Inverse Psoriasis: Symptoms, Causes, Treatment

What are the symptoms of inverse psoriasis?

Inverse psoriasis, also known as flexural psoriasis, is a form of psoriasis that occurs in the folds of the skin, such as under the breasts, in the armpits, around the groin, and between the buttocks. The symptoms of inverse psoriasis include:

1. Red, inflamed patches: The affected areas typically appear red and inflamed.
2. Smooth skin: Unlike other forms of psoriasis that may have a scaly appearance, the patches in inverse psoriasis are usually smooth.
3. Shiny lesions: The skin in the affected areas may appear shiny.
4. Moisture: Due to the location in skin folds, the lesions may remain moist.
5. Pain and irritation: The affected areas can be sore, tender, and prone to irritation, especially where skin rubs against skin or clothing.
6. Fungal or bacterial infections: The moist environment in skin folds can increase the risk of secondary fungal or bacterial infections.

If you suspect you have inverse psoriasis, it is important to consult with a healthcare provider for an accurate diagnosis and appropriate treatment.

What are the causes of inverse psoriasis?

The exact cause of inverse psoriasis, like other forms of psoriasis, is not fully understood, but it is believed to result from a combination of genetic, immune system, and environmental factors. Here are some potential causes and contributing factors:

1. Genetic Predisposition: A family history of psoriasis increases the likelihood of developing the condition, including inverse psoriasis.
2. Immune System Dysfunction: Psoriasis is an autoimmune disorder where the immune system mistakenly attacks healthy skin cells, leading to rapid skin cell turnover and the formation of lesions.
3. Skin Friction and Irritation: Inverse psoriasis commonly occurs in skin folds where friction, sweat, and moisture can irritate the skin, potentially triggering or worsening the condition.
4. Infections: Fungal and bacterial infections in skin folds can act as triggers for inverse psoriasis.
5. Hormonal Changes: Hormonal fluctuations, such as those occurring during puberty, pregnancy, or menopause, can influence the onset or exacerbation of psoriasis.
6. Stress: Emotional and physical stress is known to trigger psoriasis flare-ups in some individuals.
7. Obesity: Excess weight can lead to more skin folds and increased friction, which may contribute to the development and severity of inverse psoriasis.
8. Environmental Factors: External factors like heat, humidity, and sweating can exacerbate inverse psoriasis, particularly in skin folds where moisture accumulates.
9. Certain Medications: Some medications, such as lithium, beta-blockers, and antimalarials, have been linked to triggering or worsening psoriasis.

It’s important to note that the triggers and contributing factors can vary from person to person. If you suspect you have inverse psoriasis, a healthcare provider can help identify specific triggers and recommend appropriate treatment options.

How is the diagnosis of inverse psoriasis made?

The diagnosis of inverse psoriasis is typically made based on a combination of clinical evaluation, medical history, and physical examination. Here are the steps involved in making a diagnosis of inverse psoriasis:

1. Physical examination: A dermatologist or healthcare provider will examine the affected area to look for characteristic signs of inverse psoriasis, such as:
   • Red, inflamed, and scaly skin lesions
   • Lesions that are typically symmetrical and bilateral (occurring on both sides of the body)
   • Lesions that are located in areas where skin folds or creases are present (e.g., armpits, groin, under the breasts, behind the knees)
2. Medical history: The healthcare provider will ask questions about the patient’s medical history, including:
   • Previous history of psoriasis or family history of psoriasis
   • Symptoms such as itching, burning, or stinging in the affected area
   • Duration and pattern of symptoms
3. Clinical features: The healthcare provider will look for specific clinical features that are typical of inverse psoriasis, such as:
   • Lesions that are flat or slightly elevated
   • Lesions that are thickened and scaly
   • Lesions that are often accompanied by inflammation and redness
4. Differential diagnosis: The healthcare provider will rule out other conditions that may resemble inverse psoriasis, such as:
   • Eczema (atopic dermatitis)
   • Fungal infections (e.g., candidiasis)
   • Bacterial infections (e.g., impetigo)
5. Skin scrapings or biopsies: In some cases, a skin scraping or biopsy may be performed to confirm the diagnosis. A skin scraping can help identify fungal or bacterial infections, while a biopsy can provide histopathological evidence of psoriasis.
6. Other diagnostic tests: In some cases, additional tests may be ordered to rule out other conditions or to confirm the diagnosis, such as:
   • Blood tests to check for inflammatory markers (e.g., erythrocyte sedimentation rate)
   • Imaging tests (e.g., X-rays) to rule out other conditions that may cause similar symptoms

It’s important to note that a definitive diagnosis of inverse psoriasis can only be made by a healthcare provider with expertise in dermatology. If you suspect you may have inverse psoriasis, it’s best to consult with a dermatologist for an accurate diagnosis and treatment plan.

What is the treatment for inverse psoriasis?

Inverse psoriasis is a type of psoriasis that appears as a red, inflamed, and often painful rash in the folds of the skin, such as the armpits, groin, and buttocks. The treatment for inverse psoriasis typically involves a combination of topical and systemic therapies, as well as lifestyle modifications. Here are some common treatments for inverse psoriasis:

Topical treatments:

1. Corticosteroid creams or ointments: These are usually prescribed to reduce inflammation and relieve symptoms.
2. Vitamin D analogues: These medications, such as calcipotriene (Dovonex), help slow down skin cell growth and reduce inflammation.
3. Salicylic acid: This beta hydroxy acid can help exfoliate the skin and unclog pores.
4. Coal tar products: These can help reduce inflammation and slow down skin cell growth.
5. Topical retinoids: These are derived from vitamin A and can help slow down skin cell growth and reduce inflammation.

Systemic treatments:

1. Oral medications:
   • Methotrexate: This is often used to treat moderate to severe inverse psoriasis. It works by slowing down skin cell growth and reducing inflammation.
   • Acitretin (Soriatane): This is an oral retinoid that can help slow down skin cell growth and reduce inflammation.
   • Cyclosporine: This immunosuppressant medication can be used to treat severe inverse psoriasis by reducing the immune system’s response.
2. Biologics:
   • Humira (adalimumab): This medication targets a protein called TNF-alpha, which is involved in inflammation.
   • Enbrel (etanercept): This medication also targets TNF-alpha and is used to treat moderate to severe inverse psoriasis.

Lifestyle modifications:

1. Moisturizing: Keeping the affected areas moisturized with a gentle, fragrance-free moisturizer can help reduce irritation and dryness.
2. Avoiding irritants: Avoid using harsh soaps, fragrances, or other products that can irritate the skin.
3. Wearing loose clothing: Wearing loose-fitting clothing can help reduce friction and irritation in the affected areas.
4. Staying cool: Keeping the body cool by wearing light, breathable clothing and avoiding hot showers or baths can help reduce inflammation.

Phototherapy:

1. UVB phototherapy: Exposure to specific wavelengths of ultraviolet B light can help reduce inflammation and slow down skin cell growth.
2. Narrowband UVB therapy: This is a targeted form of UVB therapy that is specifically designed for treating inverse psoriasis.

It’s important to note that each person’s experience with inverse psoriasis is unique, and it may take some trial and error to find the right combination of treatments that work best for you. It’s essential to consult with a dermatologist or healthcare provider to develop a personalized treatment plan.