Inverse Psoriasis: What Does It Look Like?

Psoriasis is an autoimmune disease condition that affects the skin where the immune system attacks the own body. The skin cells that have psoriasis, proliferate excessively faster than normal skin cells. Psoriasis forms a red or pink colored patch on light skin tones, a silvery or white colored patch on normal skin tones and a dark brown, grey or violet patch on dark skin tones. It may depend on the type of the psoriasis. There are several types of psoriasis and inverse psoriasis is one of them. Inverse psoriasis is a disease that affects the skin as same as psoriasis. But an inverse psoriasis rash is shiner than a psoriasis rash.

Overview of Inverse Psoriasis

Inverse psoriasis is also called as intertriginous psoriasis or hidden psoriasis which affects the skin folds. It occurs in the areas of the body where the skin rubs over the skin. Although there isn’t a cure for inverse psoriasis, there are treatments that help to lessen the symptoms like discoloration and itching. 21-30% of the people who have psoriasis are affected by inverse psoriasis. Moreover, those with deep skin creases are more likely to experience it.

What Does Inverse Psoriasis Look Like?

Inverse psoriasis in the groin and buttocks area, displaying red patches with white scales, and symptoms of a sore, itchy, red rash

Inverse psoriasis presenting as red, itchy patches with white scales located in the groin and butt crack area.

Inverse psoriasis can be characterized by the red or pink lesions on lighter skins and purplish or brown lesions on darker skins. These lesions may develop on sweaty, moist and hidden skin folds.

There is another type of psoriasis called plaque psoriasis that typically forms scales on dry and open areas of skin like knuckles, elbows, scalp and knees. Unlike plaque psoriasis, inverse psoriasis invades the hidden skin folds such as armpits, under the breasts, behind the knees, between belly folds, groins, belly button, between buttocks, in inner thighs and around penis, scrotum or vulva. Inverse psoriasis is common on sensitive areas of skin that rub over the other.

Symptoms of Inverse Psoriasis

The most common symptoms of inverse psoriasis are as below.

• A smooth, shiny and a discolored rash on skin folds. (pink or red on light skin tones and purple or brown on dark skin tones)
• Pain and itching on the rashes.
• Fissures on lesions.
• Wetness at the infected sites.

Causes and Risk Factors

Since inverse psoriasis is an autoimmune disorder, it is caused by an abnormality in the immune system of the body. However, the symptoms of inverse psoriasis are triggered by friction and moisture on skin in the form of perspiration.

Obese or overweight people are at a higher risk of developing inverse psoriasis, because they may have deeper skin folds.

In addition to that people who have stress, drink alcohol, smoke, have vitamin D deficiency and who take medicines infrequently are also more likely to get inverse psoriasis.

And also, when one form of a psoriasis is developed, that person is more prone to have inverse psoriasis. If one parent of an individual has psoriasis, his risk of getting inverse psoriasis is 15% whereas it is 75% if both the parents have psoriasis.

Diagnosis

Inverse psoriasis can be diagnosed by the following methods.

• Clinical examination: The affected areas will be examined by the healthcare professionals and search for typical symptoms related to inverse psoriasis. They will also inquire about the family history and use of any medication or product before the flare-up.
• Diagnostic tests: The healthcare professionals may do several tests including allergy test, biopsy test and blood test to determine any other factors that might be the source of the particular rash.

Treatment Options

There are several treatment options available for inverse psoriasis. Consulting a dermatologist may help in selecting the best treatment option according to the requirement.

• Topical treatments: These are the creams, ointments, lotions, gels, sprays, foams and oils that are applied on skin surface. Applying corticosteroid preparations may reduce inflammations caused by inverse psoriasis. According to some dermatologists, tacrolimus ointment can be used to treat inverse psoriasis. Coal tar and anthralin are also used to treat inverse psoriasis but they must be diluted or applied only for a short time on skin and washed off. Calcipotriene is a topical form of a synthetic vitamin D3 derivative that slows down the skin cell proliferation excessively.
• Systemic treatments: These are also called as biologic medicines. They are made up of living cells that target specific regions of the immune system that cause inverse psoriasis. These drugs are administered intravenously such as TNF alpha inhibitors, IL-23 inhibitors and TYK2 inhibitors etc.
• Phototherapy: Ultraviolet (UV) light treatment is effective for many kinds of psoriasis conditions. As inverse psoriasis affects the regions that are difficult to reach on skin, visiting the dermatologist is a must to get phototherapy.
• Oral medicines: These are the capsules or tablets taken by mouth. They are used in the cases of severe inverse psoriasis. Oral medicines include methotrexate, cyclosporine and acitretin etc. Dapsone was found to be effective against inverse psoriasis around genital skin folds.
• Lifestyle Changes: Taking an oatmeal bath, dressing cool and dry cloths, showering frequently, maintaining a healthy body weight and applying ointments like petroleum jelly are some of the daily changes that help in calming the sensitive areas of the skin.

Prevention and Management

Inverse psoriasis cannot be prevented in any way. Inverse psoriasis may appear and disappear throughout the life of an individual. Even those with severe psoriasis can only experience symptom reduction with treatment. Followings are some tips for the proper management of psoriasis.

Preventive measures:

Try to avoid activities that triggers inverse psoriasis, like sweating and friction. Maintaining a healthy body weight and keeping the outer environment cool may help in reducing perspiration. Avoid stressful occasions. Avoid the foods that trigger inverse psoriasis.

Daily management:

Apply coconut oil or any other cream or ointment to moisturize and hydrate the skin. Choose gentle soaps and products that are free of dyes, perfumes and alcohol. Wear loose and cotton underwear and clothes which will absorb skin moisture and let the affected areas to breathe.

Living with Inverse Psoriasis

It can be physically and emotionally challenging to live with inverse psoriasis. However, there are steps to lessen the effects. Individuals with psoriasis typically dress loosely and stay away from activities that make them sweat heavily. Loose tops will not irritate the sensitive skin and may keep away moisture from being trapped in skin folds. Powdering the affected areas with corn starch, baking soda and zinc oxide will help in absorbing moisture. Some useful counselling sessions may aid to cope with inverse psoriasis emotionally. Regular check-ups with a dermatologist are required to select the best treatment option for the prevailing condition of the inverse psoriasis.

Inverse Psoriasis: Frequently Asked Questions (FAQs)

How common is inverse psoriasis?

The prevalence of inverse psoriasis in various populations is not well documented. But in general, white people are more likely to get psoriasis. Accordingly, Asians experience a lower incidence of inverse psoriasis than other ethnic groups.

How do I know if I have inverse psoriasis?

In contrast to ordinary psoriasis, this inflammation is wet rather than dry which primarily affects the skin folds such as groin, armpits, under the breasts and behind the knees etc.

Is Vaseline good for inverse psoriasis?

If you know that you are going to move the affected area, Vaseline may be useful to reduce inflammation. Because, Vaseline aids in shielding the skin from friction caused by motion.

Can inverse psoriasis be cured?

Inverse psoriasis cannot be cured. There could be periods when the rash disappears and when it flares up. The symptoms may alleviate with treatments.

Can I have sex if I have an inverse psoriasis flare-up on my genitals?

Although inverse psoriasis is not a sexually transmitted infection (STI), it may still appear to be a STI. Being open and sincere with your partner during flare-up is a smart move. You might feel pain or discomfort during intercourse if you are affected with inverse psoriasis on your genitalia. Condoms and sexual lubricants can help reduce pain, discomfort and itching. Cleanse and pat your genitalia after having sex and apply any anti-psoriasis cream.