Psoriasis

AAD 2022: Psoriasis revealed after chemical peels of face


Facial psoriasis has been unmasked in patients undergoing medium-depth chemical peeling for severe sun damage, according to Australian researchers presenting at AAD 2022. 

A retrospective audit of 81 patients who underwent the chemical peels at two major teaching hospitals in NSW in 2018-2022 found 12.3% had prolonged erythema beyond one month.

This is consistent with other evidence that prolonged erythema occurs in about 11% of patients following deep chemical peels.

The study, presented at the American Academy of Dermatology 2022 Annual Meeting, said likely causes of prolonged erythema have variously been reported as retinoid use before and/or after a chemical peel, exacerbation of pre-existing skin disease, genetic susceptibility, contact dermatitis, contact sensitisation, and alcohol consumption.

Patients were initially managed with a variety of treatments including oral and topical corticosteroids, oral antibiotics, and topical calcineurin inhibitors.

However on further investigation, patients were found to have other signs and symptoms consistent with palmoplantar, scalp and nail psoriasis and psoriatic arthritis. 

Resolution of facial erythema was achieved in patients who adhered to local and/or systemic treatment regimens for moderate-to-severe psoriasis including acitretin and methotrexate, monoclonal antibodies, and UVA phototherapy. Only one patient declined systemic treatment and follow-up. 

The study, by Dr Liang Joo Leow, from St Vincent’s Private Hospital and the University of NSW, said responses to treatment beyond resolution of facial erythema included clearance of extrafacial psoriasis and improvement in arthralgia.

The findings suggest that facial psoriasis should be considered in patients with prolonged erythema who do not respond to conventional therapies.  

“Our data support facial psoriasis as the primary cause of prolonged erythema in the context of medium, and possibly also deep, chemical peels.”

“Careful history-taking alongside examination and investigation of any sign or symptom of psoriasis form essential work-up prior to medium chemical peels of the face.”

He said the Koebner phenomenon may help explain some of the facial psoriasis in this patient group. As well, the exfoliative effects of chemical peels may uncover underlying facial psoriasis otherwise hidden by severe sun damage.

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