Inverse psoriasis
Inverse psoriasis is found in the armpits, groin, under the breasts, and in other skin folds around the genitals and the buttocks. This type of psoriasis first shows up as lesions that are very red and usually lack the scale associated with plaque psoriasis. It may appear smooth and shiny. Inverse psoriasis is particularly subject to irritation from rubbing and sweating because of its location in skin folds and tender areas. It is more common and troublesome in overweight people and people with deep skin folds.
Treatment can be difficult due to the sensitivity of skin in these areas. Steroid creams and ointments are considered very effective, but they should not be occluded (covered) with plastic dressings. Overuse or misuse of steroids, particularly in skin folds, can result in side effects, especially thinning of the skin and stretch marks. Because these areas are prone to yeast and fungal infections, doctors may test for infection and then may use diluted topical steroids in combination with other medications, for example, 1% or 2% hydrocortisone with anti-yeast or antifungal agents.
Other topical agents, such as Dovonex, coal tar or anthralin, can be somewhat effective in treating psoriasis in skin folds, but they may also be irritating. They should be used with caution and under the direction of a doctor. People with severe inverse psoriasis may occasionally require systemic medications to control the condition.
Protopic (also known by its generic name tacrolimus) and Elidel (also known by its generic name pimecrolimus) are two topical medications approved by the U.S. Food and Drug Administration for the treatment of eczema. Many dermatologists have found they work well for psoriasis lesions in the skin folds.
Sometimes a product called Castellani's Paint (prescribed by a doctor and compounded by a pharmacist, or bought over the counter as brand name Castederm) is used to treat inverse psoriasis. It is a liquid that can be painted on the affected skin and can help to dry moist lesions of psoriasis in folds. The use of powders may also help to dry the moist lesions associated with inverse psoriasis. Some people will use creams at night and powders in the morning.
Updated December 2005
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