Treatment of Facial Psoriasis
Start with calcipotriene (vitamin D analogue) combined with a low-potency corticosteroid (such as hydrocortisone) applied twice daily for 8 weeks as first-line therapy for facial psoriasis. 1
First-Line Recommended Regimen
The American Academy of Dermatology specifically recommends this combination for facial psoriasis, demonstrating significantly superior clearance compared to monotherapy (odds ratio 2.01,95% CI: 1.33-3.05). 1
Application Protocol:
- Weeks 1-2: Apply calcipotriene combined with low-potency corticosteroid (hydrocortisone) twice daily 1
- After Week 2: Transition to weekend-only corticosteroid application with weekday calcipotriene to minimize steroid exposure while maintaining efficacy 1
- Maximum duration: 8 weeks for the initial treatment course 1
- Safety limit: Do not exceed 100 g per week of vitamin D analogue to avoid hypercalcemia 1
Alternative First-Line Option for Sensitive Facial Areas
Tacrolimus 0.1% ointment is recommended as monotherapy for facial psoriasis when corticosteroid-related side effects are a concern. 2, 1
- Tacrolimus achieves clearance within 2 weeks in pediatric facial psoriasis and avoids the risk of skin atrophy that occurs with corticosteroids on thin facial skin 2, 1
- This is particularly appropriate for periorbital areas, eyelids, and other highly sensitive facial regions 3
Critical Pitfalls to Avoid
Never Use High-Potency Corticosteroids on the Face
High-potency (Class 1-2) or even moderately potent (Class 3) corticosteroids are contraindicated on facial skin due to significantly increased risk of skin atrophy, telangiectasias, and perioral dermatitis. 2, 1
- The face requires special caution with dithranol as well, which can cause severe irritation and staining on sensitive facial sites 2
- Only low-potency corticosteroids should be used on facial psoriasis 3
Drug Interaction Warning
Do not combine calcipotriene with salicylic acid - the acidic pH inactivates calcipotriene and eliminates its therapeutic effectiveness. 1
When Topical Therapy Fails
If first-line topical treatments are ineffective after an adequate trial (8 weeks), escalation options include: 2, 3
- Phototherapy (UVB or narrowband UVB) - though facial psoriasis may show variable response to UV radiation, and 5% of patients have photosensitive psoriasis that worsens with UV exposure 3
- Systemic therapy - reserved for extensive disease or when facial involvement significantly impacts quality of life despite topical therapy 2
The decision to escalate to systemic treatment should be made by a dermatologist experienced in managing psoriasis, considering both objective disease severity and psychosocial impact. 2