Classification of facial psoriasis based on the distributions of facial lesions

Abstract

BACKGROUND: Psoriasis is a common chronic inflammatory skin disease that may involve any skin site. In particular, psoriasis on the face gives rise to considerable concern because of associated cosmetic problems and psychosocial distress. Some authors have reported that a significant proportion of patients with psoriasis have facial involvement, and several reports have suggested that facial involvement is a marker of severe psoriasis. However, patients with facial psoriasis seem to have clinical characteristics that depend on the distributions of their facial lesions. OBJECTIVE: We sought to classify facial psoriasis and evaluate clinical characteristics according to the distribution of facial psoriatic lesions, and to compare the severities of body and scalp psoriasis in patients with central or peripheral facial lesions. METHODS: A total of 194 patients with psoriasis with facial involvement who presented at our psoriasis clinic were enrolled in this study. Onset of psoriasis, family history, history of phototherapy or systemic therapy, and admission history were recorded. Severity of psoriasis on whole body, face, and scalp were rated using Psoriasis Area and Severity Index (PASI) scores. Patients were categorized into 3 types according to facial lesion distribution: peripherofacial type (PF) (upper forehead and/or periauricular lesions), centrofacial type, and mixed type. RESULTS: The PF and mixed type were more common than the centrofacial type. Peripherofacial involvement was related to a high scalp PASI score, whereas centrofacial involvement was associated with a high whole body PASI score. Disease duration before facial lesion development was less for the PF. Early onset of disease and extensive treatment were more frequent for centrofacial type than PF. The relationship between facial and body psoriasis progression was less strong for PF. LIMITATIONS: This was a retrospective study conducted at a single location, and the severity and extent of psoriasis were evaluated only once, at first visits. CONCLUSION: Facial psoriasis can be categorized into 3 different types. Peripherofacial involvement might be a consequence of severe scalp psoriasis, whereas centrofacial involvement might be a marker of severe body psoriasis. Thus, it would help during the treatment of patients with psoriasis to consider that different lesion distributions may reflect different clinical characteristics.