Background: Psoriasis of the skin is in itself a disturbing disorder both physically and psychologically. However, most often the scaly
plaques can be hidden by clothing. When psoriasis involves the face it can be more disabling and can decrease the patient’s quality of
life. Facial psoriasis is difficult to treat and is associated with severe cutaneous disease. Patients who have a long duration of psoriasis
or early age of onset are more likely to suffer from facial involvement. Facial psoriasis may also be associated with pruritus, psoriatic
arthritis, and with a family history of psoriasis.
Objective: The authors report a case of a female patient with psoriasis with severe cutaneous disease and extensive facial involvement
successfully treated with adalimumab. This 50-year-old Caucasian female had a history of cutaneous psoriasis since 1990 and psoriatic
arthritis since 2005. The patient had associated pruritus and a family history (maternal). Systematic treatment with mycophenolate
mofetil and acitretin proved unsuccessful. The patient also lost efficacy after months of ultraviolet light B and topical psoralen plus
ultraviolet light A phototherapy.
Results: In 2007, the patient was screened and initiated therapy with a monoclonal humanized tumor necrosis factor alpha inhibitor,
adalimumab. She had severe facial and body involvement with a body surface area of 25%, a Psoriasis Area and Severity Index of
20.4 (PASI), and a head and neck psoriasis area and severity index (HNPASI) of 3.6. Photographic documentation was carried out
with improvement noted as soon as 4 weeks with continuing significant response thereafter. No adverse effects were noted. The
patient’s quality of life also improved.
Limitations: Although severe facial psoriasis is rare and associated with only the most extensive and severe psoriatic cases, it is
likely the most psychologically disturbing and cosmetically disrupting to the patient because it cannot easily be covered or concealed.
The authors hope this case can illustrate an excellent therapeutic option for these patients.
Conclusion: Although facial psoriasis is difficult to treat, with newer systemic therapy now available in the form of biologics, patients
now have a hope for this disease, especially devastating when associated with severe and extensive cutaneous involvement. The
case gives promise in a serial photo-documented fashion of the success that can be achieved.
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