Is facial involvement a sign of severe psoriasis?

Facial involvement in psoriasis receives little attention in standard descriptions of the disease. To our knowledge there has been only one comparison study on the severe of psoriasis between patients with and without facial involvement. The purpose of this study was to define the prevalence and characteristics of facial involvement, and to compare the severity of psoriasis between patients with and without facial involvement. A total of 120 consecutive patients with psoriasis seen in our polyclinic between January 2005 and May 2005 were enrolled in this study. They were categorized into patients with and without facial psoriasis. The age of onset, family history, nail and joint involvement, associated skin or systemic disease, history of phototherapy or systemic therapy, extent of involvement, the effect of external factors and Psoriasis Area and Severity Index (PASI) scores were recorded. Patients who had PASI score lower than 5 were excluded from the study. Patients with facial psoriasis frequently report early onset, or long duration, and tend to have more extensive disease and more intensive treatment. The patients with facial psoriasis have more positive family histories and Koebner responses. The nail, joint involvement and pruritus did not appear to influence the presence of facial psoriasis. Facial involvement in psoriasis is much more common than generally appreciated. This study demonstrates the significance of facial involvement in psoriasis. In view of its significance as a marker of severe disease, extra care must be taken during treatment to ensure clearance from this site.