Treatment of Eyelid Psoriasis

First-Line Treatment Approach

The American Academy of Dermatology recommends using low-potency topical corticosteroids, such as hydrocortisone, combined with calcipotriene for initial treatment of psoriasis on the eyelid, with careful monitoring for complications 1, 2, 3
Apply low-potency topical corticosteroids once daily for 2-4 weeks maximum during acute flares, and avoid mid-to-high potency corticosteroids on eyelids due to high risk of skin atrophy and other complications 1, 2, 4, 5

Tacrolimus 0.03% or 0.1% ointment is an excellent steroid-sparing option for eyelid psoriasis, particularly for chronic management, with a 89% response rate in managing periocular inflammatory conditions 6, 7
For adults, use tacrolimus 0.1% ointment once daily to external eyelids and lid margins, and for children ages 2-15 years, use tacrolimus 0.03% ointment 6, 7

The treatment algorithm recommends starting with hydrocortisone 1% ointment once daily to eyelid skin, adding calcipotriene ointment in the evening if tolerated, and using emollients/moisturizers liberally to reduce scaling 1, 3, 4
Taper corticosteroid to every-other-day or weekend-only application after 4 weeks, and continue calcipotriene daily 1, 3, 5

Arrange ophthalmology review within 4 weeks when using tacrolimus on eyelids, and refer immediately if patient develops eye pain, vision changes, or signs of corneal involvement 6, 7
Baseline and periodic IOP measurement is recommended if using any corticosteroids periocularly 7, 8

Never use potent or superpotent corticosteroids on eyelids, and avoid continuous daily corticosteroid application, even with low-potency agents 5
Do not combine salicylic acid with calcipotriene, and avoid anthralin and coal tar on eyelids due to severe irritation risk 1, 2, 4, 5

Explain that psoriasis is chronic and requires long-term management with intermittent therapy, and warn about potential for skin atrophy and telangiectasia with prolonged corticosteroid use on eyelids 5, 9
Emphasize importance of emollient use to maintain skin barrier, and inform patients that tacrolimus may cause initial burning sensation that typically improves with continued use 4, 1, 6, 7

Refer for routine assessment if mild-to-moderate disease does not respond to topical treatment and lid hygiene, as recommended by the British Journal of Dermatology 10