What are the treatment options for facial psoriasis?

From the Guidelines

The most effective treatment for facial psoriasis is the combination of calcipotriene or tacalcitol ointment with hydrocortisone, as it has been shown to be efficacious in achieving clear or almost clear skin 1. When considering treatment options, it's essential to prioritize gentle and targeted approaches due to the sensitive nature of the facial skin.

Treatment Options

• For mild to moderate facial psoriasis, low-potency topical corticosteroids like hydrocortisone 1% or desonide 0.05% can be applied thinly once or twice daily for short periods (1-2 weeks) to avoid skin thinning 1.
• Calcineurin inhibitors such as tacrolimus 0.1% ointment or pimecrolimus 1% cream are excellent steroid-free alternatives that can be used longer-term without causing skin atrophy.
• Vitamin D analogs like calcipotriene (Dovonex) can also be effective when applied once daily 1.
• Combination products with calcipotriene and corticosteroids are recommended for the treatment of psoriasis, including facial psoriasis 1.

Additional Considerations

• Gentle, fragrance-free cleansers should be used for cleansing, and treatment should always be followed with a non-comedogenic moisturizer to maintain the skin barrier 1.
• Harsh exfoliants or alcohol-based products that can trigger flares should be avoided.
• For more severe or resistant facial psoriasis, systemic treatments like methotrexate, biologics, or oral retinoids may be prescribed by a doctor.
• Sun protection is crucial as some psoriasis medications increase photosensitivity, so applying SPF 30+ sunscreen daily is recommended 1.

Evidence-Based Recommendations

The use of combination treatments with vitamin D analogues and potent topical corticosteroids for up to 52 weeks is more effective than either agent alone for the treatment of psoriasis, including facial psoriasis 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.

From the FDA Drug Label

The safety and efficacy of Enbrel were assessed in two randomized, double-blind, placebo-controlled studies in adults with chronic stable PsO involving ≥ 10% of the body surface area, a minimum Psoriasis Area and Severity Index (PASI) score of 10 and who had received or were candidates for systemic antipsoriatic therapy or phototherapy Among PASI 75 achievers in both studies, the median time to PASI 50 and PASI 75 was approximately 1 month and approximately 2 months, respectively, after the start of therapy with either 25 or 50 mg twice a week.

The treatment options for facial psoriasis are not directly addressed in the provided drug labels. However, etanercept (Enbrel) is mentioned as a treatment option for plaque psoriasis, which may include facial psoriasis.

• Etanercept (Enbrel) doses of 25 mg or 50 mg twice a week have been shown to be effective in achieving a reduction in PASI score of at least 75% from baseline.
• The median time to achieve PASI 50 and PASI 75 was approximately 1 month and 2 months, respectively, after the start of therapy with either 25 or 50 mg twice a week. However, it is essential to note that the provided drug labels do not specifically address facial psoriasis, and therefore, the effectiveness of etanercept (Enbrel) for this particular condition is not directly supported by the provided information 2.

From the Research

Treatment Options for Facial Psoriasis

• Topical corticosteroids are effective in treating facial psoriasis, with a potential ranging from superpotent to least potent (class 1-7) 3
• Topical immunomodulators, such as pimecrolimus and tacrolimus, are also effective on the face and intertriginous psoriatic lesions 3
• Limited application of fluticasone propionate ointment, 0.005%, has been shown to be effective and safe in the short- and long-term management of moderate to severe psoriasis of facial and intertriginous areas 4
• Combination therapy with topical corticosteroids and vitamin D analogs, such as calcipotriene, may be beneficial in treating facial psoriasis, with a strong scientific rationale for decreased side effects 5

Additional Treatment Considerations

• Phototherapy, alone or in combination with coal tar or psoralen, may be effective in treating moderate to severe psoriasis, but can lead to erythema and pruritus acutely, and long-term problems such as wrinkling, solar elastosis, and an increased risk of skin cancer 6
• Systemic therapies, such as methotrexate, acitretin, cyclosporine, hydroxyurea, and biologics, may be necessary for patients with more severe or recalcitrant psoriasis, but are associated with significant systemic toxicity 6, 7
• Combination therapies, including adjunctive topical therapies used with other antipsoriatic regimens, have been demonstrated to provide many clinical benefits and may be used to achieve clear skin 7