Inverse psoriasis is a rare form of psoriasis that doesn’t really look anything like what we think of as psoriasis. First of all, it doesn’t show up in the usual places where we normally see psoriasis. Second, it is not treated as well with the usual treatments implicated in psoriasis.
Inverse psoriasis begins as small lesions or red spots in the folds of the skin. This can include the area under the breasts, the armpits, the folds in the groin, the skin under the fat folds of the abdomen, and the folds in the urogenital folds. It can also appear in the cleft of the buttocks or in the space between the buttocks and the cheeks. Because inverse psoriasis requires these skin folds, it is much more common for people who are overweight.
Unlike plaque psoriasis, inverse psoriasis does not accumulate as many scales and, instead, the lesions appear confluent, well-defined and very red. It can be bright red and may have soft patches of skin that are itchy and sometimes painful. Any time a patient with this disease rubs their skin, such as walking with their thighs rubbing together or rubbing the skin in their armpits, psoriasis worsens and is aggravated by movement. People find it painful to move when the disease becomes severe.
Fungal infections of the skin are commonly associated with inverse psoriasis, but it is not known if the fungal infection triggers psoriasis or if the irritated, sweaty skin of psoriasis causes the fungal infection. To properly treat such a condition, it is important to treat both the yeast infection with a yeast infection cream or yeast infection lozenge, and inverse psoriasis with the various inverse psoriasis treatments available.
The treatment of inverse psoriasis is difficult due to the high sensitivity of the affected skin. Steroid ointments and creams tend to be very effective; however, you cannot use steroid occlusive dressings because they only cause the moisture to build up even more. If you use too much of the steroid cream, your skin may become too thin and you may have excessive stretch marks on your skin. Because the skin involved in inverse psoriasis is already too thin, there can be systemic side effects and increased skin side effects as a result of using a steroid cream that is too strong or used for too long. Diluted topical steroids, such as 1-2 percent hydrocortisone cream, can be used in conjunction with an antifungal cream.
Dovonex or calcipotriene is another topical agent that can work well for inverse psoriasis, but can be very irritating to this delicate skin and should be used with caution. The same goes for coal tar preparations and anthralin cream. Skin irritation can only make psoriasis worse. Some topical treatments include Protopic and Elidel, which have also been approved for eczema.
Systemic treatment is the best form of treatment in patients with extensive skin involvement and skin irritation. Systemic therapy involves biologics given by injection every two weeks that act directly on the immune system to reduce its activity. Enbrel and Humira are examples of biologics that are injected and can dramatically change the appearance and symptoms of inverse psoriasis.
