Psoriasis is a chronic autoimmune condition that accelerates the life cycle of skin cells, causing a rapid buildup on the skin’s surface. This process leads to the formation of thick, scaly, and often itchy patches known as plaques. When these plaques appear on the eyelids, they present as red, discolored, and scaly patches of skin that cause significant irritation, dryness, and discomfort. Eyelid involvement is a high-impact site for psoriasis due to its visibility and sensitivity. Treating psoriasis here requires immediate medical consultation and a highly cautious approach, as the skin’s delicate nature and proximity to the eye pose unique safety challenges.
Why Eyelid Psoriasis Requires Special Care
The skin on the eyelids is exceptionally thin, making it significantly more susceptible to the side effects of topical medications compared to skin on other parts of the body. This thinness means that any medication applied is absorbed much more readily and deeply into the tissue. The close proximity of the treated area to the ocular surface introduces a serious risk of medication migrating into the eye itself.
Misuse or prolonged application of certain topical treatments, particularly potent corticosteroids, can be dangerous to eyesight. These strong medications can cause serious ocular complications, including the development of cataracts and glaucoma. These risks are why any treatment regimen for eyelid psoriasis must be strictly monitored by a dermatologist or ophthalmologist.
Standard over-the-counter psoriasis treatments formulated for the body, such as those containing coal tar or salicylic acid, should never be used near the eyes. Ingredients intended for thicker skin are too harsh for the eyelids and can cause severe irritation or even chemical injury to the eye. The goal of treating eyelid psoriasis is to manage the inflammation and scaling while minimizing the risk of adverse effects to the eye and the surrounding delicate skin.
In addition to potential ocular damage, long-term use of stronger topical steroids can lead to skin atrophy, or thinning of the skin, around the eyelids. This atrophy can cause easy bruising, changes in pigmentation, and the development of dilated surface blood vessels. Due to these dangers, the use of topical treatments in this area must adhere to specific, short-term limits prescribed by a healthcare provider.
Prescription Topical Treatment Options
For managing acute flare-ups of eyelid psoriasis, a physician may temporarily prescribe very low-potency topical corticosteroids. These are generally the weakest steroids available, such as hydrocortisone 1% or desonide 0.05% cream. The use of these medications is typically limited to very short durations, often no more than one or two weeks, to minimize the risk of side effects like skin thinning or ocular damage.
When topical steroids are used, it is necessary to follow the doctor’s instructions precisely, applying only a tiny amount directly to the affected skin and avoiding the eyes completely. While some studies suggest that low-potency steroids applied to the face may not increase the incidence of glaucoma or cataracts, caution is still advised, especially with chronic use. The decision to use any steroid must weigh the benefits of rapid symptom relief against the potential for short- and long-term complications.
For longer-term management and maintenance therapy around the eye, topical calcineurin inhibitors (TCIs) are frequently the preferred option. These non-steroidal medications, which include tacrolimus and pimecrolimus, work by reducing the immune system’s activity in the skin to decrease inflammation. TCIs are particularly beneficial for sensitive areas like the eyelids because they do not carry the same risk of causing skin atrophy as topical steroids.
Though these agents were initially approved for treating atopic dermatitis, their use for psoriasis in sensitive areas is a common and accepted “off-label” practice in dermatology. Tacrolimus and pimecrolimus can be used for longer periods without the side effects associated with steroid use, such as glaucoma or skin thinning. While they may cause temporary irritation or a burning sensation when first applied, this usually subsides within about a week of use.
When topical treatments are insufficient, particularly for severe or widespread psoriasis, systemic or biologic therapies may be considered. Systemic treatments affect the entire body and can include oral medications or injectable biologics. These treatments work by targeting specific immune pathways that drive the inflammatory process of psoriasis, and their use may lead to the improvement of eyelid symptoms as part of overall disease control.
Safe Supportive Care and Symptom Management
Daily supportive care is a fundamental part of managing eyelid psoriasis, focusing on reducing irritation and maintaining the skin barrier. Patients should use mild, fragrance-free cleansers and moisturizers formulated for sensitive skin to prevent irritation and dryness. Products that are ophthalmologist-tested are particularly beneficial for the eye area.
Non-irritating emollients, such as thick creams or petroleum jelly, can be applied gently to the plaques to help hydrate the skin and soften scales. These moisturizing products help to reduce the dryness and discomfort associated with the condition. It is important to apply these products with extreme care, using a gentle, dabbing motion to avoid friction and trauma to the delicate skin.
Avoiding common environmental and behavioral triggers can also help prevent flare-ups around the eyes. Patients should avoid rubbing or scratching the eyelids, which can worsen inflammation and increase the risk of infection. During flares, it is advisable to temporarily stop using makeup and harsh soaps, as these products can further irritate the skin.
Cool compresses can be applied to the eyelids to help soothe inflammation and reduce itching without the use of medication. A warm, damp cloth can also be placed over the closed eyes for a short time to help loosen any scales that may be stuck to the eyelashes. For persistent dryness or irritation of the eye itself, artificial tears may be used to provide relief.
If a person experiences any signs of eye pain, sudden vision changes, or severe, persistent redness, they should seek immediate medical attention from a dermatologist or ophthalmologist. Psoriasis can sometimes be associated with more serious eye conditions, such as uveitis, which is inflammation inside the eye, and needs prompt, specialized management. Regular eye exams are recommended for individuals with psoriasis to monitor for any associated ocular disorders.