Inverse psoriasis is a rare form of psoriasis that actually doesn’t look much like what we think of as psoriasis at all. First of all, it doesn’t show up in the usual places we normally see psoriasis. Secondly, it is not as well treated by the usual treatments involved in psoriasis.
Inverse psoriasis begins as small, red lesions or spots in the folds of the skin. This may include the area beneath the breasts, the armpits, the creases in the groin, the skin beneath the fat folds of the abdomen, and the creases in the urogenital folds. It can also appear in the gluteal cleft or the space between your buttocks cheeks. Because inverse psoriasis requires these skin folds, it is much more common for people who are overweight to get it.
Unlike plaque-type psoriasis, inverse psoriasis does not build up as many scales and instead, the lesions look confluent, well-demarcated and very red. It can be bright red in color and can have smooth patches of skin that are itchy and sometimes painful. Anytime a patient with this disease rubs his or her skin together as in walking with thighs rubbing together or rubbing the skin in the armpits together, psoriasis worsens and is aggravated by the movement. People find it painful to move around when the disease becomes severe.
Yeast infections of the skin are commonly associated with inverse psoriasis but it is not known whether the yeast infection triggers the psoriasis or whether the irritated and sweaty skin from the psoriasis causes the yeast infection. In order to properly treat such a condition, it is important to treat both the yeast infection with a yeast infection cream or yeast infection pill, and the 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 it only makes the moisture build up even more. If you overuse the steroid cream, the skin can thin out too much and you can get excess stretch marks in the skin. Because the skin involved in inverse psoriasis is already too thin, there can be systemic side effects and increased skin side effects that occur as a result of using steroid cream that is too strong or is used for too long. Diluted topical steroids such as 1-2 percent hydrocortisone cream can be used along with an antifungal cream.
Dovonex or calcipotriene is another topical agent that can work well for inverse psoriasis but it can be very irritating to this delicate skin and should be used with caution. The same holds true for coal tar preparations and anthralin cream. Irritation of the skin can only make the 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 a lot of skin involvement and irritation of the skin. Systemic therapy involves biologics that are given in injectable form every other week and that act directly on the immune system to reduce its activity. Enbrel and Humira are examples of biologics that are given by injection and can produce a drastic change in the appearance and symptoms of inverse psoriasis.