Facial psoriasis: comparison of patients with and without facial involvement

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. 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. A total of 282 consecutive patients with psoriasis seen in our psoriasis clinic between May 2002 and November 2002 were enrolled in this study. 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. Early recognition of facial psoriasis as a marker of severe disease can contribute to treatment of patients with psoriasis.