Flare-ups of psoriasis around the eyes pose unique challenges due to the delicate skin and the potential impact on vision. If you experience the typical psoriasis flaking of the skin in the eye area, there are some things you need to know to preserve your health.
In this article, we sum up the symptoms, causes, diagnosis, and treatment of psoriasis on the skin around the eyes, as a guide for patients and their families.
Psoriasis on Skin Around the Eyes
Psoriasis flare-ups near the eyes are rare, but still, when it happens, that's not something a person can control. And the worst part is, they are quite difficult to treat and could be very painful.
Having psoriasis around the eyes may impact a person's quality of life. That's not only due to the physical discomfort but also the social and psychological effects of the inflammation.
After all, the skin around the eyes is thinner and more sensitive than other areas, making it more susceptible to irritation and damage. It's also way harder and riskier to mask or conceal.
Symptoms of Psoriasis Around the Eyes
Symptoms of psoriasis in the eye area may include:
Red and/or inflamed skin
Skin discoloration of the eye area
Scaling and flaking of the skin
Intense itching
Swelling of the eyelids
Pain when blinking or moving eyelids
Curving of the eyelids inward (with lashes potentially poking the eye)
Curving of the eyelids outward (causing dry eyes)
Dryness and cracking of the skin
Possible skin bleeding
Causes of Psoriasis Around the Eyes
The exact cause of psoriasis is not fully understood. It is believed to be a combination of genetic, environmental, and immune system factors.
When it comes to psoriasis on the skin around the eyes, these factors can play a significant role:
Genetic predisposition
Immune system dysfunction
Environmental triggers
Skin damage or injury
A family history of psoriasis increases the likelihood of developing the condition. Also, psoriasis is an autoimmune disorder where the immune system mistakenly attacks healthy skin cells, explaining the random flare-ups.
External factors like stress, smoking, infections, cold weather, and some medications may trigger or intensify psoriasis breakouts close to the eyes. Trauma or injury around the eyes can trigger the development of psoriasis plaques in those already predisposed to the condition. Sunburns and bug bites may also be a flare-up trigger.
Getting a Diagnosis
Identifying psoriasis around the eyes is quicker if you already have the psoriasis diagnosis.
The process may take a while if your eye flare-ups are the first indication you have the condition. That's because the delicate skin around the eyes requires careful assessment to distinguish psoriasis from other skin conditions and eye problems as a possible cause of inflammation.
The diagnostic process involves a medical history check, physical examination, and sometimes a biopsy.
Medical history checks explore the history of symptoms, family history of psoriasis, and any known triggers. Visual inspection of the area by a dermatologist and an ophthalmologist is also a must-do. In some cases, a small skin sample may be taken for microscopic examination to confirm the diagnosis.
Treatment Options for Psoriasis Around the Eyes
Psoriasis doesn't go away on its own. Yet, getting successful treatment can result in remission, sometimes for months or even years.
Managing psoriasis on the skin around the eyes requires a careful approach due to skin sensitivity. Treatment aims to reduce inflammation, relieve symptoms, and prevent flare-ups.
Topical Treatments
Corticosteroids
Calcineurin inhibitors
Low-potency corticosteroids (ex: hydrocortisone) may reduce inflammation and itching but should be used in moderation to avoid skin thinning. Sometimes, corticosteroids are prescribed with other treatments to boost effectiveness and minimize side effects.
Calcineurin inhibitor medications (ex: tacrolimus, pimecrolimus) are non-steroidal creams. They work by modulating the immune response, thus reducing plaque formation without the risk of skin thinning.
These types of topical treatments should ONLY be used if prescribed by a medical professional!
Systemic Treatments
Systemic steroids
Biologics therapies and injectables
TNF Inhibitors: Drugs like etanercept (Enbrel) and adalimumab (Humira) target tumor necrosis factor (TNF), a substance in the body that causes inflammation in psoriasis.
Interleukin Inhibitors: Medications such as ustekinumab (Stelara) and secukinumab (Cosentyx) target specific interleukins involved in the inflammatory process of psoriasis.
Oral Medications: Drugs such as methotrexate, cyclosporine, and acitretin can help control severe or widespread psoriasis.
For more severe cases, systemic treatments may be necessary.
Biologics therapies are injectable medications targeting specific parts of the immune system. Biologics can be highly effective for severe psoriasis.
Preventive Strategies for Psoriasis Skin Flaking
Moisturizers and Emollients
Hydrating Creams
Ointments
Maintaining skin hydration is crucial for managing psoriasis around the eyes. The application of gentle, fragrance-free moisturizers recommended by a dermatologist can improve skin barrier function.
In some cases, thick ointments like petroleum jelly (Vaseline) can also lock in moisture, provide a protective barrier, and soothe irritated skin.
Moisturizers and emollients should ONLY be used if specifically recommended by the dermatologist, who actively monitors your psoriasis!
Lifestyle Changes
Stress Management
Healthy Diet
Good Eye Hygiene
Check-ups with Doctors
Avoiding Triggers
Stress is a known trigger for psoriasis flare-ups. Meditation, yoga, and mindfulness can be coping methods to manage stress levels. A balanced diet rich in antioxidants and anti-inflammatory foods can support overall eye and skin health.
Patients should watch out for changes in their condition and practice good eye hygiene to prevent further inflammation.
Regular visits to a dermatologist AND ophthalmologist are the best way to monitor psoriasis and adjust treatments as necessary.
And lastly, identifying and avoiding known triggers - certain medications or environmental factors can also prevent flare-ups.
Resources:
Ocular Manifestations in Psoriasis Screening (OcMaPS) Questionnaire, Journal of Clinical Medicine
Tear Film and Ocular Surface Assessment in Psoriasis, British Journal of Ophthalmology
Checked by Atanas Bogoev, MD.