Inverse Psoriasis

Overview

What is inverse psoriasis?

Inverse psoriasis is a disease that causes your skin cells to reproduce very quickly. It’s a type of psoriasis that appears in areas where your skin rubs against itself (skin folds), including:

  • Armpits (axilla).
  • Belly button (navel).
  • Below your breasts.
  • Groin.

It looks like a shiny, smooth, discolored (brown, red or purple) rash, and it may feel damp.

Inverse psoriasis is commonly referred to as an autoimmune disease. But the antibody that causes the condition hasn’t been identified. So, it’s technically categorized as an immune-mediated disease. This means the exact cause is unknown, but experts believe it has something to do with your immune system response.

Healthcare providers sometimes call it intertriginous (inter-trij-uh-nus) psoriasis.

What is the difference between psoriasis and inverse psoriasis?

Psoriasis and inverse psoriasis are both diseases that affect your skin.

Psoriasis features thick, discolored patches of skin covered with white or silvery scales. The thick, scaly patches are plaques.

Inverse psoriasis doesn’t feature the thick, scaly plaques like other types of psoriasis, most likely because it’s present in moist areas of your body. An inverse psoriasis rash also looks shinier than a psoriasis rash.

What is the difference between inverse psoriasis and intertrigo?

Inverse psoriasis and intertrigo are both inflammatory skin conditions that result in rashes in your skin folds. However, inverse psoriasis and intertrigo have different causes and treatments.

Skin rubbing against itself causes intertrigo. Trapped moisture causes the surfaces of your skin to stick together in your skin folds. The moisture increases the friction, which leads to skin damage and inflammation. Keeping the affected area dry, clean and cool can help alleviate intertrigo.

Inverse psoriasis is an immune-mediated disease. That means your body’s immune system attacks parts of your skin instead of protecting your body from foreign invaders like bacteria or viruses. Treatments can help reduce inverse psoriasis symptoms or make them go away. However, inverse psoriasis is a long-lasting (chronic) condition, which means flare-ups can occur throughout your life.

Who does inverse psoriasis affect?

Anyone can get inverse psoriasis. However, you may be more likely to develop inverse psoriasis if you:

How serious is inverse psoriasis?

Inverse psoriasis can be annoying and painful, but it’s rarely serious. It tends to affect parts of your body where your skin is sensitive.

Scratching your inverse psoriasis rash can break your skin and lead to an infection, which can be more serious to treat.

How common is inverse psoriasis?

Psoriasis affects up to 2% of the world’s population and up to 3% of the U.S. population. Between 3% and 7% of those with psoriasis also have inverse psoriasis.

How does inverse psoriasis affect my body?

Inverse psoriasis commonly affects sensitive skin areas that rub against each other, such as skin folds. The most common places that inverse psoriasis occurs include:

  • In the crease(s) of your neck.
  • In your armpits.
  • Beneath your breasts.
  • Between your belly folds.
  • Between your buttocks.
  • In your groin.
  • Around your penis, scrotum or vulva.
  • In your inner thighs.

Moist, sensitive skin areas are more likely to develop inverse psoriasis, so you may be more likely to experience:

  • Bacterial, fungal or yeast
  • Itching and irritation.
  • Pain or discomfort during sex.

Symptoms and Causes

What are the symptoms?

Symptoms of inverse psoriasis include:

  • A shiny, smooth, discolored (brown, pink, purple or red) rash.
  • Cracks (fissures) in your skin creases.
  • Itchiness.
  • Moist patch of skin.

Symptoms of inverse psoriasis with an infection may include:

  • Bumps in the affected area that contain pus.
  • A foul smell.
  • Small cuts or tiny cracks in your skin.
  • Swelling.
  • Tenderness.

What causes inverse psoriasis?

Inverse psoriasis is an immune system problem. Your immune response overreacts, causing inflammation, which leads to new skin cells growing too fast.

Typically, new skin cells grow every 28 to 30 days. But in people with inverse psoriasis, new cells grow and move to the surface of your skin every three to four days. The buildup of new cells replacing old cells creates a shiny rash.

Inverse psoriasis runs in families, so there may be a genetic trigger. Parents may pass it down to their children.

What causes inverse psoriasis flare-ups?

Inverse psoriasis flare-ups differ from person to person. No one knows exactly what causes them. Common inverse psoriasis triggers may include:

Is inverse psoriasis contagious?

Inverse psoriasis isn’t contagious. You can’t spread inverse psoriasis to another person through skin-to-skin contact or unprotected sex.

Diagnosis and Tests

How is inverse psoriasis diagnosed?

Your healthcare provider will examine your affected areas, and they’ll look for common signs of inverse psoriasis. They’ll also ask about your symptoms, your family history and if you’ve recently started or stopped using a product or medication just before your flare-up.

What tests will be done to diagnose inverse psoriasis?

Your healthcare provider may perform several tests to rule out other conditions that could cause your rash. This is a differential diagnosis. The tests may include:

  • Allergy test.
  • Biopsy.
  • Blood tests to check for causes of a rash that aren’t related to inverse psoriasis.

Management and Treatment

Can inverse psoriasis go away?

There isn’t a cure for inverse psoriasis. You may have flare-ups and times where the rash goes away (remission). Treatment can provide relief for your symptoms.

What medications or treatments are used?

Your healthcare provider may prescribe or recommend the following to help relieve your symptoms:

  • Calcipotriene skin ointment. Calcipotriene is a form of vitamin D that helps reduce discoloration.
  • Corticosteroid creams or ointments. Your healthcare provider may prescribe corticosteroid creams or ointments to reduce inflammation.
  • Injectable medicines. Your healthcare provider may use a hypodermic needle to inject medicine under your skin or into your vein. Examples include adalimumab, etanercept and infliximab.
  • Oral medicines. Oral medicines are pills or capsules taken by mouth. They treat severe forms of inverse psoriasis. Examples include acitretin capsules, apremilast oral tablets and methotrexate tablets.
  • Pimecrolimus skin cream or tacrolimus ointment. These medicines typically treat eczema, but they may help treat inverse psoriasis, too.
  • Phototherapy. Phototherapy uses ultraviolet light, usually ultraviolet B (UVB), from special lamps. The ultraviolet light waves found in sunlight can help certain skin disorders, including inverse psoriasis.

Are there any home remedies for symptoms of inverse psoriasis?

Several home remedies can help control the symptoms of inverse psoriasis.

While home remedies are safe for most people, it’s a good idea to check with your healthcare provider before trying some of the following options. You may be at risk of developing an allergic reaction.

  • Take over-the-counter (OTC) antihistamines for severe itching.
  • Bathe or shower in lukewarm — not hot — water. Limit the amount of time you spend in the water to under 15 minutes.
  • Use mild soaps or other products that are free of perfumes, dyes and alcohol. Look for products labeled “fragrance-free,” “hypoallergenic” or “for sensitive skin.”
  • Moisturize your skin several times a day using a cream or ointment, including after your bath or shower. Coconut oil can also keep your skin hydrated while providing relief.
  • Wear loose underwear and clothing that allow affected areas to breathe.
  • Wear cotton underwear to absorb moisture or underwear made out of synthetic materials to wick away moisture.
  • Apply talcum powder to your affected areas to absorb moisture.
  • Some studies suggest that herbal therapies, including Oregon grape (Mahonia aquifolium), indigo naturalis and aloe vera, may provide some relief.

Prevention

How can I prevent this?

There isn’t any way to prevent inverse psoriasis. If you have inverse psoriasis, it may come and go throughout your life. Treatments can reduce symptoms, even in people with severe psoriasis.

Outlook / Prognosis

What can I expect if I have inverse psoriasis?

Inverse psoriasis may flare up and go into remission throughout your life. However, it can generally be well managed with treatment.

Are there other complications of inverse psoriasis?

If you have inverse psoriasis, you may be at a higher risk of:

Can I have sex if I have an inverse psoriasis flare-up on my genitals?

Inverse psoriasis isn’t a sexually transmitted disease or infection (STD or STI). Still, it can look like an STD or STI. It’s a good idea to be honest with your partner if you have a flare-up. If they have any questions, encourage them to talk to a healthcare provider before you have sex.

If you have inverse psoriasis on your genitals, you may experience discomfort or pain during sex. Sexual lubricants (lubes) and condoms can help ease discomfort, pain or itching.

After sex, carefully clean and dry your genitals and reapply any inverse psoriasis medications.

Living With

How do I take care of myself?

If you have inverse psoriasis, the best way to take care of yourself is to:

  • Take medications as instructed.
  • Thoroughly dry your skin folds or affected areas after bathing, and keep them dry.

Other steps to stay as healthy as possible include:

  • Talking to your healthcare provider about lowering your risk for related conditions, including heart disease, depression and diabetes.
  • Lowering your stress through meditation or exercise or seeing a mental health professional.

When should I see my healthcare provider?

Contact your healthcare provider if:

  • You develop new symptoms.
  • Your symptoms don’t improve after treatment.
  • Your rash looks infected (red, purple, gray or white skin; irritation and swelling).

What questions should I ask my healthcare provider?

  • How can you tell that I have inverse psoriasis?
  • If I don’t have inverse psoriasis, what other skin condition might I have?
  • How can I prevent flare-ups and control my symptoms?
  • What medicines do you recommend?
  • Do the medicines have any side effects?
  • What at-home treatments do you recommend?
  • Do the at-home treatments have any side effects?
  • What else should I do to improve my symptoms?
  • Is there a cream or ointment that you can prescribe?
  • Should I see a dermatologist or another specialist?

A note from Cleveland Clinic

Inverse psoriasis is an immune-mediated disease that causes a rash in areas of your body where your skin rubs against itself. It can make you feel self-conscious, and it can be unpleasant if it itches. However, it isn’t contagious, and treatments can help your symptoms improve.

It’s important to pay attention to your skin. Contact your healthcare provider as soon as you notice a rash.

Last reviewed by a Cleveland Clinic medical professional on 04/25/2022.

References

  • Guglielmetti A, Conlledo R, Bedoya J, et al. Inverse psoriasis involving genital skin folds: successful therapy with dapsone. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510394/) Dermatol Ther (Heidelb). 2012; 2(1): 15. Accessed 4/25/2022.
  • Lawley LP, McCall CO, Lawley TJ. Eczema, Psoriasis, Cutaneous Infections, Acne, and Other Common Skin Disorders. In: Jameson J, Fauci AS, Kasper DL, et al., eds. Harrison's Principles of Internal Medicine, 20th Edition. McGraw Hill; 2018. Accessed 4/25/2022.
  • Merola JF, Li T, Li WQ, et al. Prevalence of psoriasis phenotypes among men and women in the USA. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915990/) Clin Exp Dermatol. 2016; 41(5): 486-489. Accessed 4/25/2022.
  • Sanchez MR. Cutaneous Manifestations of Human Immunodeficiency Virus. In: Kelly A, Taylor SC, Lim HW, et al., eds. Taylor and Kelly's Dermatology for Skin of Color, 2nd Edition. McGraw Hill; 2016. Accessed 4/25/2022.
  • Usatine RP, Wipperman JL. Psoriasis. In: Usatine RP, Smith MA, Mayeaux, Jr. EJ, et al. eds. The Color Atlas and Synopsis of Family Medicine, 3rd Edition. McGraw Hill; 2019. Accessed 4/25/2022.

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