About Inverse Psoriasis
Inverse psoriasis, also known as intertriginous psoriasis or hidden psoriasis, is a form of psoriasis that affects the skin folds of the body. It is a chronic autoimmune disease where the body's immune system mistakenly attacks healthy cells in these areas.
This type of psoriasis appears in areas where skin rubs against skin, such as the groin, armpits, inner thigh regions, under the breasts, and between the buttocks. It is characterized by shiny red patches of skin that may be itchy and inflamed. Inverse psoriasis is estimated to affect between 21% and 30% of people with psoriasis, but it may be underreported in individuals with darker skin tones. It can often coexist with other forms of psoriasis on different parts of the body.
Inverse psoriasis can be caused by a combination of genetic and environmental factors. While the exact cause is not fully understood, there are some known risk factors that can increase the likelihood of developing inverse psoriasis.
Non-modifiable risk factors for inverse psoriasis cannot be controlled or changed. They include:
- Family history: Having a family member with psoriasis, especially inverse psoriasis, increases the risk of developing the condition. This suggests a genetic component to the disease.
- Other forms of psoriasis: People who already have another form of psoriasis, such as plaque psoriasis, are more likely to develop inverse psoriasis as well.
- Deeper skin folds: People with deep skin folds can create a warm and moist environment, which is conducive to the development of inverse psoriasis.
Modifiable risk factors for inverse psoriasis can be influenced by individual habits and lifestyle. They include:
- Overweight: Individuals who are overweight or have obesity have a higher risk of developing inverse psoriasis. This may be due to increased friction and moisture in skin folds.
- Lack of mobility: People with limited mobility, such as those who are bedridden or use wheelchairs, may be at higher risk due to increased friction and moisture against the skin.
- Diabetes: Having diabetes is associated with an increased risk of developing inverse psoriasis.
- Hot and humid environment: Living in a hot and humid climate can contribute to the development of inverse psoriasis, as it can lead to increased sweating and moisture on the skin.
- Wearing splints, braces, or other medical devices: These devices can create friction and trap moisture against the skin, increasing the risk of developing inverse psoriasis.
Common areas affected by inverse psoriasis include the armpits, under the breasts, groin and other skin fold areas. It can also occur in the genital area. Common early symptoms include:
- Skin Appearance: Smooth, inflamed patches that look bright red on lighter skin and purple or brown on darker skin.
- Itching and Pain: Patches may cause itching or pain, often worsened by sweating or skin rubbing.
- Skin Splitting or Irritation: Skin in the affected areas may crack or become irritated.
Additional symptoms in severe cases include:
- Chafing and Irritation: Heat and sweat can worsen discomfort in skin folds.
- Secondary Infections: Fungal or yeast infections, like Candida albicans, can occur in the affected areas.
- Skin Thickening: Repeated rubbing or scratching can lead to lichenification (thickened skin).
- Thinned Skin: Overuse of strong steroid creams may thin the skin over time.
- Sexual Difficulties: Embarrassment or discomfort can interfere with intimacy.
- Co-occurrence with Plaque Psoriasis: Many people with inverse psoriasis also have plaque psoriasis, which causes thick, scaly patches on areas like the elbows, knees, and scalp but not in skin folds.
Doctors can diagnose inverse psoriasis by examining an individual's skin and skin lesions. They may also perform several tests and procedures to confirm the diagnosis and determine the stage or severity of the condition.
Commonly performed examinations, tests, and procedures to diagnose inverse psoriasis include:
- Skin biopsy: This involves collecting a small sample of the person's skin to examine under a microscope. A skin biopsy helps doctors confirm the presence of psoriasis and rule out other skin conditions.
- KOH exam: This test checks if a fungus is causing the symptoms. During a KOH exam, a doctor scrapes a small portion of the affected skin with a needle or blade and examines it under a microscope. This test helps differentiate between inverse psoriasis and fungal infections like intertrigo.
- Wood lamp skin exam: In this exam, a doctor looks at the affected skin area under UV light to check if a bacterium is causing the symptoms. This test helps identify if there is an underlying bacterial infection contributing to the psoriasis symptoms.
Additional examinations, tests, and procedures may include:
- Body surface area (BSA) assessment: Doctors use BSA to evaluate the extent of psoriasis involvement on the body. They calculate the percentage of body surface affected by psoriasis lesions, which helps determine disease severity.
- Psoriasis area severity index (PASI): PASI is another tool used to assess disease severity in psoriasis. It takes into account both the extent of body surface involvement and the severity of individual lesions.
The goals of treatment for inverse psoriasis are to reduce inflammation and discomfort in the affected areas. There are several medication types and treatment options that can help achieve these goals:
- Topical Treatment: This involves using creams or medications that you rub into your skin. The first-line treatment method for inverse psoriasis is topical creams. These creams aim to reduce inflammation and discomfort in the sensitive skin folds.
- Steroid creams are commonly used to reduce inflammation, but they can also cause the skin to become thinner and more sensitive. If prescribed a topical treatment, your doctor will monitor your progress and adjust the dosage if needed.
- Alternatives to topical steroids are topical calcineurin inhibitors like tacrolimus and pimecrolimus, which work by stopping the immune system from producing substances that may cause skin disease.
- Infected Inverse Psoriasis Treatment: Inverse Psoriasis is prone to yeast and fungal infections due to the moist and inflamed skin environment. To address this, doctors may prescribe antibacterial or antifungal medicines along with typical psoriasis treatments.
- Home Remedies: For mild symptoms, home remedies may help alleviate inflammation. Suggestions include taking short baths or showers in lukewarm water, limiting time spent in the water to 15 minutes, using fragrance-free soap for sensitive skin, and moisturizing the affected area with fragrance-free moisturizer within 5 minutes of bathing.
- Systemic Treatments: If home remedies or topical medications are not effective, a doctor may prescribe stronger treatments. Systemic therapy, which targets the whole body rather than just the affected skin area, may also be recommended.
- Oral systemic therapies such as cyclosporine, apremilast, and methotrexate can calm an overactive immune system but may have side effects.
- Injectable biologics are another option that target specific cells in the body and interfere with the inflammatory process.
- Phototherapy: Phototherapy, or light therapy, is a treatment option for moderate to severe Inverse Psoriasis. It involves using a light box that emits artificial UVB rays for a specified time during each session. This therapy can slow down the growth of skin cells in some people with psoriasis.
It's important to note that while there is no permanent cure for inverse psoriasis, these treatments can help manage symptoms and reduce their likelihood of recurring.
Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.