially those receiving biological treatment, to diagnose and manage ocular complications promptly 7.