Facial psoriasis: Comparison of patients with and without facial involvement

Background: Facial involvement in psoriasis has received little attention in standard descriptions of the disease because the face has long been thought of as rarely involved. A few reports have suggested that facial involvement might be a sign of severe psoriasis. However, there have been no comparison studies on the severity of psoriasis between patients with and without facial involvement. Objective: We sought to evaluate the prevalence and characteristics of facial involvement, and to compare the severity of psoriasis between the patients with and without facial psoriasis. Methods: A total of 282 consecutive patients with psoriasis seen in our psoriasis clinic between May 2002 and November 2002 were enrolled in this study. Results: Facial involvement was a marker of severe psoriasis. The face was often involved for patients with long duration or early onset of disease; with nail or joint involvement; and those requiring more extensive treatments. Patients with facial involvement were found to have more frequent pruritus, positive family history, and history of Koebner response. Conclusion: Early recognition of facial psoriasis as a marker of severe disease can contribute to treatment of patients with psoriasis.