What is Psoriasis?
Psoriasis is a skin disease resulting from an overgrowth of skin cells on a particular body part. It presents as itchy, dry, and scaly patches. According to the National Psoriasis Foundation, the condition affects about 8 million Americans.1
Common symptoms of psoriasis include:
- Rashes that flare up
- Redness in the affected area
- Peeling skin/scales
- Dry, cracked skin patches
- Itching or inflammation
Psoriasis can manifest differently depending on your skin tone:
- Light-skinned people may have pink or red patches with silvery-white scales
- Fair skin may show salmon-colored with silvery-white scales
- Darker skin tones may show violet- or brown-colored patches with grayish scales
Can Psoriasis Develop on Eyelids?
According to the National Psoriasis Foundation, 50% of psoriasis patients experience facial symptoms. Eyelids are among the commonly affected parts.2
Eyelid skin is very tender. When affected by psoriasis, it can be challenging to manage. In severe cases, eyelid psoriasis may progress to the eye, causing inflammation, dryness, or even blindness.
What Causes Eyelid Psoriasis?
The cause of eyelid psoriasis is not well understood, but scientists associate it with family history, lifestyle, and immune system dysfunction. Common triggers include:
- Hormonal changes, especially in women (puberty, menopause, etc.)
- Certain medications such as lithium, NSAIDs, and antimalarial medicines
- Skin injuries such as cuts and sunburns (Koebner phenomenon)
- Environmental factors such as allergens
Symptoms of Eyelid Psoriasis
Eyelid psoriasis can affect your quality of life due to its location. Common symptoms of eyelid psoriasis include:
- Skin discoloration and scaling around the eyelids
- Dry and cracked skin that may bleed
- Irritation, swelling, itching, and pain in the affected area
- Trouble blinking or opening and closing your eyelids
- Dandruff-likes scales sticking to the eyelashes
- Pain during eye movement
- Dry eyes
Severe inflammation, such as psoriatic arthritis (PsA), may cause swelling and inward or outward turning (ectropion) of the eyelids.
If the eyelid edges turn inwards (entropion), eyelashes will rub against the eyeball, causing irritation and discomfort. Outward turning will prevent the eye from closing, causing dryness, irritation, and other complications.
5 Ways to Treat Psoriasis on Eyelids
Psoriasis treatment aims to reduce symptoms and slow down cell overgrowth and buildup.
Below are the standard treatment options:
1. Topical Treatments
Creams and ointments containing corticosteroids and other ingredients are available for application on psoriatic patches. However, use them cautiously, as some may harm the sensitive eyelid skin.
Commonly prescribed topical treatments include Protopic (tacrolimus) and Elidel (pimecrolimus). These are approved for short-term treatment of eczema (eyelid dermatitis), but doctors use them as off-label treatment options for psoriasis.5
Other topical medications include:
- Corticosteroids, e.g., hydrocortisone
- Synthetic vitamin A
- Vitamin D analogues, such as calcipotriene (Sorilux) and calcitriol (Vectical)
- Retinoids such as Tazarotene
Phototherapy (light therapy) involves exposing the affected area to natural or artificial ultraviolet A or B (UVA or UVB).6 According to research, UVB penetrates the skin cells and slows cell growth.
Although UVB from natural sunlight is effective against psoriasis, it's not recommended for everyone. The safest options for UVB include the following:
- UVB phototherapy. It uses UVB units with UV lamps or LED bulbs.
- Excimer laser. An FDA-approved device that uses laser beams to target the affected areas.
- Home UVB phototherapy. A convenient and economical option that requires a consistent application schedule.
UVA is considered ineffective for psoriasis but works in combination with light-sensitizing agents (psoralens). This therapy is known as psoralen plus ultraviolet A, or PUVA.7 PUVA slows down cell overgrowth and clears psoriasis symptoms for varying periods.
Phototherapy should not be used for extended periods and should be applied under medical supervision. Overexposure to UV rays can damage the outermost layers of your eyelid skin, causing more problems.8
Biologics is a new treatment that targets specific immune system components, reducing the severity of psoriatic symptoms.9 The medications are made from living cells in a lab or through a biological process.
There are four classes of biologics for psoriasis:
- Blockers of tumor necrosis factor-alpha (TNF-alpha), such as etanercept (Enbrel) and adalimumab (Humira)
- IL-17 inhibitors, such as brodalumab (Siliq), secukinumab (Cosentyx), and ixekizumab (Taltz)
- IL-23 inhibitors, such as risankizumab-rzaa (Skyrizi), and guselkumab (Tremfya)
- Interleukin 12 and 23 (IL-12/23) inhibitors, such as ustekinumab (Stelara)
Biologics are considered safer than medications like methotrexate, which significantly suppresses the immune system.
Biologics are currently recommended for people with moderate to severe psoriasis. More research is underway to introduce better and safer biologics into the market.
4. Systemic Medications
Systemic medications are oral or injectable drugs prescribed in cases of severe psoriasis or when ointments have failed. They can be used alone or with other therapies, such as phototherapy and biological therapy (biologics).10
Systemic medications are prescribed on a short-term basis (during flare-ups) due to the potential adverse effects. Your doctor will advise you on the best systemic treatment for your psoriasis and the usage timelines.
Common systemic medications for psoriasis include:
- Oral retinoids, e.g., acitretin (Soriatane), made from vitamin A
These medications slow down the immune system, affecting how skin cells grow and shed.
5. Warm Compress
Gently apply a warm, damp cloth to loosen the scales and remove flakes stuck on the eyelids. Use over-the-counter eyelid cleaners, like OCuSOFT® and TheraTears® SteriLid Antimicrobial, for stubborn scales.
What are the Risks of Eyelid Psoriasis?
People with eyelid psoriasis are at a greater risk of developing the following conditions:
- Psoriatic arthritis (pain, stiffness, and swelling on the skin and around the joints)
- Hypertension (high blood pressure)
- Heart disease/stroke
- Eye conditions, including conjunctivitis, blepharitis, glaucoma, uveitis, etc.
- Temporary skin discoloration after plaques heal, i.e., post-inflammatory hypopigmentation or hyperpigmentation
- Autoimmune diseases, such as celiac disease, sclerosis, and Crohn's disease
- Type 2 diabetes
- Mental health issues, such as low self-esteem and depression
Can Eyelid Psoriasis Cause Vision Loss?
Eyelid psoriasis is challenging to treat due to the skin's sensitivity around the eye. However, if left untreated, the condition can affect other eye parts, causing notable damage and potential vision loss.
Psoriasis-related uveitis and iritis are common causes of blindness. For this reason, close monitoring through regular eye examinations is recommended.11
Tips for Living With Eyelid Psoriasis
Eyelid psoriasis can interfere with everyday life. It can affect your self-esteem, relationships, sleep comfort, vision clarity, and more.
Thankfully, there are ways to reduce impact, especially during flare-ups:
- Wash the affected lids and lashes using clean water, eyelid wipes, and a gentle soap like baby shampoo.
- Use artificial tears to relieve itching instead of rubbing, which can cause more irritation.
- Know the risks and effects of certain creams and ointments on the tender skin of your eyelids to avoid complications.
- Attend regular eye exams to ensure the recommended treatments are working well and not harming you.
- Manage baseless misconceptions such as, "Psoriasis can be spread through skin contact." You can educate those who hold this belief to prevent further stigma to you and others.
- Talk to someone who understands the condition and can provide clarity, including possible breakthroughs in psoriasis treatment.
Can You Prevent Psoriasis?
Psoriasis cannot be prevented. However, there are ways to manage psoriasis symptoms and reduce flare-ups:
- Use moisturizers to prevent dryness
- Avoid medications such as beta-blockers and lithium, which are known to cause flare-ups
- Take care of your skin and avoid picking or scratching the scales
- Stay out of dry, cold weather
- Avoid scraps, cuts, and irritating bumps on your skin
- Treat your skin to some sunlight
- Avoid stress
- Eat a well-balanced diet
- Use a humidifier in the house
- Psoriasis is a skin disease characterized by an overgrowth of skin cells, forming itchy, dry, and scaly patches on the affected area.
- Psoriasis can manifest differently depending on your skin tone.
- The condition can affect different body parts, including the eyelids, with a potential for vision loss if left untreated.
- The cause of psoriasis is not well understood, but scientists associate it with family history, immune system dysfunction, and triggers.
- Common treatments for psoriasis include phototherapy, topical treatments, systemic medications, and biologics.
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