Recognizing the Signs & Symptoms of Inverse Psoriasis or Jock Itch

What are Inverse Psoriasis and Jock Itch?

Inverse psoriasis is a rare form of psoriasis, which is a chronic autoimmune disorderInverse psoriasis affects the skin folds, including the folds of skin around your genitals.(1,2,3) Due to the location, many people tend to often confuse inverse psoriasis with jock itch or other skin infections caused by fungus. Psoriasis is a chronic autoimmune disease that tends to develop when your body’s immune system is unable to function properly and mistakes your healthy cells for foreign objects.(4,5) Due to this, the body starts to attack these cells in an attempt to defend itself against a perceived threat. According to the estimates of the National Psoriasis Foundation, there are between 21 to 30 percent of people living with psoriasis who may go on to develop inverse psoriasis.(6,7)

Inverse psoriasis affects the areas of the body where the skin rubs against the skin, including the armpits, groin, or the inner thigh regions. People with inverse or genital psoriasis have red, painful areas of skin in the folds of the body, especially parts that are prone to sweat or where there is increased skin-to-skin friction. You are more likely to develop inverse psoriasis if you are overweight or obese or you already have another form of psoriasis.

Jock itch, on the other hand, is the common name used to refer to a type of fungal infection known as Tinea cruris. It also typically affects the groin area, buttocks, or the thighs.(8) Jock itch is not an autoimmune disease, and people are more likely to develop jock itch if they sweat a lot. This is why jock itch is quite common in athletes.(9) Jock itch causes a round-shaped, itchy rash near the groin area, on the inner thighs, and on the buttocks. Friction, along with sweat, can also contribute to jock itch. People who are overweight or obese are also at an increased risk of getting jock itch.

Unlike psoriasis, the cause of which is not clearly understood, jock itch is caused by fungi known as dermatophytes. These fungi are very similar to those that cause ringworm.

Recognizing the difference between inverse psoriasis and jock itch can make it easier for you to seek treatment.

Symptoms of Inverse Psoriasis

The symptoms of inverse psoriasis can be very similar to those of jock itch. Both these conditions can cause itchy and red skin in the groin region, though there are some key differences that can help you tell the two conditions apart. Let us look at the symptoms of inverse psoriasis first.

Psoriasis occurs in different forms, and the most common skin symptoms associated with psoriasis include raised, red patches of skin that sometimes have a silvery scale. Bleeding or itching can also occur.(10)

These raised skin patches are known as plaques, and they can affect any part of your body.(11) Plaque psoriasis tends to commonly involve the following parts:

People with inverse psoriasis are most likely to find the folded areas of the body getting affected or parts of the body where the skin touches the skin. It is common for many doctors even to mistake this type of psoriasis for being a fungal infection like jock itch. This is because of the common development of inverse psoriasis in the groin area.

Some of the common symptoms of inverse psoriasis include:

  • Red areas that may appear shiny
  • Smooth areas of redness in the armpits, under breasts, or groin region
  • Pain and tenderness
  • Patches of inflamed skin at the skin folds – there may be no flaking

A rash caused by inverse psoriasis is usually smooth and can even be shiny. This is one of the telltale signs of inverse psoriasis since a rash caused by jock itch is generally accompanied by flaking or peeling skin.(12)

Symptoms of Jock Itch

Jock itch is also known to cause redness in the groin region, along with burning, itching, and overall discomfort and irritation. You are also likely to see scaling, which can either appear on the buttocks or the thighs.(13)

One of the main ways by which doctors tell the difference between jock itch and other skin conditions is by looking at demarcation. Fungal infections tend to cause fine, elevated scales towards the reddish edge of the lesions. The center of the lesion also becomes brownish, and it may also become less scaly and red.

Inverse psoriasis does not have this scale, and if it does, then also it is more evenly distributed over the entire patch of skin. Inverse psoriasis also tends to appear more evenly red as compared to jock itch because of this distinction.(14)

Some of the symptoms of jock itch that are similar to inverse psoriasis include:

  • Cracked skin
  • Red skin, especially in the creases of the groin – redness primarily spreads outwards.
  • Half-moon shaped or circular areas of redness
  • Skin peeling or flaking
  • Burning or stinging
  • Itching

What are the Triggers for Inverse Psoriasis and Jock Itch?

There are different factors that trigger jock itch outbreaks and flare-ups of inverse psoriasis.

Triggers for a flare-up of inverse psoriasis can vary from person to person and are likely to include the following:

  • High levels of stress
  • Infections and illnesses such as respiratory infections or strep throat
  • Certain medications like antimalarials, lithium, and some blood pressure drugs.

Many people with inverse psoriasis suspect that diet and allergies can also be potential triggers for their flare-ups, but there is no evidence to prove this yet.(15,16)

Jock itch is caused by a fungus that lives on the skin. Therefore, any trigger that provides the fungus with a better environment for growth can trigger jock itch. Some of these triggers may include:

  • Heavy sweating due to sports, exercise, or hot weather.
  • Moist skin or skin that has not been dried properly.
  • Friction created by wearing tight clothes or skin rubbing against the skin.
  • Sharing towels, clothes, or exercise equipment with others.

Another risk factor for developing inverse psoriasis is genetics. If someone in your family has any form of psoriasis, your chances of having it increases. Stress and smoking are also known risk factors of triggering a flare-up of inverse psoriasis.

Jock itch and inverse psoriasis also share certain common triggers. For example, both these conditions are more likely to develop in parts of the body that are sweaty or experience frequent friction. They are also more commonly observed in people who are obese or overweight. Being overweight or obese is a risk factor because the fungus is able to live in the skin folds and multiply rapidly since this fungus thrives in warm and moist places.

In some cases, weather can act as a trigger for a flare-up of inverse psoriasis or make a person more prone to developing jock itch.(17)

What is the Treatment for Inverse Psoriasis and Jock Itch?

Treating both jock itch and inverse psoriasis involves managing the delicate skin in such sensitive parts of the body. Gentle treatment options for both conditions include home remedies, along with both over-the-counter and prescription medications.

There is no cure for psoriasis, but there are treatments that can help you manage the symptoms.(18) These include:

  • Topical creams
  • Oral medications
  • Biologics
  • Other therapies that help control your symptoms

These psoriasis treatments will help you get relief from your symptoms and also address the underlying immune function. So even though they won’t cure the condition completely, the likelihood of experiencing flare-ups goes down.

You can also treat jock itch with topical creams and oral medications. Some of these medications are even available over-the-counter at any local pharmacies.(19)

Practicing good personal hygiene is essential in the management of both conditions. Take daily showers with gentle soap and lukewarm water. After the shower, make sure to dry the skin properly with a clean towel.

Maintaining a healthy weight will also alleviate the symptoms of both jock itch and inverse psoriasis.

Here are some home remedies that can benefit people with inverse psoriasis:

  • Avoid and manage your stress before it gets out of hand.
  • Take note of and avoid any trigger allergens or foods.
  • Moisturize regularly with a gentle moisturizer – you can always ask your doctor for a recommendation.
  • Try taking baths with colloidal oatmeal, gentle bath oils, or Epsom salt.
  • Stay away from very hot water.
  • Don’t use soap that contains harsh chemicals or irritants.
  • Get some exposure to sunlight every day.

Some home remedies for people who experience frequent outbreaks of jock itch are as follows:

  • Change your clothes at the earliest after sweating.
  • Take a shower immediately after doing sports or exercising.
  • Wear clean underwear every day.
  • Use powder in the groin area to help absorb any extra moisture.
  • Keep the buttocks, groin, and thigh area dry and clean.
  • Treat any other fungal infections, for example, athlete’s foot.
  • Do not share sports equipment or clothes with others.
  • Wipe down any athletic equipment after use.
  • Avoid wearing tight-fitting clothes.

In cases of psoriasis where the home remedies do not help, your doctor may recommend the next level of treatments, including:

  • Prescription topical medications
  • Steroid creams and ointments
  • UVB light therapy
  • Systemic treatments that affect the entire body.

OTC antifungal creams, powders, or sprays are usually recommended for the treatment of jock itch, and in severe cases, your doctor may recommend a prescription-strength antifungal medication.

Some people with inverse psoriasis may also develop a fungal infection around the groin area. Your doctor is likely to recommend an antifungal medication to treat the infection.

Conclusion

Regardless of whether you have inverse psoriasis or jock itch, it is important that you make an appointment with your doctor if your symptoms last longer than ten days or if they worsen and do not respond to any over-the-counter treatments. Getting an accurate diagnosis is the first step to start your treatment and start feeling better.

It is possible to manage both jock itch and inverse psoriasis with healthy lifestyle changes and proper treatments. Discovering the right treatment for inverse psoriasis may take some time and some trial and error. Your doctor will work with you to find what works best for your condition.

Cases of jock itch, on the other hand, are usually mild to moderate and can be resolved without needing to go to a doctor. However, if necessary, your doctor will prescribe antifungal medication for treati`ng jock itch.

References:

  1. Syed, Z.U. and Khachemoune, A., 2011. Inverse psoriasis. American journal of clinical dermatology, 12(2), pp.143-146.
  2. Omland, S.H. and Gniadecki, R., 2015. Psoriasis inversa: a separate identity or a variant of psoriasis vulgaris?. Clinics in dermatology, 33(4), pp.456-461.
  3. Micali, G., Verzì, A.E., Giuffrida, G., Panebianco, E., Musumeci, M.L. and Lacarrubba, F., 2019. Inverse psoriasis: from diagnosis to current treatment options. Clinical, cosmetic and investigational dermatology, 12, p.953.
  4. Weisenseel, P. and Reich, K., 2015. Inverse psoriasis. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete, 66(6), pp.408-412.
  5. De Rosa, G. and Mignogna, C., 2007. The histopathology of psoriasis. Reumatismo, pp.46-48.
  6. Guglielmetti, A., Conlledo, R., Bedoya, J., Ianiszewski, F. and Correa, J., 2012. Inverse psoriasis involving genital skin folds: successful therapy with dapsone. Dermatology and therapy, 2(1), pp.1-9.
  7. Merola, J.F., Li, T., Li, W.Q., Cho, E. and Qureshi, A.A., 2016. Prevalence of psoriasis phenotypes among men and women in the USA. Clinical and experimental dermatology, 41(5), pp.486-489.
  8. Brodin, M.B., 1980. Jock Itch. The Physician and sportsmedicine, 8(2), pp.102-108.
  9. Luke, A. and d’Hemecourt, P., 2007. Prevention of infectious diseases in athletes. Clinics in sports medicine, 26(3), pp.321-344.
  10. Parrish, L., 2012. Psoriasis: symptoms, treatments and its impact on quality of life. British journal of community nursing, 17(11), pp.524-528.
  11. Griffiths, C.E. and Barker, J.N., 2007. Pathogenesis and clinical features of psoriasis. The Lancet, 370(9583), pp.263-271.
  12. Griffiths, C.E. and Barker, J.N., 2007. Pathogenesis and clinical features of psoriasis. The Lancet, 370(9583), pp.263-271.
  13. Crissey, J.T., 1998. Common dermatophyte infections: a simple diagnostic test and current management. Postgraduate medicine, 103(2), pp.191-205.
  14. Milam, E.C., Meehan, S.A. and Ramachandran, S., 2016. Well-Demarcated, Scaly Plaques. Jama, 315(5), pp.508-509.
  15. Naldi, L., Parazzini, F., Peli, L., Chatenoud, L., Cainelli, T. and PSORIASIS STUDY GROUP OF THE ITALIAN GROUP FOR EPIDEMIOLOGIC RESEARCH IN DERMATOLOGY, 1996. Dietary factors and the risk of psoriasis. Results of an Italian case–control study. British Journal of Dermatology, 134(1), pp.101-106.
  16. Wolters, M., 2005. Diet and psoriasis: experimental data and clinical evidence. British Journal of Dermatology, 153(4), pp.706-714.
  17. Balato, N., Di Costanzo, L., Patruno, C., Patrì, A. and Ayala, F., 2013. Effect of weather and environmental factors on the clinical course of psoriasis. Occupational and environmental medicine, 70(8), pp.600-600.
  18. Greaves, M.W. and Weinstein, G.D., 1995. Treatment of psoriasis. New England Journal of Medicine, 332(9), pp.581-589.
  19. Ramsey, M.L., 1990. How I manage jock itch. The Physician and sportsmedicine, 18(8), pp.63-72.

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