Inverse Psoriasis: Causes, Symptoms and Treatment

Inverse psoriasis is a skin condition that causes red and inflamed lesions in the skin folds of the body. It is also known as intertriginous psoriasis.

The location and appearance of these lesions set inverse psoriasis apart from other types of psoriasis. Inverse psoriasis appears as a red, smooth, and shiny lesions found in skin folds of the body.

The armpits, groin, under the breasts, and other skin folds are particularly at risk from inverse psoriasis.

People who are overweight or who have deep skin folds are more likely to develop inverse psoriasis. People with inverse psoriasis are more likely also to have other types of psoriasis elsewhere on the body.

Causes of inverse psoriasisa

The cause of psoriasis is complicated. Physicians believe that people inherit the genes needed to cause psoriasis. Having the gene does not mean for sure that someone will develop the condition, however.

It is believed that a person who has the gene for psoriasis must also be exposed to a specific trigger in order to get the disease.

The triggers of psoriasis can vary from person to person. What causes a flare-up in one person, may not affect another.

Some events are more likely to cause a flare in a number of people.

These include:

•       Severe stress

•       Injuries, such as injections, sunburn, or a scratch - this is known as the Koebner phenomenon

•       Certain medications: Drugs that have been linked to psoriasis include lithium, antimalarials, Inderal, Quinidine and Indomethacin

•       Infections that affect the immune system, especially strep infections or other common respiratory infections

Other triggers that have not been proven through research may include allergies, diet, or even the weather.

It can be helpful for a person keep a journal of their outbreaks to help them identify the specific triggers that may affect them.

A person with a history of psoriasis should inform their dermatologist of all of their medications, in case one of them is behind their symptoms.

Symptoms of inverse psoriasis

Psoriasis is marked by scaly, inflamed, and red patches of skin on the body.

However, the lesions associated with inverse psoriasis often appear smooth and shiny. They do not have the scaly texture normally associated with psoriasis.

This is because the patches occur in the skin folds. In the presence of warmth, moisture, and friction, the appearance of the skin and lesions change.

Complications

The lesions tend to occur in areas of the body where the skin is thin and sensitive. These areas are more at risk of infection.

Skin folds also tend to be warm, moist areas that are prone to yeast or other bacterial infections.

If the skin becomes injured or opened, it is more likely to become infected.

In addition, the medications given to treat inverse psoriasis can make the skin thinner, and this increases the risk of infection.

Long-term use of these medications can also cause stretch marks.

Diagnosis

A physician will normally diagnose psoriasis using the patient's description of the symptoms, a physical exam, and an inspection of the lesions.

If the lesions occur in an area where the skin rubs against itself, it may be inverse psoriasis.

The doctor may take a culture to rule out other conditions with similar symptoms.

Treatment of inverse psoriasis

Treating inverse psoriasis can be difficult due to the thin and sensitive skin found in the areas where it occurs.

The steroid creams usually used to treat psoriasis are effective. Side effects may occur because the skin in the affected area will be thin. This increases the absorption of the steroids.

Unwanted effects include further thinning of the skin and the appearance of stretch marks.

Due to the higher risk for bacterial, fungal or yeast infections, some doctors will also test for these infections. If there is an infection, it will need treatment.

In addition to topical steroids, some physicians will recommend using tacrolimus or pimecrolimus. These medications are used to treat eczema, but they have also been successful in managing psoriasis in some patients.

In some severe cases, ultraviolet B light therapy may be used with topical creams, in order to manage the symptoms.

Home care

Careful hygiene and self-care can help manage the symptoms. This may improve the appearance of psoriatic patches.

Good practice includes:

•       Regular bathing with warm water and mild soaps

•       Avoiding harsh soaps and hot water

•       Adding bath oil, Epsom salts, or colloidal oatmeal to a bath for extra moisture

•       Using a moisturizer every day, or several times a day in especially cold and dry weather

•       Practicing regular stress management techniques

•       Avoiding alcohol, as it may reduce the effectiveness of some treatments

•       Getting a few minutes of sunlight each day

•       Losing weight if necessary

Itching can be a big problem for people with inverse psoriasis. There are several anti-itch and cooling lotions that are available over the counter to relieve these symptoms. Antihistamine drugs can also relieve itching symptoms.

It is also helpful to learn what provokes an individual's symptoms and to avoid those triggers where possible.