How Is Inverse Psoriasis Diagnosed

How Is Psoriasis Diagnosed

Doctors usually diagnose psoriasis by examining the skin, scalp, and nails. They’ll also ask whether someone else in the family has psoriasis and if the child recently had an illness or started taking a new medicine.

Rarely, doctors might take a skin sample to check more closely. A biopsy can tell the doctor whether it’s psoriasis or another condition with similar symptoms.

How Can Parents Help

For some children, psoriasis is just a minor inconvenience. For others, it is a difficult medical condition.

To manage symptoms and make outbreaks less likely, your child should:

• Wash hands well and often and stay away from people who are sick to prevent infections.
• Manage stress through exercise, yoga, or meditation.
• Not smoke or drink alcohol.
• Keep a healthy weight. People who are overweight tend to have more severe psoriasis symptoms.

Kids and teens with psoriasis may feel uncomfortable with the way their skin looks. Help your child understand that psoriasis is common and treatments can help.

Whether your child’s psoriasis is mild or severe, learn about the condition together. Offer to help find a therapist or join a support group if that might help. Talk to your doctor or check websites like:

Inverse Psoriasis: From Diagnosis To Current Treatment Options

Accepted for publication 4 December 2019

3 January 2020Volume 2019:12 Pages 953959

Giuseppe Micali, Anna Elisa Verzì, Giorgia Giuffrida, Enrico Panebianco, Maria Letizia Musumeci, Francesco Lacarrubba Dermatology Clinic, University of Catania, Catania, ItalyCorrespondence: Giuseppe MicaliDermatology Clinic, University of Catania, Via S. Sofia 78, Catania 95123, ItalyTel + 39 095 321705Email Abstract: Inverse psoriasis represents a clinical variant of psoriasis that is sometimes difficult to diagnose due to its clinical similarity with other skin disorders involving the folds, mainly including mechanical intertrigo, fungal and bacterial infections, contact dermatitis, seborrheic dermatitis, and lichen planus. Dermoscopy represents a useful tool for an enhanced non-invasive diagnosis. The treatment of inverse psoriasis may be challenging and include topical corticosteroids, topical calcineurin inhibitors, vitamin D analogs, traditional oral systemic therapies such as cyclosporine and methotrexate, and biologic therapies.Keywords: psoriasis, inverse, diagnosis, dermoscopy, confocal microscopy, treatment

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Inverse Psoriasis: Causes Symptoms And Treatments

Inverse psoriasis, also known as flexural or intertriginous psoriasis, is a rare and painful form of the inflammatory skin disease. It typically appears as smooth, shiny red patches in the armpits, genital and anal areas, and under the breasts. Symptoms of inverse psoriasis can worsen with warmth, moisture, and friction.

Between 3 percent and 7 percent of people with psoriasis have inverse psoriasis. It mainly affects infants and young children, but can appear at any age. Being overweight is believed to be a risk factor for inverse psoriasis. Among adults, inverse psoriasis most frequently occurs in the genital area. Up to 79 percent of people with this skin disease have lesions in the groin.

Because symptoms of inverse psoriasis can mimic other skin diseases, such as dermatitis, fungal or bacterial infections, or sexually transmitted diseases, its often difficult to diagnose. Its also difficult to treat because of skin sensitivity in the affected areas. For this reason, its important to get an accurate diagnosis and proper treatment from a licensed dermatologist.

What Can Prevent Someone From Getting A Second Type Of Psoriasis

Most types of psoriasis cannot be prevented.

That said, if you already have plaque psoriasis, it may be possible to reduce your risk of developing another type of psoriasis on your skin. Dermatologists recommend taking the following precautions:

• Protect your skin to prevent sunburn

• Take medication as directed and speak with your dermatologist before stopping a medication

• Treat your psoriasis so that its well-controlled

• Watch your weight so that you stay at a weight thats recommended for your age and height

Watching your weight may help prevent inverse psoriasis. This type of psoriasis is more common in people who are 20 or more pounds overweight.

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How To Treat Inverse Psoriasis In Your Creases Crevices And Skin Folds

Sometimes not feeling well seems worse than being sick in bed. When you have a mild cold, you still have to function in your job and home life. When you have the flu, however, you take days off and rest.

Inverse psoriasis is the not feeling well of psoriasis.

Its not so bad that you have to stop living your regular life, but its really uncomfortable. Most of the time, you can hide your skin rash, but you never stop feeling it. You have irritated, itchy, and sometimes infected skin that never seems to let you forget your condition.

Fortunately, theres a way to treat inverse psoriasis.

Once you figure out what triggers this condition for you, youll be able to make changes to soothe your skin and begin an inverse psoriasis treatment to help you keep it under control.

Can Psoriasis Be Cured

There is currently no cure for psoriasis. As a chronic autoimmune disease, most people with psoriasis will always have it. But it is possible to treat the condition. In fact, the right medications and therapies can reduce symptoms and even clear up the skin entirely in some people.

More psoriasis treatments may be available in the future. Researchers are currently trying to uncover what causes the lesions on a cellular level and how to prevent flare-ups caused by the immune system.

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What Should You Do If You Develop Another Type Of Psoriasis

Life-threatening signs and symptoms, such as redness that covers most of your body, fever, and chills, require immediate medical care.

When signs and symptoms are not life threatening, you should see a board-certified dermatologist for a diagnosis. Youll find pictures of the different types of psoriasis and learn more about the possible signs and symptoms at Psoriasis: Signs and symptoms

ImagesImage 1: Getty ImagesImage 2: J Am Acad Dermatol 2013 69:245-52.

ReferencesBrummer GC, Hawkes JE, et al. Ustekinumab-induced remission of recalcitrant guttate psoriasis: A case series. JAAD Case Rep. 2017 3: 4325.

Egeberg A, Thyssen JP, et al. Prognosis after hospitalization for erythroderma. Acta Derm Venereol. 2016 96:959-92.

Gottlieb A, Korman NJ, et al. “Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: Overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol 2008 58:851-64.

Gudjonsson JE and Elder JT. Psoriasis. In: Wolff K, Goldsmith LA, et al. Fitzpatricks Dermatology in General Medicine. McGraw Hill Medical, New York, 2008:178-81.

Khosravi H, Siegel MP, et al. Treatment of Inverse/Intertriginous Psoriasis: Updated Guidelines from the Medical Board of the National Psoriasis Foundation. J Drugs Dermatol. 2017 16:760-6.

Navrotski BRF, Nihi FM, et al. Wet wrap dressings as a rescue therapy option for erythrodermic psoriasis. An Bras Dermatol. 2018 93:598-600.

What Are Other Types Of Psoriasis

Plaque psoriasis is the most common type. About 80% to 90% of people with psoriasis have plaque psoriasis.

Other, less common types of psoriasis include:

• Inverse psoriasis appears in skin folds. It may look like thin pink plaques without scale.
• Guttate psoriasis may appear after a sore throat caused by a streptococcal infection. It looks like small, red, drop-shaped scaly spots in children and young adults.
• Pustular psoriasis has small, pus-filled bumps on top of the red patches or plaques.
• Sebopsoriasis typically appears on the face and scalp as red bumps and plaques with greasy yellow scale. This type is a cross between psoriasis and seborrheic dermatitis.

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What Are The Risk Factors For Inverse Psoriasis

Inverse psoriasis is more common in people who are overweight or have deep skin folds. Often, people who develop it already have another form of psoriasis, such as plaque psoriasis. No differences in sex or other risk factors are known.

Other factors that contribute to skin irritation in intertriginous and flexural areas include:

• Having , excessive , or a weakened immune system

• Living in a hot, humid climate

• Participating in activities that chafe the skin

What Causes Inverse Psoriasis

Psoriasis comes from a combination of genetic and environmental factors, but the specific triggers of psoriasis vary for every individual. People often experience a flare of psoriasis when there is stress to the body mental, emotional, or physical. The physical stress of getting ill or experiencing a car accident may trigger the symptoms. The emotional stress of divorce or family illness could be another cause. Even the mental stress of college, tests, or a high-stakes work deadline can trigger psoriasis flares.

For others, food affects their condition. There arent specific foods that trigger psoriasis for everyone this is very person-dependent. For some people, gluten triggers a reaction. Others can eat as much gluten as they want and their psoriasis wont be affected.

There are also genetic links to psoriasis. Its not 100% hereditary just because your parents have it, doesnt mean youll get it. However, it does tend to run in families.

Typically, its a combination of these factors that causes psoriasis to appear. If you get it, youre likely genetically predisposed to psoriasis and experiencing a stressor that triggered a reaction.

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What Is Inverse Psoriasis

Inverse psoriasis, sometimes called hidden psoriasis or intertriginous psoriasis, is a form of psoriasis that affects skin folds. These are areas of your body where skin rubs against skin.

Inverse psoriasis can occur under your arms, under a womans breasts, or in the groin or inner thigh area.

People who have inverse psoriasis often have another form as well, like plaque psoriasis, on other parts of their body. While raised lesions of dry, scaly skin a key sign of plaque psoriasis often cover large sections of your body, inverse psoriasis tends to appear in smaller patches.

Inverse Psoriasis Vs Jock Itch

They can affect the same area, but there are differences between inverse psoriasis and jock itch.

• Jock itch shows up as reddened skin in the crease between your thigh and groin. It gradually spreads to your upper thigh in a half-moon shape. There could be blisters at the edges. You might also see a ring-shaped rash on your thighs and buttocks. Your skin might itch or burn, and it could get flaky or scaly. Jock itch is a fungus, and you can treat it with an antifungal medicine and by keeping the area clean and dry.
• Inverse psoriasis also can show up in the crease between your thigh and groin, but itâll just be red and white, and not scaly. You might also have cracks in your skin. And you could have scaly round patches on your upper thighs. If youâre overweight, you might also get intertrigo, a painful rash that results from skin rubbing together. Unlike jock itch, which tends to affect the crease between your thighs and groin and your buttocks and upper thighs, you can get psoriasis anywhere in your genital area. Learn what you can do about psoriasis in unexpected places on your body.

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Who Gets Nail Psoriasis

After developing a type of psoriasis on your skin, its common for psoriasis to affect the nails. Nail psoriasis becomes more common with age. Its also more common if youve had psoriasis on your skin for some time or have severe psoriasis.

Signs of nail psoriasis include tiny dents in your nails , discoloration under one or more nails, and a nail lifting away from the nail bed so that its no longer completely attached. Some people have a buildup of skin under one or more of their nails, which can also cause a nail to lift up.

What Else Should I Ask My Healthcare Provider

If you have psoriasis, ask your healthcare provider:

• How can I prevent outbreaks and control symptoms?
• What medication will work best for me?
• What else should I do to improve symptoms?
• What are my options if creams dont work?
• Will psoriasis ever go away?

A note from Cleveland Clinic

Psoriasis, an itchy skin condition, can come and go throughout your life. Its related to an overactive immune response and is not contagious. If you have skin changes that arent going away, talk to your healthcare provider. There is no cure for psoriasis, but psoriasis treatments can improve symptoms. Your provider may prescribe a special cream or moisturizer or medications. Other therapies are available if creams or medicines dont work. Maintaining your overall health will also help improve symptoms.

Last reviewed by a Cleveland Clinic medical professional on 10/17/2020.

References

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What Type Of Psoriasis Treatment Will I Need

Several treatment options can relieve psoriasis. Creams or ointments may be enough to improve the rash in small areas of skin. If the rash affects larger areas, or you also have joint pain, you may need other treatments. Joint pain may be a sign that you have arthritis.

Your provider will decide on a treatment plan based on:

• Severity of the rash.

• Vitamin A or retinoid creams.

Continue Learning About Plaque Psoriasis

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.

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What Are The Best Ways To Treat This

Since inverse psoriasis is often confused with an allergic skin reaction or a fungal infection , its important to make an appointment with a dermatologist who specializes in psoriasis, especially if youve noticed that you have a rash in a skin fold or crease that isnt healing, says Keith Choate, MD, a Yale Medicine dermatologist.

This specialist can accurately make a diagnosis and choose a tailored treatment for you, he says.

Todays inverse psoriasis treatment plans include the use of calcipotriene, a cream or ointment that contains vitamin D3 to help slow the growth of skin cells and reduce inflammation coal tar, a soothing gel and Castellanis Paint, a paint-on liquid that can help dry rashes.

The next line of defense: Mild topical corticosteroids that you apply directly to the skin. These topical creams are also effective in helping to reduce irritation and discomfort.

Applying topical steroids can help to calm inflammation, redness, and itch in the skin, says Tsippora Shainhouse, MD, a dermatologist in Los Angeles. Topical vitamin D can also slow down the production of new skin cells so that there are fewer cells building up and creating thick scale.

While topical steroids are the biggest go-to recommendation for treating inverse psoriasis, their use can cause the skin to become thinner and prompt more sensitivity.

Thats why these creams should be used only under the guidance of your healthcare provider, Dr. Choate says.

How Is Inverse Psoriasis Diagnosed

Diagnosis. A physician will normally diagnose psoriasis after listening to the person’s description of the symptoms and carrying out a physical examination and an inspection of the lesions. If the lesions occur in an area where the skin rubs against itself, the doctor may diagnose inverse psoriasis.

Just so, what does inverse psoriasis feel like?

Inverse psoriasis is known for its red, shiny, smooth rash. Unlike the scales, pustular spots, and crusting skin associated with other forms of psoriasis, the rash caused by inverse psoriasis is neither raised nor dry.

how common is inverse psoriasis? Inverse psoriasis occurs in 2 to 6 percent of people with psoriasis and most often alongside some other form of the condition, such as plaque psoriasis. It’s more common in people who are overweight or obese or have deep skin folds.

Herein, does inverse psoriasis go away?

“It doesn’t ever completely go away,” Beck said. The most common type of psoriasis in the genital area is inverse psoriasis . It usually appears as smooth, dry, red lesions.

How psoriasis is diagnosed?

Your doctor usually can diagnose psoriasis by taking your medical history and examining your skin, scalp and nails. Skin biopsy. Rarely, your doctor may take a small sample of skin . The sample is examined under a microscope to determine the exact type of psoriasis and to rule out other disorders.

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Physical Exam And Medical History Remain The Primary Tools

• Treating Psoriasis and Preventing Flares

Psoriasis is an autoimmune disorder primarily affecting the skin. The diagnosis typically involves a physical examination to identify the signs of the disease.

A review of your medical history would also be conducted to assess your symptoms and to rule out any other explanations for your condition. Less commonly, a tissue sample may be obtained to examine skin cells from the affected area with a microscopic.

Unlike some autoimmune disorders, there are no blood tests or imaging studies that can aid in the diagnosis of psoriasis.

Natural Treatments For Inverse Psoriasis

You may want to consider natural treatments to complement prescribed medications or to reduce the chance of a psoriasis flare-up. There are many natural options you can try that can help your psoriasis symptoms. Scientists havent proven that all of these treatments work.

Its important to speak with your doctor before trying any new treatments, including natural treatments. They may react with medications or other treatments youre using.

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What Causes Psoriasis Outbreaks

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

• Skin injury .
• Streptococcal or other infection that affects the immune system.
• Certain prescription medications .
• Cold weather, when people have less exposure to sunlight and humidity and more to hot, dry indoor air.