Inverse psoriasis (also called intertriginous psoriasis or flexural psoriasis) is a type of psoriasis that develops on areas of the body such as the armpits, groin, under the breasts, the crease of the buttocks, and in other areas where skin touches skin on the body. This skin condition causes patches of red, thick, scaly and flaky skin. Inverse psoriasis affects between 21 to 30 percent of people who have psoriasis.
Treatment for inverse psoriasis includes:
- Topical treatments, such as creams and ointments
- Prescription topical treatments
- Steroids
- Anthralin
- Calcipotriene (Dovonex)
- Calcipotriene and betamethasone (Taclonex)
- Calcitriol (Vectical)
- Tazarotene (Tazorec)
- Over-the-counter (OTC) topical treatments
- Salicylic Acid
- Coal Tar
- Moisturizers
- Fragrance-free
- Apply after showering and hand washing
- Shower in lukewarm water and limit showers to 10 minutes or less
- Bath solutions such as oatmeal, oil, Epsom salts, or Dead Sea salts
- Scale lifters (keratolytics) usually contain an active ingredient of salicylic acid, urea, lactic acid, or phenol
- Coverings (occlusion) applied over topical treatments such as plastic wrap, cellophane, waterproof dressing, cotton socks, or a nylon suit
- Anti-itch treatments such as hydrocortisone, calamine, diphenhydramine hydrochloride, camphor, benzocaine, and menthol (may increase irritation and dryness)
- Aloe vera, jojoba, zinc pyrithione, capsaicin and others may also help moisturize, soothe, remove scales, or relieve itching
- Prescription topical treatments
- Systemic treatments
- Biologics and biosimilars
- Tumor necrosis factor-alpha (TNF-alpha) inhibitors such as certolizumab pegol (Cimzia), etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), golimumab (Simponi and Simponi Aria)
- Interleukin 12 and 23 (IL-12, IL-23) inhibitors such as ustekinumab (Stelara)
- Interleukin 17 (IL-17) inhibitors such as secukinumab (Cosentyx), brodalumab (Siliq), and ixekizumab (Taltz)
- T-cell inhibitors such as Orencia (abatacept)
- Interleukin 23 (IL-23) inhibitors such as tildrakizumab-asmn (Ilumya), risankizumab-rzaa (Skyrizi), and Tremfya (guselkumab)
- Biosimilars to adalimumab (Humira)
- Biosimilars to etanercept (Enbrel)
- Biosimilars to infliximab (Remicade)
- Disease-modifying antirheumatic drugs (DMARDs) including tofacitinib (Xeljanz and Xeljanz XR)
- Traditional oral systemics
- Acitretin (Soriatane)
- Cyclosporine
- Methotrexate
- Off-label systemics, including hydroxyurea (Hydrea), isotretinoin, mycophenolate mofetil, sulfasalazine, and 6-Thioguanine
- Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen (Advil, Motrin)
- Biologics and biosimilars
What Are Symptoms of Inverse Psoriasis?
Inverse psoriasis develops on skin folds, areas where skin touches skin. Symptoms of inverse psoriasis include:
- Smooth patches of skin that look raw
- On Caucasian skin, patches appear in body folds as bright red lesions in body folds
- On skin of color, patches appear in body folds as lesions of purple, brown, or darker than the surrounding skin
- Sore or painful skin
- Lesions are aggravated by rubbing and sweating
- Little, if any, silvery-white coating that can usually be seen in plaque psoriasis
Frequently, people who have inverse psoriasis have another type of psoriasis elsewhere on the body at the same time.
What Causes Inverse Psoriasis?
Inverse psoriasis is caused by an overactive immune system, but the reason this occurs in some people is not known.
Inverse psoriasis is more common in overweight and obese people and people who have deep skin folds.
Common triggers for inverse psoriasis include:
- Friction in deep skin folds
- Sweating in skin folds
- Certain medicines
- Starting and stopping medicines
- Infections
- Injury to the skin
- Stress
- Tobacco or alcohol use
