How Can Psoriasis Affect Skin Folds?

Reviewed by: HU Medical Review Board | Last reviewed: July 2016.

Psoriasis is a chronic, autoimmune inflammatory condition that can cause symptoms anywhere on a person’s skin. For some people, the symptoms of psoriasis occur within skin folds and creases; the symptoms in these areas are usually caused by a specific type of psoriasis called “inverse psoriasis1.”  Inverse psoriasis is a form of psoriasis that affects between 3% and 7% of the patients with psoriasis2.

Psoriasis symptoms located in the skin folds often appear red or pink in color, shiny, and smooth. Unlike psoriasis symptoms in other areas, however, symptoms located in the skin folds do not tend to be covered in silvery scales (like traditional plaques). This is usually because the area between the folds is very moist and constantly rubbing together2. It is possible that it may be misdiagnosed as a fungal infection1.

Where do psoriasis symptoms in the skin folds tend to occur?

Psoriasis symptoms can appear in any of the skin folds located throughout the body. Areas where symptoms are particularly common include1:

  • Under the arm and in the armpits
  • In the creases between the upper thighs and the groin
  • Under the breasts
  • Around the navel
  • In the area between the buttocks

Symptoms can also occur in other skin fold areas, such as behind the knees, inside the elbows, and behind the ears.

Psoriasis in the skin folds can be very itchy and cause discomfort. Unfortunately, rubbing and/or scratching the area can make the symptoms worse. Some people with psoriasis symptoms in their skin folds develop what are called “fissures” deep within the crease of the fold. Fissures are cracks in the skin, and they can be quite painful until they heal2. But healing can be difficult because the fissure is repeatedly re-opened due to movement in the knee or elbow, for example.

Sweating and friction can cause irritation in the skin folds and make symptoms worse as well. For example, running or walking can cause chafing and irritation. A similar reaction can occur in areas where an article of clothing is tight or has elastic causing friction and trapping moisture. Areas within skin folds can also tend to develop fungus or yeast infections.

How is psoriasis in skin folds treated?

Psoriasis symptoms in skin folds will often improve with treatment, but finding the right treatment regimen can sometimes be difficult1. The skin within the folds can be very sensitive and tend to become irritated. This means that the types of medicines that can be used on psoriasis symptoms in other areas of the body cannot be used in the skin folds because they are too strong and can cause irritation2.

For this reason, healthcare providers will often recommend that patients try using milder forms of medicines for psoriasis in skin folds. Topical treatments are usually the first step for patients who have mild or moderate symptoms. Topical treatments are medicines that are applied directly to the symptoms in the affected area.

A common type of topical treatment for psoriasis in skin folds is corticosteroid cream or ointments. Corticosteroids work by reducing inflammation, which helps to reduce the amount of skin cells produced by the body. Other types of topical treatments that healthcare providers may recommend include calcipotriene (vitamin D derivative), coal tar preparations, and anthralin. However, it is important to use these exactly as instructed, because using too much can cause further irritation1.

Some patients will need to try different treatments, or combinations of treatments, to find the best treatment regimen for their particular symptoms. People who have moderate or severe psoriasis may need treatment with stronger systemic and/or biologic medicines that affect the way the immune system functions to treat the symptoms2.

Tips for living with psoriasis in skin folds

One treatment that is used particularly for inverse psoriasis symptoms in skin folds is called “Castellani’s Paint,” which works by drying out the moist areas between the folds. This is available over the counter, but patients should check with their healthcare providers to make sure that it is okay to try the treatment. Castellani’s Paint is a special liquid that is painted onto the skin affected by the symptoms3.

Some people also find it helpful to use a combination emollients and powders at different times in the skin folds.3 Creams can moisturize and soften the skin, and powders can work to dry out the moist areas in the folds where the symptoms occur.

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