Face Psoriasis
Psoriasis causes areas of dry, red, flaky skin called psoriatic plaques. They can be found on many parts of the body, including the face, hairline, and scalp. Plaques are itchy and can hurt. About 80% of people with psoriasis have plaque psoriasis.
How Severe Is My Psoriasis?
When psoriasis is severe, it can cover large areas of the body. Many doctors gauge how severe psoriasis is, in part, by how much of your body it covers.
Plaque Redness
With psoriasis, skin cells multiply fast -- up to 10 times faster than normal. The buildup of dead skin cells forms dry, scaly, and itchy plaques. How red, thick, and scaly the psoriasis patches are also plays a part in judging severity.
When severe, psoriasis lesions can crack and bleed.
Itching and Pain
Sleeping, dressing, moving, and other everyday activities can be hard with psoriasis.
Intense itching can distract you and make it hard for you to get things done. Sometimes, plaques become painful and can keep you from working and doing the things you enjoy.
How much your psoriasis affects your day-to-day life also plays a role in determining severity.
Dandruff and Scalp Psoriasis
Psoriasis can cause crusting on the scalp and a silvery sheen. White, powdery flakes or thick, dry flakes are also common. About half of people with psoriasis have it on the scalp.
Over-the-counter medicated shampoo that contains ketoconazole, tar, pyrithione zinc, selenium sulfide, or salicylic acid may help. If not, see your doctor.
Plaque Psoriasis: Elbows and Knees
Doctors aren’t sure why, but elbows and knees are some of the most common places for plaques. The cause of psoriasis is unknown, but scientists think it's linked to genes and immune system problems. Coming into contact with things that bother your skin, like metals or fragrances, can trigger flares.
Plaque Psoriasis: Ears
Scales and flakiness build up on the outside of the ear and the outer ear canal. The buildup can even cause short-term hearing loss.
See a doctor to avoid eardrum damage. Prescription drops and ointment can help treat ear psoriasis.
Pustular Psoriasis
Widespread, pus-filled blisters called pustules can form on psoriasis plaques. These can sometimes be triggered by corticosteroid medicine, infections, or pregnancy.
A form of pustular psoriasis called Von Zumbusch happens suddenly. If you also have a fever, chills, or dehydration, see a doctor right away.
Pustular Psoriasis: Palmar-Plantar
Pustules can form on fleshy parts of the hands or feet. They start out yellow, then turn brown, peel, crust, shrink, and fade. This type of psoriasis can happen alone or with other forms.
Hand or foot psoriasis is sometimes severe. It can be debilitating and painful.
Nail Psoriasis
Flaky, splitting nails are common, especially in severe psoriasis. Nails can turn yellowish and peel away from the nail bed. In some cases, skin can build up under the nail.
Nail psoriasis can cause tiny pits in nails, as well as yellow-red discoloration that looks like a drop of oil beneath the nail.
Inverse Psoriasis
Inverse psoriasis is shiny and smooth, without silvery scales. It’s usually found in areas such as the armpits and under breasts, and in skin folds of the groin, private parts, and buttocks.
Inverse psoriasis can be hard on people who are overweight or who have deep skin folds. Sweat and friction tend to make it worse.
Guttate Psoriasis
Children and young adults are more likely to get guttate psoriasis. Small red spots the size and shape of raindrops cover large areas of the body.
Sores come on suddenly on the trunk, arms, and scalp. Strep throat, tonsillitis, colds, and the flu may trigger outbreaks.
Fixing Moderate to Severe Psoriasis
There is no cure, but there are treatments.
And even people with severe psoriasis can get relief during flare-ups in about 85% to 90% of cases.
Ointments & Lotion
Thick, over-the-counter ointments and lotions with emollients may help soften and soothe dry skin.
Your doctor may also prescribe skin treatments made with tar, corticosteroids, vitamin D, or retinoids.
For more severe psoriasis, doctors may move to stronger treatments, but they can have greater side effects.
Light or Phototherapy
Skin is exposed to ultraviolet B or ultraviolet A light to slow the rapid growth of skin cells. The type of light depends on where you have psoriasis and its severity.
You get these treatments weekly until the psoriasis goes into remission, then occasionally after that. Like all exposure to UV rays, treatment may raise the risk of skin cancer.
Laser Therapy
This slide shows psoriasis before and after laser therapy. A doctor targets psoriasis with a targeted beam of light. This minimizes normal skin’s exposure to UV light. For most people, this therapy is painless.
Plaques thin after a series of treatments over 4 to 5 weeks and can go into remission.
Oral Medications
These drugs curb immune system reactions and can help control skin cell growth and flares. They’re used when other treatments haven’t worked. Common medicines include methotrexate, retinoids, cyclosporine, and hydroxyurea. They can have serious side effects, so you'll need to be in touch with your doctor.
Biologics
Biologic treatments target specific immune system cells and proteins that play a role in inflammation. You can get some biologic medicines by injection, others by IV. These drugs treat moderate to severe psoriasis.
In some cases, treatment can lead to remission. But they do carry a risk of side effects, including infection.
Treatment Rotation
After a while, psoriasis may stop responding to a treatment. Also, the risk of side effects may grow with long-term use. Some doctors rotate treatments every 6 to 24 months to avoid those problems. But if your treatment is working well, your doctor may not rotate treatments.
Social Stigma and Depression
Getting treatment can be important for your quality of life. Besides pain and itching, psoriasis can cause unwelcome stares and questions. Some people withdraw socially. One study found nearly 24% of people with psoriasis suffer from depression.
Finding ways to manage your frustration, anger, and stress is an important part of treatment. Remember that stress can trigger flares.