What Is Inverse Psoriasis?

Overview

Inverse psoriasis is a chronic skin condition that causes red, inflamed patches of skin in areas of the body that have folds, such as the armpits, groin, and under the breasts. It is also known as intertriginous psoriasis or skin-fold psoriasis.¹ Inverse psoriasis is a chronic inflammatory condition caused by an overactive immune system. One-third of the people living with psoriasis develop inverse psoriasis.² Inverse psoriasis can be uncomfortable and difficult to manage, but with the right treatment and lifestyle changes, it can be controlled. 

Causes of inverse psoriasis

The exact cause of inverse psoriasis is unknown, but it is believed to be related to an overactive immune system. Like other types of psoriasis, inverse psoriasis is thought to be an autoimmune disease in which the body’s immune system mistakenly attacks healthy skin cells. Certain factors can trigger the onset of inverse psoriasis, including:³

• Skin irritation or injury: This can include rubbing or chafing of the skin, as well as cuts, burns, or insect bites. People with inverse psoriasis may experience flare-ups in areas where the skin is already irritated or damaged
• Bacterial or fungal infections: In some cases, infections such as jock itch or yeast infections can lead to inverse psoriasis. These infections can cause inflammation and itching in skin folds, which can trigger psoriasis symptoms
• Hot and humid weather conditions: Warm and humid weather can cause sweating, which can irritate the skin and trigger inverse psoriasis. People with this condition may notice flare-ups during the summer months or in humid climates
• Stress: Emotional stress can trigger psoriasis in some people. Stress-reduction techniques such as yoga, meditation, or mindfulness may help manage psoriasis symptoms
• Hormonal changes: Hormonal changes in those assigned females at birth (AFABs) during pregnancy or menopause may trigger psoriasis flare-ups.Increasing the risk of psoriasis
• Certain medications: Some medications, such as beta-blockers (used to treat high blood pressure) and lithium (used to treat bipolar disorder), may trigger or worsen psoriasis symptoms. If you are taking a medication that you believe is causing or worsening your psoriasis, talk to your doctor about alternative options
• Hereditary: Inverse psoriasis can also be hereditary. Parents can pass it down to their children

Signs and symptoms of inverse psoriasis

Inverse psoriasis usually appears as smooth, red, and shiny patches of skin in the folds of the skin. The affected areas can be itchy, painful, and uncomfortable. Other symptoms of inverse psoriasis include:

• Red or purple areas of skin
• Raw, sensitive skin
• Smooth, shiny patches of skin
• Cracks or fissures in the affected skin
• Patches of skin that appear moist or damp
• Burning or stinging sensation

Diagnosis of inverse psoriasis

Your healthcare provider will ask about the symptoms you are experiencing and conduct a physical examination and will also enquire about your medical and family history. 

To rule out other conditions that could cause your rash, your healthcare provider may order several tests. The tests may include:

• Allergy test to check if the immune reaction is due to some allergens
• Skin Biopsy, where a small sample of skin is for analysis in a laboratory
• Blood tests to check for causes of a rash that aren’t related to inverse psoriasis

Management and treatment for inverse psoriasis

There is currently no cure for inverse psoriasis, but it can be managed and treated with various options. Treatment plans for inverse psoriasis are tailored to each individual and may include a combination of the following: ^1,2

• Topical medications: Creams, ointments, and gels that are applied directly to the affected skin can help reduce inflammation and itching. Creams or ointments containing corticosteroids, vitamin D analogues, or calcineurin inhibitors may be prescribed to reduce inflammation and relieve itching
• Phototherapy: Also known as light therapy, this treatment uses ultraviolet light to slow down the production of skin cells and reduce inflammation. Phototherapy involves exposing the skin to controlled amounts of natural or artificial ultraviolet (UV) light to reduce inflammation
• Systemic medications: For severe cases of inverse psoriasis, oral or injected medications may be prescribed to suppress the immune system and reduce inflammation. Oral medications like retinoids, methotrexate, and cyclosporine may be prescribed for severe cases of inverse psoriasis. Biologics, which are medications that target specific components of the immune system, may also be prescribed in severe cases
• Moisturizers: Regularly applying a moisturiser to the affected areas can help reduce the risk of skin cracking and dryness
• Lifestyle changes: Maintaining a healthy lifestyle, including avoiding triggers such as friction and moisture, wearing loose-fitting clothing, and keeping the affected areas dry, can help reduce the severity and frequency of inverse psoriasis flare-ups. Certain lifestyle changes, such as losing weight, managing stress, and avoiding triggers like hot and humid weather, can help reduce the severity of symptoms
• Antifungal creams: Antifungal creams or ointments may be prescribed in case of fungal infections that can often accompany inverse psoriasis

FAQs

How can I prevent inverse psoriasis?

As with many chronic conditions, there is no sure way to prevent inverse psoriasis. However, avoiding triggers that can cause or worsen the condition may help. These triggers can include sweating, rubbing or chafing of the affected areas, stress, obesity, and smoking.

Is inverse psoriasis contagious?

No, inverse psoriasis is not contagious. It is a chronic inflammatory condition that affects the skin.

Who is at risk of inverse psoriasis?

Anyone can develop inverse psoriasis, but certain factors can increase the risk. These factors include:

• A family history of psoriasis
• Obesity
• Smoking
• Stress
• Certain medications, such as lithium and some beta-blockers

How common is inverse psoriasis?

Inverse psoriasis is less common compared to the other forms of psoriasis.¹ One-third of the people with psoriasis can develop inverse psoriasis.²

When should I see a doctor?

If you notice smooth, red, and shiny patches of skin in the folds of the skin, or if you have a persistent rash or other skin condition, it is important to see a healthcare professional.

Summary

Inverse psoriasis is a chronic inflammatory condition that affects the skin in areas where it folds and rubs against itself, such as the armpits, groin, and buttocks. The condition is not contagious and can be managed with a range of treatment options, including topical creams and ointments, phototherapy, and systemic medications. Avoiding triggers that can cause or worsen the condition, such as sweating, rubbing or chafing, stress, obesity, and smoking, may also be helpful. Anyone can develop inverse psoriasis, but certain factors can increase the risk, including a family history of psoriasis, obesity, smoking, stress, and certain medications. If you notice smooth, red, and shiny patches of skin in the folds of the skin, or if you have a persistent rash or other skin condition, it is important to see a healthcare professional.