Facial Psoriasis: Which cream to choose?

On the face, psoriasis plaques tend to appear on the forehead, eyebrows, sides of the nose, eyelids, near the ears, or in the beard area for men. In children, the lesions are primarily concentrated around the mouth and on the eyelids.

Psoriasis lesions on the face are often mistaken for seborrheic dermatitis due to similar manifestations.

Facial psoriasis presents itself through the emergence of red patches covered with white scales. These can be accompanied by varying degrees of itchiness. Moreover, as facial psoriasis is highly visible, individuals are more prone to stigmatisation.

If you are suffering from psoriasis on the face, there are certain recommendations that you need to adopt:

• Consult a dermatologist.

  The first step is to consult a dermatologist. Thanks to their medical expertise, the dermatologist will provide an accurate diagnosis. If you are suffering from psoriasis, they will prescribe a medication treatment tailored to your case. There are local treatments (dermocorticoids, dermocorticoids combined with a keratolytic agent, vitamin D analogues, etc.) as well as systemic treatments for more severe cases. These treatments are generally suspensive, with a risk of relapse upon their discontinuation. Alongside treatments, adopting a suitable routine can improve the skin's condition.

• Gently cleanse your face.

  In the case of facial psoriasis, it is advisable to cleanse the face with water only in the evening. Indeed, repeated contact with water can be irritating due to the presence of limestone and chlorine. To best respect your skin and restore your skin barrier, use a gentle cleanser, soap-free and with a neutral pH or close to the skin's pH (around 5.5). Once your skin is cleansed, spray thermal water or floral water on your face to remove any limestone residues.

If you wish to refresh your face in the morning, opt for a hydrosol or thermal water.

• Gently dry your face.

  Given that psoriasis lesions worsen with friction (Koebner phenomenon), facial drying should be as gentle as possible. Ideally, it should be done using a cotton towel, by patting.

• Apply a suitable moisturising cream.

  The more a skin is hydrated and nourished, the more it will resist external aggressions and the less likely it will be to become irritated. Furthermore, moisturising creams help to reduce skin dryness and the formation of scales.

The use of a moisturising cream is especially important for individuals undergoing medicinal treatments, such as oral retinoids or phototherapy, which are particularly drying for the skin.

As mentioned earlier, establishing a routine with suitable dermo-cosmetic products can improve the condition of the skin and reduce the frequency and severity of psoriasis flare-ups. But a question arises: how to choose a face cream in the case of facial psoriasis?

A cream suitable for skin prone to psoriasis should be as simple as possible. In other words, it should not contain allergenic components. Moreover, certain active ingredients are beneficial for improving the symptoms of psoriasis:

• The nourishing actives.

  Even though psoriasis does not necessarily equate to dry skin, nourishing active ingredients are beneficial against the scales that cover the lesions. These will help to reduce the dead skin resulting from the excessive proliferation of keratinocytes. Among these active ingredients, we can mention ceramides, vegetable oils or vegetable butters (linseed oil, calendula macerate, shea butter, etc.).

There are also other active ingredients that reduce flaking. This is the case of theallantoin for example.

• Keratolytic agents.

  Within psoriasis lesions, numerous scales or immature dead cells are observed, which cannot naturally eliminate themselves. These are particularly noticeable on the face and can be a source of poor self-esteem. Keratolytic agents (glycolic acid, salicylic acid, lactic acid, urea...) therefore allow for the effective removal of these dead cells. For instance, salicylic acid is used in psoriasis to halt severe scaling and facilitate the removal of scales.

Many creams combine moisturising agents and keratolytic agents. This dual effect is highly beneficial for skin prone to psoriasis.

• The soothing active ingredients.

  Psoriasis often goes hand in hand with itching. This can be particularly bothersome in daily life. Moreover, scratching exacerbates psoriasis lesions.

  Five minutes of scratching accelerates skin renewal and is sufficient to reactivate psoriasis for two weeks.

  Calming anti-itching agents such as the bisabolol or calendula help to soothe and alleviate itching sensations.

• GRIFFITHS C. E. M. & al. Psoriasis : epidemiology, clinical features, and quality of life. Annals of the Rheumatic Diseases (2005).

• FANG J. Y. & al. Apoptotic or antiproliferative activity of natural products against keratinocytes for the treatment of psoriasis. International Journal Of Molecular Sciences (2019).