Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Coping
Inverse psoriasis is an autoimmune condition that causes itchy, smooth lesions in places where your skin rubs together, like the armpits, groin, and under the breasts. It is also known as flexural psoriasis orintertriginous psoriasis.
Inverse psoriasis is rare, accounting for 3% to 7% of allpsoriasiscases. It disproportionately affects overweight people.Getting the right treatment can help reduce rashes in skin folds, but inverse psoriasis cannot be cured.
Symptoms of Inverse Psoriasis
Inverse psoriasis lesions are:
Because inverse psoriasis affects skin folds, which hold extra moisture, lesions are not dry likeskin plaquestypical of plaque psoriasis, the more common type. Because these areas rub together often, skin cells naturally slough off before patches can become scaly.
DermNet /CC BY-NC-ND
Inverse psoriasis symptoms include:
Inverse psoriasis can develop exclusively or co-occur with other types of psoriasis, which may come withother signs and symptoms.
Location
Inverse psoriasis appears where skin touches skin, like the armpits. This also differentiates it from plaque psoriasis, which often affectsextensor surfaceslike the kneecap.
The skin folds most commonly affected are those:
In people with obesity, lesions can develop within rolls of abdominal skin, under double chins, between the thighs, and alongside the overhanging skin of the upper arm.
Why Is It Called Inverse Psoriasis?Inverse psoriasis is so-named because it occurs opposite the places whereplaque psoriasisdoes. Instead of appearing on the outside of a joint, inverse psoriasis affects flexural and intertriginous surfaces, or those that curve, bend, or fold and have skin-on-skin contact.
Why Is It Called Inverse Psoriasis?
Inverse psoriasis is so-named because it occurs opposite the places whereplaque psoriasisdoes. Instead of appearing on the outside of a joint, inverse psoriasis affects flexural and intertriginous surfaces, or those that curve, bend, or fold and have skin-on-skin contact.
Inverse psoriasis, like all other forms of psoriasis, is an inflammatoryautoimmune disease.
For reasons poorly understood, the immune system will suddenly regard skin cells as harmful and launch aninflammatory assaultto control what it presumes to be an infection.
The inflammation causes still-maturing skin cells, calledkeratinocytes, to develop at an extremely fast rate.
As the cells move from the middle layer of skin (dermis) to the outer layer of skin (epidermis), they start to compress and break through the protective barrier of the epidermis (stratum corneum).
When this happens, the affected skin will thicken and form the lesions recognized as psoriasis.
Is sex safe with inverse psoriasis on my genitals?Inverse psoriasis is not a sexually transmitted disease (STD), though it is sometimes mistaken for one since it can occur around the genitals. If you have a psoriasis flare on your genitals, sex may cause pain or discomfort.Sexual lubricants and condoms may ease discomfort, pain, or itching.
Is sex safe with inverse psoriasis on my genitals?
Inverse psoriasis is not a sexually transmitted disease (STD), though it is sometimes mistaken for one since it can occur around the genitals. If you have a psoriasis flare on your genitals, sex may cause pain or discomfort.Sexual lubricants and condoms may ease discomfort, pain, or itching.
Inverse psoriasis is not a sexually transmitted disease (STD), though it is sometimes mistaken for one since it can occur around the genitals. If you have a psoriasis flare on your genitals, sex may cause pain or discomfort.
Sexual lubricants and condoms may ease discomfort, pain, or itching.
What Triggers Inverse Psoriasis?
Among some of the more common triggers of psoriasis are:
Some scientists have suggested that fat-storing (adipose) cells play a central role in the development of inverse psoriasis. These are known to release inflammatory proteins calledcytokinesthat maytrigger a flarein fatty tissue.
Others believe that theKoebner phenomenonplays a part. The phenomenon, in which rash develops along the lines of a skin trauma, affects around 25% of people with psoriasis.
The very fact that skin folds rub against each other suggests that the Koebner phenomenon may play a role in aggravating, if not inducing, a psoriatic flare.
There are no lab tests or imaging studies that can definitively diagnose inverse psoriasis. The diagnosis is primarily based on a visual examination of the skin and a review of your medical history.
In addition to evaluating the lesions, a skin specialist called adermatologistwill look for signs ofnail psoriasisand evidence of plaque psoriasis on thescalpor other parts of the body. Many people with inverse psoriasis have one or both of these forms of psoriasis, and they often appear first.
Your medical history may also hold clues, including a family history of psoriasis or risk factors associated with the disease.
If in doubt, a dermatologist may perform askin biopsyfor evaluation under the microscope. Unlike normal tissue, psoriatic tissue will appear hyperplastic (thickened) withacanthotic(compressed) cells.
Considering Other Possibilities
Other conditions can be mistaken for inverse psoriasis. A healthcare provider will consider all other possible causes to ensure that the appropriate treatment is delivered.
The process, known as adifferential diagnosis, will assess for conditions with symptoms similar to those of inverse psoriasis. These may include:
Inverse psoriasis cannot be cured, but there are a number of lifestyle changes and medical treatment options to help manage and treat it. Many of these are thesame treatmentsused for other forms of psoriasis.
Lifestyle Changes
As a disease closely linked to obesity, inverse psoriasis will almost invariably improve if youlose excess weight.
By eating right and exercising regularly, ideally under the supervision of a body-positive healthcare provider, your overall inflammatory burden can be relieved.
You will also want to take steps toavoid known triggers. This includes, but is not limited to:
Medical Treatments
Depending on the severity of the symptoms, medical treatment may include:
With respect to inverse psoriasis specifically,topical antifungals or antibacterialsmay be used to treat secondary infections that can occur in affected folds of skin. Oral versions may be used in extreme cases. These drugs are not used to prevent disease due to the risk of drug resistance.
In people with inverse psoriasis, the oral antibiotic Aczone (dapsone) appears especially effective. It is typically prescribed in a 100-milligram (mg), once-daily dose until the infection resolves.
The antifungal Lamisil (terbinafine), commonly used to treat ringworm and athlete’s foot, is used with caution as it can sometimes trigger a flare or, worse yet, a severe form of the disease known aspustular psoriasis.
To better cope with the discomfort of inverse psoriasis:
Summary
Inverse psoriasis is a type of psoriasis that appears in body parts where the skin rubs together. This might include the armpits, groin, or folds of skin under the breasts or on the abdomen. Lesions are red, smooth, shiny, and itchy.
Your healthcare provider may recommend topical creams, injectable medication, or lifestyle changes to help manage the condition.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Jfri A, Leung B, Said JT, Semenov Y, LeBoeuf NR.Prevalence of inverse psoriasis subtype with immune checkpoint inhibitors.Adv Immunother. 2022;2(1):ltac016. doi:10.1093/immadv/ltac016National Psoriasis Foundation.Inverse psoriasis.Micali G, Verzì AE, Giuffrida G, et al.Inverse Psoriasis: From Diagnosis to Current Treatment Options. Clin Cosmet Investig Dermatol. 2019 Dec 31;12:953-959. doi: 10.2147/CCID.S189000American Academy of Dermatology Association.Psoriasis: causes.Arias-Santiago S, Espiñeira-Carmona MJ, Aneiros-Fernández J.The Koebner phenomenon: psoriasis in tattoos.Cmaj. 2013;185(7):585-. doi:10.1503/cmaj.111299Omland SH, Gniadecki R.Psoriasis inversa: a separate identity or a variant of psoriasis vulgaris?Clin Dermatol. 2015;33(4):456-61. doi:10.1016/j.clindermatol.2015.04.007Jfri A, Leung B, Said JT, Semenov Y, LeBoeuf NR.Prevalence of inverse psoriasis subtype with immune checkpoint inhibitors.Immunother Adv. 2022;2(1):ltac016. doi:10.1093/immadv/ltac016
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Jfri A, Leung B, Said JT, Semenov Y, LeBoeuf NR.Prevalence of inverse psoriasis subtype with immune checkpoint inhibitors.Adv Immunother. 2022;2(1):ltac016. doi:10.1093/immadv/ltac016National Psoriasis Foundation.Inverse psoriasis.Micali G, Verzì AE, Giuffrida G, et al.Inverse Psoriasis: From Diagnosis to Current Treatment Options. Clin Cosmet Investig Dermatol. 2019 Dec 31;12:953-959. doi: 10.2147/CCID.S189000American Academy of Dermatology Association.Psoriasis: causes.Arias-Santiago S, Espiñeira-Carmona MJ, Aneiros-Fernández J.The Koebner phenomenon: psoriasis in tattoos.Cmaj. 2013;185(7):585-. doi:10.1503/cmaj.111299Omland SH, Gniadecki R.Psoriasis inversa: a separate identity or a variant of psoriasis vulgaris?Clin Dermatol. 2015;33(4):456-61. doi:10.1016/j.clindermatol.2015.04.007Jfri A, Leung B, Said JT, Semenov Y, LeBoeuf NR.Prevalence of inverse psoriasis subtype with immune checkpoint inhibitors.Immunother Adv. 2022;2(1):ltac016. doi:10.1093/immadv/ltac016
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Jfri A, Leung B, Said JT, Semenov Y, LeBoeuf NR.Prevalence of inverse psoriasis subtype with immune checkpoint inhibitors.Adv Immunother. 2022;2(1):ltac016. doi:10.1093/immadv/ltac016National Psoriasis Foundation.Inverse psoriasis.Micali G, Verzì AE, Giuffrida G, et al.Inverse Psoriasis: From Diagnosis to Current Treatment Options. Clin Cosmet Investig Dermatol. 2019 Dec 31;12:953-959. doi: 10.2147/CCID.S189000American Academy of Dermatology Association.Psoriasis: causes.Arias-Santiago S, Espiñeira-Carmona MJ, Aneiros-Fernández J.The Koebner phenomenon: psoriasis in tattoos.Cmaj. 2013;185(7):585-. doi:10.1503/cmaj.111299Omland SH, Gniadecki R.Psoriasis inversa: a separate identity or a variant of psoriasis vulgaris?Clin Dermatol. 2015;33(4):456-61. doi:10.1016/j.clindermatol.2015.04.007Jfri A, Leung B, Said JT, Semenov Y, LeBoeuf NR.Prevalence of inverse psoriasis subtype with immune checkpoint inhibitors.Immunother Adv. 2022;2(1):ltac016. doi:10.1093/immadv/ltac016
Jfri A, Leung B, Said JT, Semenov Y, LeBoeuf NR.Prevalence of inverse psoriasis subtype with immune checkpoint inhibitors.Adv Immunother. 2022;2(1):ltac016. doi:10.1093/immadv/ltac016
National Psoriasis Foundation.Inverse psoriasis.
Micali G, Verzì AE, Giuffrida G, et al.Inverse Psoriasis: From Diagnosis to Current Treatment Options. Clin Cosmet Investig Dermatol. 2019 Dec 31;12:953-959. doi: 10.2147/CCID.S189000
American Academy of Dermatology Association.Psoriasis: causes.
Arias-Santiago S, Espiñeira-Carmona MJ, Aneiros-Fernández J.The Koebner phenomenon: psoriasis in tattoos.Cmaj. 2013;185(7):585-. doi:10.1503/cmaj.111299
Omland SH, Gniadecki R.Psoriasis inversa: a separate identity or a variant of psoriasis vulgaris?Clin Dermatol. 2015;33(4):456-61. doi:10.1016/j.clindermatol.2015.04.007
Jfri A, Leung B, Said JT, Semenov Y, LeBoeuf NR.Prevalence of inverse psoriasis subtype with immune checkpoint inhibitors.Immunother Adv. 2022;2(1):ltac016. doi:10.1093/immadv/ltac016
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