Clinical Study of Facial Psoriasis / 대한피부과학회지

BACKGROUND: Many clinicians tend to assume that psoriasis rarely involves the face, and therefore have little interest in facial psoriasis. However, the face is the most important area of cosmetic concern and social activity, and facial involvement of psoriasis is more common than we think. A few reports have even suggested that facial psoriasis could be a marker of severe psoriasis. OBJECTIVE: To investigate the epidemiological and clinical characteristics of facial psoriasis. METHODS: A total of 235 patients with facial psoriasis were enrolled in this retrospective study at the psoriasis clinic, Department of Dermatology, Seoul National University. Epidemiological and clinical data from patient records was collected and analyzed. RESULTS: The most frequent age of onset for facial psoriasis was in the 3rd decade of life. The peak age of onset of facial psoriasis in male patients was in the 3rd and 4th decade of life, whilst for female patients it was in the 3rd decade. Most patients had presented with facial psoriasis before they were 40. The sites of the face most often affected were the upper (73.9%) and lower (46.2%) aspects of the forehead and periauricular area (45.7%). The eyelid, perioral area and nasolabial fold were relatively unaffected. Patients who had scalp-unrelated facial psoriasis presented with a more severe condition than patients who only had scalp-related facial psoriasis. With reference to the extent of psoriasis, 43.8% of patients were moderate cases, whereas 29.6% were mild and 26.6% were severe. With reference to the activity, 40.3% of patients were mild, while 38.5% were moderate and 21.2% were severe. Family history was observed in 39.9% of patients and nail involvement was observed in 27.7% of patients. Only 38.2% of patients had no pruritus, while 16.3% of patients experienced moderate or severe pruritus. CONCLUSION: The present retrospective analysis contributes to our understanding of the clinical characteristics of facial psoriasis.

Treatment of Psoriasis on the Face with Calcitriol Ointment / 대한피부과학회지

BACKGROUND: Facial involvement of psoriasis requires a different approach than that used for typical plaque psoriasis on other skin areas. Calcitriol ointment may improve lesions on the face without atrophy or other local side effects associated with the use of topical corticosteroids. OBJECTIVE: Our purpose was to determine the efficacy and tolerability of calcitriol 3 microgram/g ointment for the treatment of facial psoriasis. METHODS: In the psoriasis clinic of Seoul National University Hospital, a total of 53 patients were treated with calcitriol 3 microgram/g for 8 weeks. Efficacy was evaluated by an investigator's assessment of the area and a severity index score of facial psoriasis at the 2nd, 4th, and 8th week. Global assessment was also determined at the 8th week. RESULTS: A total of 10 patients discontinued prematurely from the study, due to disappearing during follow-up treatment (n=9) and combined use of topical corticosteroids (n=1). The remaining patients showed the following response to treatment; excellent (n=10), good (n=14), fair (n=11), and poor (n=8). After 8 weeks of treatment with calcitriol ointment, clinical improvement was achieved in 81.4% of the patients. Among them, 55.8% showed excellent (23.3%) or good effect (32.5%) with calcitriol ointment. Five patients (11.6%) showed a local adverse reaction such as erythema, exfoliation, or an itching sensation, and 2 patients discontinued treatment due to adverse reactions. However, no patient showed telangiectasia, skin atrophy, or systemic side effects. CONCLUSION: Our results suggest that calcitriol ointment is an effective and tolerable agent for treatment of psoriasis on the face.