Inverse psoriasis is a type of psoriasis that is more common in overweight people or those with deep skin folds. Lesions are usually smooth, shiny, and red with well-defined borders. These lesions can cause cracks (called fissures) to develop in the skin creases, which may bleed.
Inverse psoriasis often appears:
In the armpits
In skin folds around the genitals and between the buttocks
Under the breasts
In the groin
Sometimes, inverse psoriasis is mistaken for a different skin problem such as a fungal infection. Because of its location, inverse psoriasis may lead to:
Irritation from rubbing and sweating
Yeast or fungal infections
Sexual problems due to discomfort or embarrassment
Treatment for Inverse Psoriasis
Your doctor may prescribe topical medications, which can be quite effective. However, some medicines may irritate your skin if you have inverse psoriasis. Talk to your doctor if this happens.
Corticosteroid creams, lotions, solution, sprays, foams, and ointments
Low-dose/potency hydrocortisones are effective anti-inflammatory medications. Doctors often prescribe these first.
Do not use a plastic dressing to cover these areas, since bandages trap moisture. If you have a yeast or fungal infection, your doctor may prescribe an anti-yeast or anti-fungal medication combined with the corticosteroid.
Be careful about overusing corticosteroids, especially stronger ones. Overuse can result in stretch marks or skin thinning in areas that already tend to have thin skin. It can also make your psoriasis worse. Apply these medications exactly as your doctor directs.
This synthetic vitamin D compound slows production of skin cells and reduces inflammation. It is often effective but may cause irritation. If it does, talk to your health care provider.
Pimecrolimus (Elidel) cream and Tacrolimus (Protopic) ointment
These drugs have been approved by the FDA for eczema. Some dermatologists suggest these drugs for treating psoriasis on skin folds. The FDA recommends short-term use because of concerns about possible cancer risks.
Castellani’s Paint (Castederm)
Your doctor may suggest this product, which is “painted” onto your skin. It helps dry moist psoriasis lesions in skin folds. This is available by prescription from a compounding pharmacy. You may also buy it over the counter. Powder can also help keep moist areas dry.
Other topical medications
Medications such as coal tar and anthralin can irritate skin folds. Your doctor may recommend diluting the creams with a softening emollient. Or you may apply them for short periods and then wash them off. Your doctor may suggest using these products alone or combined with a topical corticosteroid.
Ultraviolet light therapy is often used to treat psoriasis, but because inverse psoriasis can occur in areas that are difficult to reach, you may need to have light therapy in the doctor’s office.
If you have severe inverse psoriasis, your doctor may recommend treatments that affect the whole body to ease your symptoms. Some of these drugs, such as Soriatane (acitretin), Rheumatrex, Trexall (methotrexate), and Neoral, Sandimmune (cyclosporine), are taken orally. Other biologic treatments, such as Humira (adalimumab), Amevive (alefacept), Enbrel (etanercept), Remicade (infliximab), and Stelara (ustekinumab), are given by injection or infusion.