Q: What would you suggest to patients who are dealing with itch from inverse psoriasis?
A: Itch is a big problem. Pain is a big problem, too, because the skin in these areas is torn or eroded or ulcerated, and many times, very painful to touch. So in addition to a gentle cleanser, maybe add a mild topical steroid with Eucerin moisturizer or plain Aquaphor. Sarna lotion is a very good anti-itch and cooling over-the-counter product along with a mild cortisone.
Q: Do you find that antihistamines are effective for itch related to inverse psoriasis?
A: I think it is effective in the same way it would be effective for other issues of the skin. I like to use both H1 and H2 antihistamines. I’ll use something like hydroxyzine at night, especially when a better night’s sleep is needed. In most cases, it won’t give you a hangover the next morning. Then, use a non-sedating antihistamine like Fexofenadine during the day.
Q: Is it normal for inverse psoriasis to be weepy or moist? Is it okay to use products like baby powder or cornstarch to keep these areas dry?
A: Infection and weeping of skinfolds is a frequent and frustrating problem. I think baby powder and cornstarch are fine as long as the lesion is not too wet to where you get a lot of caking and buildup of debris. Putting a Kleenex or a washcloth in with it to help soak up any of the excessive moisture might help.
Q: Are there materials for undergarments that are better necessarily than others?
A: Well, I think cotton is the best way to go, and I think anything with fragrance or dyes that can act as an irritant might be a problem. This includes detergents, so watch for contact dermatitis or primary irritation. With laundering, double rinsing may be necessary to minimize irritation.
Q: Other than washing several times a day, what can you do about the smell or the odor?
A: Typically, body odors are generated by bacterial flora of different types. So the key approach I think is frequent bathing with gentle bathing methods that don’t irritate the affected areas and possibly some sort of an antibacterial topical agent. Neo-Synalar might be a good one to start with and, maybe, if the body odor continues, cultures of skin folds for possible unusual microbial flora would be in order.
Dr. James E. Turner is a board-certified dermatologist at Mid-South Dermatology in Bartlett, Tennessee. Dr. Turner discussed inverse psoriasis in "Three reasons inverse psoriasis is difficult, but doable to treat" and in one of our health webcasts. Registration for our health webcasts is always free. Portions of this discussion were edited for length and clarity. Click on the YouTube video below for the full version.
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