All About Inverse Psoriasis Causes, Symptoms & treatment

What Is Psoriasis?

Psoriasis is a long-term, immune-mediated skin disease. An overactive immune system makes skin cells multiply much faster than normal, and the extra cells build up into inflamed, often scaly patches.

Psoriasis is not contagious, so it can't pass from person to person. It has several types based on the size, location and look of the patches, and treatment varies with the type. One of these types is inverse psoriasis.

What Is Inverse Psoriasis?

Inverse psoriasis, also called intertriginous or flexural psoriasis, forms in the skin folds of the body. Because it sits in folds, it is sometimes called hidden psoriasis.

It usually shows up in the armpits, under the breasts, in the groin and genital area, and between or under the buttocks. That is the "inverse" of plaque psoriasis, which favors elbows, knees and the scalp.

According to the National Psoriasis Foundation, about 21% to 30% of people with psoriasis develop inverse psoriasis. It is more common in people who are overweight or have deep skin folds.

The Common Causes of Inverse Psoriasis

Like other forms of psoriasis, inverse psoriasis is driven by the immune system, with genes and environmental factors both playing a role. Friction and sweat in skin folds can irritate the patches, which is why this type settles in folds.

Extra body weight creates deeper skin folds with more rubbing and moisture, so overweight people are at higher risk. Many people inherit genes linked to psoriasis, and symptoms appear after exposure to a trigger.

Common trigger factors may include:

Sunburn
Scratches on skin
Stress, anxiety
Hormonal imbalance
Obesity
Some medication like lithium and antimalarial tablets
Infections, such as strep throat
Smoking
Alcohol
Weather changes

What Are The Common Symptoms Of Inverse Psoriasis?

Patches look smooth and shiny, usually without the thick scale of plaque psoriasis. They appear red on lighter skin and purple, brown or darker than the surrounding skin on skin of color.

The patches can itch, burn or hurt, and lesions in the genital area can make sex uncomfortable. Moisture, sweating and friction tend to make symptoms worse.

How Can It Be Treated?

General Care

Inverse psoriasis has no cure, but treatment can control it and symptoms may clear for long periods. Try to identify and avoid your triggers.

If you're overweight, losing weight can reduce friction in skin folds. Keep the folds clean and dry, wear loose, breathable clothes, and avoid picking or scratching the patches.

Use sunscreen when you go out. A powder recommended by your clinician can help absorb moisture in skin folds.
Medical Treatment

See a dermatologist for diagnosis and a treatment plan. Skin in folds is thin and absorbs medicine easily, so treatment is chosen with care.

The goal is to reduce redness, inflammation and itching. Treatment depends on how widespread the psoriasis is, where it is, and how you respond.

- CORTICOSTEROIDS

Your dermatologist may prescribe a mild-strength topical corticosteroid. The strongest steroid creams are generally avoided in skin folds because they can thin the skin there. Steroids reduce inflammation, redness, and burning in these patches.

Use them only as long as your clinician advises. Steroid tablets are not a standard treatment for psoriasis, and stopping systemic steroids can trigger a flare.

Non-steroid creams and ointments are also effective, and your clinician may combine treatments.

- PHOTOTHERAPY

Another option is phototherapy, the medical term for light therapy. Narrowband ultraviolet B (UVB) light can slow skin cell growth in some people with inverse psoriasis, though skin folds can be hard to reach with light. Multiple sessions are planned for this phototherapy depending on the severity of the lesions.

- SYSTEMIC AND BIOLOGIC DRUGS

Because psoriasis is driven by the immune system, your doctor may recommend oral medicines or injectable biologics that calm the immune response. These are used when topical treatment isn't enough.

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