How to Spot and Treat Inverse Psoriasis

Psoriasis is an autoimmune condition that affects your skin. It is a condition where your immune system attacks your own body, causing the skin cells to multiply faster. As a result, you will see various symptoms on your skin, such as red patches, scales, silvery lesions, and sores (sometimes filled with pus).

The symptoms generally appear red or pink with silvery scales on people with light or fair skin tones. People with medium skin tone will notice salmon-colored patches with silvery white scales. Meanwhile, the scales appear greyish with violet or dark brown patches on darker skin tones.

What is Inverse Psoriasis?

While psoriasis appears on skin surfaces or the scalp, inverse psoriasis appears on hidden areas such as skin folds. It appears on areas where the skin rub against each other. The rashes in inverse psoriasis appear in specific areas where the skin folds or creases, like the groin, genitals, or under the breasts.

People with this condition often appear in smaller patches. Also known as hidden psoriasis or intertriginous psoriasis, it is a painful condition affecting 2-6% of people. It can also occur in sweaty areas of the skin, such as the neck, underarms, inner thigh, and buttocks.

How to Spot Inverse Psoriasis?

Inverse psoriasis appears in a red, shiny, or smooth rash on smaller patches. The patches look dark purple and brown on darker skin, and the skin around the area may get darker. While another psoriasis comes with scaly, crusty, and pustular spots on the skin, the rash on inverse psoriasis is not dry or raises. The inflamed part of the skin can be moist to the touch, with irritation and itching in the affected area.

Symptoms of Inverse Psoriasis

You will notice red, shiny, and sometimes moist patches in areas like −

• Armpits

• Under the breasts

• Groin

• Skin folds around buttocks and genitals

If the affected area is moist, you may also risk developing a yeast infection. The skin folds may have red lesions covering a large area. It could be one of the most painful and irritating types of psoriasis due to its tricky locations, such as genitals, armpits, buttocks, and under the breasts.

The affected areas often get tender to touch and further aggravated through rubbing of skin or sweat accumulation. Sometimes the skin in the folds may crack open, leading to bleeding or infection.

The disease may also cause −

• Extreme irritation and pain from rubbing and sweating

• Yeast, fungal, and bacterial infections

• Sexual issues due to discomfort in the area

How to treat Inverse Psoriasis?

Below are the options to treat inverse psoriasis −

Corticosteroids

Corticosteroids are topical medications used to suppress the immune system and reduce inflammation.

This is the first line of treatment prescribed by all doctors. If you test positive for infection, your doctor will prescribe diluted topical steroids and other medicines. For instance, a 1-2% hydrocortisone cream with anti-fungal or anti-yeast medication.

However, you need to be extra cautious and use them as prescribed, as they can cause skin thinning in the skin folds, which are already thin. Stopping the medication can also cause side effects lasting for days or weeks. So you need to ask your doctor to taper down the dosage.

Calcipotriene

It is available in cream or ointment containing a synthetic version of Vitamin D3 that helps slow down the skin cell turnover rate. Since it may irritate the skin, it should be used carefully while treating flexural or inverse psoriasis. It is not generally recommended to use on or around the genitals.

Coal Tar

It is a soothing agent available in gels and ointments for relieving lesions' symptoms. It is also available in liquid that can be added to bath water.

Castellani's Paint

Containing the active ingredient phenol, castellani's paint can be bought over the counter under the brand name Castederm. In some countries, it is available through prescription. It is a liquid painted over the affection area to dry the moist lesions in skin folds.

Dovonex

This drug helps in slowing down skin cell growth and reduces inflammation. It may cause your skin to sting or burn. Contact your doctor if this happens.

Pimecrolimus (Elidel) Cream and Tacrolimus (Protonic) Ointment

Pimecrolimus and tacrolimus ointment is FDA-approved for treating eczema and other skin conditions. Some dermatologists believe it to work well to relieve symptoms of inverse psoriasis. However, as stated by the FDA, these medicines should be used for a short time as they are slightly linked to cancer risks.

Anthralin

It is similar to coal tar, which treats irritated skin folds. It is often used by diluting with moisturizers, applying them on the affected area for a short time, and washing the area. Depending on your condition, doctors might recommend it alone or with a topical corticosteroid.

Phototherapy

Ultraviolet (UV) light therapy works well with several types of psoriasis. Since inverse psoriasis appears in hard-to-reach areas, you may need the help of a professional to get the treatment.

Biologic Medications

Biologics are new-age medicines made from living cells. They target specific cells of the immune system responsible for psoriasis. These drugs are administered through infusion or injection.

Some of the biologic medications used for treating Inverse Psoriasis include −

• Adalimumab (Humira)

• Infliximab-abda (Renflexis)

• ixekizumab (Taltz)

• ustekinumab (Stelara)

• adalimumab-adbm (Cyltezo)

• Infliximab (Remicade)

• Infliximab-dyyb (Inflectra)

• secukinumab (Cosentyx)

• guselkumab (Tremfya)

• etanercept (Enbrel)

Oral Medications

There are oral medications to treat severe inverse psoriasis. This treatment works by affecting the whole body to treat the symptoms. 

Some of the drugs include −

• acitretin (Soriatane)

• apremilast (Otezla)

• Sandimmune

• methotrexate (Rheumatrex, Trexall)

Lifestyle Adjustments

Inverse psoriasis is a painful condition that can affect your physical, emotional, and overall quality of life. However, you can make some lifestyle adjustments to ease your symptoms while in the treatment.

Switch to loose clothing and avoid doing things that cause sweating or friction in the crease of your skin. Fabrics like cotton or natural fibers are great for breathability and help prevent moisture from getting trapped in the skin folds.

You can also use zinc oxide, baking soda, or corn starch to powder the affected area to keep it dry.