What is Inverse Psoriasis?
Inverse psoriasis is a type of psoriasis affecting the skin folds. Psoriasis is an autoimmune skin disorder where the body’s own immune system attacks the body thinking of it as a foreign object. Patients will have rapid multiplication of the skin cells resulting in different skin symptoms including silvery and scaly lesions with red patches, and in some cases, areas of pus-filled sores. This condition is known as psoriasis. Patient will have different symptoms depending of the type of psoriasis. In inverse psoriasis, patient will have skin lesions in the skin folds where the skin rubs against skin. Some of the common areas where inverse psoriasis occurs include under a woman’s breasts, arms, underarms, inner thigh area or groin, umbilicus, vulva, penis, between the buttocks and around the anus.
Inverse psoriasis is also called intertriginous psoriasis. Patients having inverse psoriasis will also commonly have plaque psoriasis, which is another type of psoriasis. The lesions of inverse psoriasis are mostly restricted to smaller patches; whereas, the lesions of plaque psoriasis commonly affect larger parts of the body.
What are the Causes of Inverse Psoriasis?
The cause of inverse psoriasis is a defect in the patient’s immune system. However, there are secondary causes of inverse psoriasis, such as friction and moistness (sweating) in the skin folds, which lead to development of inverse psoriasis. Patients who are overweight and have plaque psoriasis are at an increased risk for developing inverse psoriasis, as the excess body weight also has excess skin and skin folds that are deeper than normal.
What are the Symptoms of Inverse Psoriasis?
- Inverse psoriasis patient has lesions or rash on the skin, which is red, smooth and shiny in appearance.
- In other types of psoriasis patient has crusting skin scales and pustular spots; whereas in inverse psoriasis, the rash or the lesions will not be dry or raised.
- Patient also will commonly develop a yeast infection in the skin folds along with inverse psoriasis. This is due to the moist environment in the skin folds.
- The inflamed patches in inverse psoriasis are moist to the touch. Inverse psoriasis patient experiences itching or irritation or both in parts that are affected by inverse psoriasis.
- There may be presence of a crease or a crack in the depth of the skin fold.
- The red lesions may cover large areas inside the skin folds.
Is there a Cure for Inverse Psoriasis?
As of now, there is no cure for inverse psoriasis or any other form of psoriasis. Inverse psoriasis and its symptoms can be successfully managed with treatment.
How is Inverse Psoriasis Treated?
- Topical Medicines: Topical creams can be applied to the affected areas and help in reducing the inflammation and discomfort, which is the main aim of treatment of inverse psoriasis. As the sensitive folds are in sensitive regions, care is needed in the type of medication used. Low strength steroid creams help in reducing inflammation; however, they have side effects which include increased sensitivity and thinning of the skin. Patient needs to be observed carefully and the dosage needs to be adjusted to manage the side effects when using a topical steroid. Other than topical steroids, non-steroidal topical applications which can be used to treat inverse psoriasis include calcineurin inhibitors, pimecrolimus and tacrolimus. If patient has fungal or yeast infection with inverse psoriasis or is prone to them, then anti-fungal and anti-yeast agents are added to the topical steroids.
- Phototherapy (Light Therapy): This treatment is beneficial in patients suffering from moderate to severe inverse psoriasis. Phototherapy helps in slowing the growth of skin cells in some patients with psoriasis including inverse psoriasis. Treatment using phototherapy consists of light box, which produces artificial UVB rays that are aimed at the affected regions for a specified amount of time. It is important to note that in phototherapy there may be temporary worsening of inverse psoriasis before it starts to get better.
- Systemic Medicines: If topical medications or phototherapy are not improving the inverse psoriasis, then patient may be prescribed systemic drugs. Biologics is a type of systemic drug which alters the function of the immune system to stop it from attacking the body. Biologics may be administered as an injection or intravenous infusion. Patient may also be told to continue with topical treatments or phototherapy along with the use of biologics.
Some of the other systemic medicines used in treatment of inverse psoriasis include sandimmune and methotrexate. These medicines modify the immune system so that there is a reduction in the action of certain skin cells.
Lifestyle Modifications in Inverse Psoriasis
Psoriasis in any form can be very uncomfortable, distressing and embarrassing for the patient. To combat the symptoms of inverse psoriasis, patients should take steps to make themselves as comfortable as possible. Patient should wear loose clothes made of natural fibers, such as cotton which allow the skin to breathe. Tight clothes will cause more friction with increased rubbing of skin against skin. Loose clothing will not rub against the skin and will be easy on the skin lesions. Loose clothes will also prevent moisture from getting trapped in the skin folds. Medicated powder can applied to the affected areas to keep the skin dry. Other than powders, patient can also use baking soda, corn starch or zinc oxide to apply in the skin folds to absorb the moisture.