How To Determine And Treat Inverse Psoriasis
Inverse psoriasis, also known as intertriginous psoriasis, is a type of psoriasis that forms in the folds of your body. This includes areas like your armpits, groin and under breasts. It can also occur between your buttocks and genitals.
Its characterized by smooth, red patches that may crack or bleed. Unlike plaque psoriasis, inverse psoriasis doesnt have the typical silvery scales associated with it. It tends to be less severe than other types of psoriasis. However, it may be more difficult to treat because of its location in skin folds.
If you have symptoms of inverse psoriasis that dont go away after one or two weeks, make an appointment with your doctor. Theyll diagnose you based on the appearance of your skin and a physical examination. You wont need any lab tests or imaging studies for a diagnosis.
Inverse psoriasis is generally treated with topical medications. Corticosteroids are usually used first. If they dont work well enough alone, they may be combined with calcipotriol or tazarotene .
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 Home Remedies Can Help Relieve Symptoms Of Genital Psoriasis
- Avoid hot water baths and use lukewarm water
- Limit the amount of time spent in the water to under 15 minutes
- Use mild soaps and other products that are free of fragrances, dyes, and alcohol
- Dry the skin gently after bathing
- Moisturize the skin several times a day using a cream or ointment
- Use coconut oil to keep the skin hydrated
- Wear loose underwear and cotton clothing that allows affected areas to breathe
- Apply petroleum jelly or talcum powder to genital areas
- Minimize stress
- Avoid any type of phototherapy that can increase the risk of developing genital cancer
- Avoid getting urine or feces on the affected area
- Consume plenty of fiber to ease bowel movements
- Take over-the-counter medicines for severe itching
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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.
How Is Inverse Psoriasis Diagnosed
Lesions that occur in delicate skin folds distinguish inverse psoriasis from other types of psoriatic disease. Smooth red patches from skin-on-skin friction particularly in the groin can be a sign of inverse psoriasis. A dermatologist will perform a physical exam and visual inspection, and possibly take skin samples to confirm psoriasis and rule out any bacterial or fungal infection.
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Natural Healing Of Inverse Psoriasis
Psoriasis is an auto-immune skin disorder where the faulty immune system triggers rapid growth of skin cells to cause scaling, inflammation and itching. The exact cause is unknown, but, leaky gut is the root of the problem as per holistic healing approach.
Leaky gut means leakage in your gut!
In simpler terms, imagine that the walls of your small intestine have a net like structure with extremely small holes. These micro holes allow only specific stuff to pass through and enter your blood stream. It restricts the body toxins from entering your blood stream. If due to some reason, this net structure gets damaged and the holes get bigger- then the above mentioned un-welcomed stuffs would seep through and mix into your blood stream. Your immune system doesnt like these foreign invaders and becomes hyperactive. Such a furious immune system would register its protest by triggering an auto-immune reaction to cause inflammation and exponential growth of skin cells.
Various factors which can cause leaky gut are:
- Compromised gut health- Chronic constipation, indigestion, poor gut flora, nutritional deficiency, food intolerances
- Faulty genes
- Infection such as strep throat
- Skin injury
- Poor lifestyle- Over consumption of processed and junk foods, obesity, improper sleep, skipping meals, too much consumption of alcohol and tobacco
- Long term consumption of antibiotics, steroids and certain medications
The holistic healing of Psoriasis involves:
Common Types Of Psoriasis
Plaque psoriasis is the most common form of psoriasis.
Its symptoms are dry skin lesions, known as plaques, covered in scales.
They normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body.
The plaques can be itchy or sore, or both. In severe cases, the skin around your joints may crack and bleed.
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Prevalence Of Inverse Psoriasis
Contrary to the most common form of psoriasis , which accounts for about 90% of all psoriatic cases, there is not all that much accurate data available for inverse psoriasis.
According to different studies and populations, the prevalence of IP is highly variable, ranging from 3 to 36%, because of the lack of precise diagnostic criteria and of the consensus whether genital localization is considered part of the disease
It is estimated that it occurs in between 3 to 7% of people already suffering from psoriasis.
Biologic And Other Systemic Treatments
Biologics and other oral systemic therapies, such as methotrexate and cyclosporine, are reserved for the more severe and resistant cases of genital and inverse psoriasis. Typically, both types of psoriasis are considered isolated lesions, and thus are not widespread enough to be considered for systemic treatment, which may be associated with more severe adverse effects . Recently, 78 global psoriasis experts in the International Psoriasis Council developed a consensus statement to recategorize psoriasis severity to consider special cases, such as in patients with genital psoriasis who are diagnosed as mild based on BSA and symptom severity but may warrant systemic therapy . This Delphi exercise has endorsed the use of a more practical approach to categorize psoriasis disease severity when it involves special areas of the body, such as genital and intertriginous areas.
Oral Systemic Therapies
Currently, there are no large clinical trials that evaluate the efficacy and safety of oral systemic therapies for genital and inverse psoriasis. There are two reports on methotrexate and one case report on mycophenolate mofetil . Methotrexate was associated with several side effects including headache, insomnia, urinary tract infections, and gastrointestinal symptoms . Thus, the use of methotrexate should be limited to patients with debilitating quality-of-life impairment .
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Diagnosis Of Inverse Psoriasis
Since classical scaling associated with psoriasis is often missing in inverse psoriasis, diagnosing it may be difficult.
If the first sign such as itching appears in the anal or genital area, many people affected do not go to the doctor out of shame.
When an examination is done, inverse psoriasis is often mistaken for eczema or a yeast infection. In fact, the moist environment in which the disease spreads also provides an ideal breeding ground for yeast fungi to grow. In this case, two different diseases have to be treated.
A precise history and histological findings are therefore essential for the diagnosis of inverse psoriasis.
The list of medications the patient is taking on a regular basis must be checked by a specialist. If a drug proves to be the trigger for the disease, the doctor will prescribe a different drug.
Pictures of inverse psoriasis as found in the armpits, and in the butt crack:
Inverse Psoriasis Vs Darier Disease
Darier disease is a rare autosomal dominant genetic disorder. It typically presents with scaly, crusted, and raised areas on the scalp, upper chest, back, and skin folds.
The raised areas have a firm, harsh feel, similar to coarse sandpaper. If several areas grow together, they may form larger, wart-like lesions, which can have an unpleasant odor within skin folds. Unlike inverse psoriasis, Darier disease usually causes lesions that are the same color as a persons skin.
It may also cause a heavily crusted rash similar to seborrheic dermatitis.
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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.
Hydrocortisone Creams And Ointments
You can buy a mild corticosteroid like hydrocortisone without a prescription. For a few small patches of psoriasis, a mild hydrocortisone works well. If you have more than a few small patches, youll likely need a prescription corticosteroid to see results.
Whether OTC or prescription, this medicine works quickly to:
Reduce the itch
If you have cracked or bleeding skin, an ointment will likely feel better than a cream. Ointments tend to be more soothing and less irritating than creams.
MoisturizerThis may help anyone who has psoriasis because psoriasis makes the skin dry and scaly. Moisturizer helps to seal water in the skin, which can:
Help your skin heal
Dermatologists recommend applying moisturizer once a day, and more often when your skin is really dry. When shopping for a moisturizer, you want to select a:
Heavy cream, ointment, or oil rather than a lotion
Product that you like and will use
Oil can be especially healing, but its also messy. To reap the benefits of oil, try applying it before bedtime.
Moisturize before washing
For best results, you want to apply your moisturizer within 3 minutes of bathing and after washing your hands.
Scale softenersYoull find OTC products and prescription medicines that contain salicylic acid. This active ingredient helps to:
Remove and soften scale
Removing the scale helps other medicine that you apply to your skin to work better.
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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, its 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 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 , indigo naturalis and aloe vera, may provide some relief.
Reducing Your Risk Of Inverse Psoriasis
It is not always possible to prevent inverse psoriasis since the disease is not fully understood. However, there may be steps you can take to protect skin in areas prone to develop inverse psoriasis. This includes:
Keeping skin dry and cool
Losing excess weight
Moisturizing with a lotion suitable for psoriasis
Using mild, fragrance-free soaps and cleansers
Wearing loose-fitting clothes made of absorbent materials. Women should wear properly-fitting, supportive bras.
If you already have psoriasis, talk with your doctor about your risk of inverse psoriasis. Ask about ways to protect your skin.
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Between 21 30 Percent Of People Living With Psoriasis Develop Inverse Psoriasis
Did You Know?
Inverse psoriasis appears on skin of color as lesions of purple-ish, brown or darker than the surrounding skin, in body folds. On Caucasian skin it appears as bright red lesions in body folds. It may appear smooth and shiny. Many people with inverse psoriasis have another type of psoriasis elsewhere on the body at the same time.
Genital And Anal Psoriasis
Plaque psoriasis at the genitals is sometimes called genital psoriasis. A study from 2017 in the journal Dermatology & Therapy reported the prevalence and effect on quality of life of people with plaque psoriasis who had genital involvement. Researchers found that 70% of the study participants had genital involvement.
Among these study participants, 100% reported itch and discomfort, 95% reported redness, burning, and stinging, 85% reported pain, and 75% reported scaling. Many of the study participants reported that itch, stinging, and burning were the most bothersome symptoms.
Inverse psoriasis is a rare form of psoriasis that affects between 3% and 7% of people with psoriasis. It often affects the genital and anal areas at areas where the skin folds or creases.
It can cause ongoing discomfort to the upper thighs, pubis, the folds between the thighs and groin, the vulva, penis, anus, and buttocks. Inverse psoriasis causes dry, red, inflamed patches on the skin of these sensitive areas.
Upper thighs: Inverse psoriasis can cause red, inflamed patches on the upper thighs. This can be especially irritating when the thighs rub together with walking or running.
Pubis: The pubis, also called the pubic bone, is located just above the genitals. In this area, the skin is very sensitive. Itching and scratching can make this area even more inflamed and sore.
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What Is The Treatment For Flexural Psoriasis
Flexural psoriasis responds quite well to topical treatment but often recurs.
Topical steroids Weak topical steroids may clear flexural psoriasis but it will usually recur sometime after discontinuing treatment. Stronger topical steroids need to be used with care and only for a few days, thinly and very accurately applied to the psoriasis. If the psoriasis has cleared, stop the steroid cream. The steroid cream may be used again short-term when the condition recurs.
Overuse of topical steroids in the thin-skinned body folds may cause stretch marks, marked thinning of the skin and can result in long term aggravation of psoriasis .
Vitamin D-like compoundsCalcipotriol cream is an effective and safe treatment for psoriasis in the flexures and should be applied twice daily. If it irritates, it can be applied once daily and hydrocortisone cream 12 hours later.
Topical calcineurin inhibitors The topical calcineurin inhibitors, tacrolimus ointment and pimecrolimus cream may be effective and do not cause skin thinning.
Combinations of the treatments listed above may be used, together with emollients. Antiseptics and topical antifungal agents are often recommended as flexural psoriasis may be complicated by bacteria and yeasts, including Candida albicans and Malassezia.
Off-label use of the phosphodiesterase-4 topical inhibitorcrisaborole has been shown to be effective for flexural psoriasis.
Systemic agents are rarely required for limited flexural psoriasis.
How To Treat Inverse Psoriasis
Options for treating inverse psoriasis most commonly include, but are not limited to:
1. Creams and ointments
Corticosteroids. Topical steroids are often the treatment of choice. These topical treatments are available in a variety of formulations such as creams, ointments, gels, lotions, foams, oils, and sprays.
Corticosteroids are very effective in calming the inflammation brought on by psoriasis. This results in less irritation and discomfort from the itchiness.
It is imperative you apply these steroids as prescribed by your doctor. Prolonged use of corticosteroids can cause the skin to get thinner and more sensitive. This is especially true in skin folds where the skin is already more sensitive when compared to other areas of the body.
Vitamin D ointment/cream. Calcipotriene is the generic name of Dovonex cream and is available in cream, ointment, and foam formulations.
Always apply as directed by your medical professional. It is generally applied twice daily.
This inverse psoriasis treatment reduces inflammation and slows the growth of new skin cells.
Topical Calcineurin Inhibitors . Tacrolimus ointment and Pimecrolimus cream.
These are typically used to treat eczema but were found to also work well when treating psoriasis.
The inhibitors change the skins immunity system to prevent it from producing substances that may bring about skin diseases.
NOTE: This is NOT recommended for any person with a weakened immune system.
2. Ultraviolet Light therapy
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Can Inverse Psoriasis Be Cured
Inverse psoriasis treatment mainly focuses on symptom relief as inverse psoriasis, just like guttate psoriasis will never completely go away. Even after successful treatment, it can flare up at any time.
Once the medical professionals have diagnosed your skin condition as inverse psoriasis, they will discuss the various inverse psoriasis treatment options available with you and then decide which one is best suited to your situation.