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Inverse psoriasis, also known as flexural psoriasis and intertriginous psoriasis, refers to a skin condition characterized by well-defined, scaly, reddish patches or plaques in skin folds.
Inverse psoriasis largely differs from psoriasis in multiple aspects, including symptoms, treatment, and affected areas. (1) Since inverse psoriasis can be difficult to treat, it is vital to consult a doctor and get appropriate timely treatment. Knowing the symptoms and risk factors can help in effectively managing the condition.
Causes of Inverse Psoriasis
Inverse psoriasis is generally caused by problems in factors that influence skin cell division, including the immune system and enzymatic levels. In addition, psoriasis is said to have a hereditary or genetic component.
Triggers for Inverse Psoriasis
Multiple factors can trigger the onset or aggravate the symptoms of inverse psoriasis, including the following:
- Skin damage or trauma such as cuts, scrapes, and sunburn
- Excessive alcohol intake or tobacco use
- Use of certain medications such as beta-blockers, antimalarial drugs, and lithium
- Skin dryness due to weather changes
- Hormonal fluctuations associated with pregnancy and menopause
- Sudden withdrawal from systemic or oral corticosteroids
Symptoms of Inverse Psoriasis
Inverse psoriasis generally manifests the following symptoms:
- Red, shiny, or silvery scaly lesions on the skin, especially in skin folds, such as in the armpits, under the breasts, and groin
- Skin fissure
- Burning sensation
- Skin abrasions around the lesions
Treatment for Inverse Psoriasis
The treatment for inverse psoriasis includes the use of both topical and oral medications. The doctor may recommend different combinations of treatments depending on the intensity and symptoms.
The topical treatments suggested for inverse psoriasis management are:
- Moisturizers (emollients). The use of moisturizers helps keep your skin hydrated and therefore lower scale buildup. It also helps in the absorption of other topical remedies. The effectiveness of moisturizers in improving skin conditions associated with psoriasis has been proved in studies. (2)
- Corticosteroids. Topical corticosteroids help control the inflammation associated with psoriasis. These are available in the form of oils, creams, sprays, lotions, gels, foams, and ointments. Corticosteroids may either be prescribed as a single treatment or in combination with other treatments. (3)
- Vitamin D analogues. Vitamin D analogues can help lower skin cell growth rate and may be prescribed in combination with topical corticosteroids. (4)
- Crude coal tar. Coal tar helps in the treatment of inverse psoriasis by inhibiting the action of enzymes and blocking new cell production. It is generally used in combination with oral drugs and phototherapy. The use of coal tar is especially effective in difficult-to-treat body parts, such as the intertriginous area, scalp, soles, and palms. (5)
- Calcineurin inhibitors. The topical calcineurin inhibitors that can be effective in the treatment of psoriasis include tacrolimus and pimecrolimus. (6) However, these are used short term only as they can potentially increase the risk of cancer.
- Salicylic acid. Salicylic acid acts as a mild exfoliant that can help remove scale buildup, debris, and excess keratin from the skin. It also encourages the skin to self-exfoliate. However, salicylic acid is not recommended for children as there is a risk of systemic absorption and toxicity. (7)
You may be prescribed certain oral medication in addition to topical treatments, depending on the severity of your condition. The oral medicines generally given for inverse psoriasis treatment include:
- Retinoids: Retinoids, such as etretinate and acitretin, are vitamin A derivatives that are shown to be effective in the treatment of inverse psoriasis. (8) Treatment with systemic retinoids is more effective when used with phototherapy.
- Immunosuppressants: Immunosuppressants help in controlling the immune response that triggers inverse psoriasis. However, these drugs must be used with caution as they can cause acute myelosuppression in some rare cases, which can be life threatening. (9)
- Biologic drugs: Biologics are a new-age treatment that targets a specific component of the immune system to help control inflammation. These drugs are safe, effective, and tolerable but are, however, a high-cost treatment. (10)
Aside from oral and topical treatments, phototherapy or light therapy is commonly used in the treatment of inverse psoriasis. It involves exposing the skin to controlled ultraviolet light, helping treat the skin lesions.
Phototherapy has been effective in treating stable psoriatic lesions, including those found in the arms, legs, trunk, and scalp. (11)
Diagnosing Inverse Psoriasis
The diagnosis of inverse psoriasis often can be done based on the physical examination of the skin. In cases where the symptoms are not common, the doctor may order a skin biopsy to understand the disease progression.
Lifestyle Changes for Managing Inverse Psoriasis
While there are multiple treatments available for inverse psoriasis, it is equally important to make lifestyle changes to control the condition better and prevent flare-ups. The following self-care measures may help in the management of inverse psoriasis:
- Improve your diet. Include fruits, vegetables, probiotics, vitamin D supplements, fish oil, and omega-3 polyunsaturated fatty acids (PUFAs) in your diet to help manage the symptoms of inverse psoriasis. (12)
- Moisturize regularly. Moisturizing your skin helps prevent skin dryness and cracks. Moisturizers also help soften the scales and control itching.
- Apply skin wraps. Applying cream to the affected skin before bedtime and wrapping it up using plastic wrap can help lock in the moisturizer, aiding in better absorption. Make sure to wear another covering layer over the plastic wrap, such as socks or gloves.
- Take an oatmeal bath. Soaking your body in an oatmeal bath is highly effective in hydrating and soothing the skin. This can also help loosen the scales. You can either use over-the-counter oatmeal bath products or simply add 1 cup of oatmeal to lukewarm bathwater.
- Bathe daily. It is suggested to soak your body in lukewarm bathwater containing bath oils and Epsom salts for 15 minutes daily. You can also use mild soaps with oils and added fats. This helps in controlling inflammation and removing the scales.
- Avoid scratching the skin. You must avoid scratching the skin as it can cause irritation and bleeding, even increasing the risk of infections.
- Refrain from consuming alcohol or smoking. The use of alcohol or cigarettes can render your treatments ineffective, so it is best to avoid them.
- Do not use chemical-based skin products. It is best to avoid soaps, body washes, or fragrances that contain artificial colors, scents, and other chemicals as these can exacerbate the symptoms of inverse psoriasis.
There are several measures that you can take to prevent the onset of inverse psoriasis, especially if you have a genetic tendency to develop the condition. The following tips may help prevent flare-ups:
- Reduce stress. Stress is a common trigger for inverse psoriasis. Therefore, practicing stress management techniques such as meditation and balancing treatments may help prevent the onset of inverse psoriasis. (13)
- Maintain a healthy weight. Since obesity is linked with an increased risk of inverse psoriasis, maintaining a healthy weight may prevent its onset.
- Wear cotton fabrics. It is suggested to avoid synthetic fibers with poor sweat-absorbing properties to prevent sweat buildup on the skin. This is especially recommended for undergarments. It is best to use cotton or linen undergarments as they absorb sweat quickly.
- Avoid prolonged exposure to water. Excessive showering or bathing or spending time in the water for long periods, especially hot water, can strip your skin of the natural oils. This increases the risk of fissures and skin irritation and, therefore, inverse psoriasis. Therefore, you must limit your water time.
- Avoid other psoriasis triggers. It is important to be mindful of what causes your inverse psoriasis to flare up. These triggers can include skin injuries, sun exposure, and stress.
When to See a Doctor
It is vital to consult your doctor on the first signs of inverse psoriasis and get timely treatment. You can also visit your doctor even if you do not have the symptoms yet but have a family history of inverse psoriasis to avoid its development.
In addition, follow up with your doctor regularly and get a checkup if the condition does not improve despite treatment or worsens and spreads to other body parts that were previously not infected.
Most-Asked Questions About Inverse Psoriasis
Can inverse psoriasis occur in combination with other skin conditions?
It is common for inverse psoriasis to be accompanied by different skin problems such as a yeast infection, fungal infection, cutaneous syphilis, and skin lymphoma.
Are natural treatments effective for inverse psoriasis?
A few natural treatments can help improve inverse psoriasis when used with other self-care measures such as avoiding triggers, moisturizing the skin, and consuming a beneficial diet.
Inverse psoriasis is a skin condition that manifests as lesions and scales that can cause itching and discomfort. Several treatment modalities can be sought to manage the condition. Consult your doctor on appropriate treatment and self-care measures to treat your symptoms. You can also try a few natural therapies upon consulting your doctor.