What Is Inverse Psoriasis?
Reviewed by: HU Medical Review Board | Last reviewed: July 2016. | Last updated: July 2020
Psoriasis is a disease in which chronic inflammation in the body triggered by the immune system causes symptoms that can affect the skin, joints, and nails. Inverse psoriasis is a form of the condition that can occur in any of the various folds of the body, such as the armpit1. Inverse psoriasis is also known as “flexural psoriasis.” Most people with inverse psoriasis have plaque psoriasis symptoms on other parts of their bodies, as well. This type of psoriasis is estimated to affect between 3%-7% of people with the condition6.
Where can inverse psoriasis symptoms occur?
The symptoms of inverse psoriasis are smooth, pink/red, shiny areas of skin. These areas are not usually covered in scales, unlike typical plaque psoriasis symptoms that occur in other parts of the body2. Some people may develop a crack (“fissure”) deep within the skin crease.
The most common place where inverse psoriasis symptoms occur are3:
Less common symptoms of inverse psoriasis
Less commonly, inverse psoriasis symptoms might occur in the following areas:
- Behind the knees
- In the elbows
- On the scalp
- Behind the ears
- In the ears
Sweating and any type of friction can both tend to make the symptoms of inverse psoriasis get worse, due to chafing and irritation. Rubbing and scratching can also worsen symptoms. People with inverse psoriasis are also more likely to get certain types of fungal, bacterial, or yeast infections4.
How is inverse psoriasis treated?
Many people with inverse psoriasis find that treatment is able to reduce and even eliminate their symptoms. However, like other types of psoriasis, people with inverse psoriasis will often go through periods of remission and relapse5. During remission, the symptoms go away for a length of time after treatment, but then symptoms return during a relapse.
Topical treatments are medicines that are applied directly to the skin of the area affected by symptoms. They might be used alone or in various combinations, along with emollients to moisturize the skin and relieve discomfort.
Treatment with topical corticosteroids is a common type of treatment that people with inverse psoriasis will try. Topical corticosteroids work by reducing the amount of inflammation in the affected area. Symptoms of psoriasis are caused by excess skin cell production, which is due to inflammation. Therefore, corticosteroids can help to reduce the symptoms of inverse psoriasis.
Milder versions of topical corticosteroids are often effective against symptoms, but the symptoms tend to come back when treatment stops. Stronger versions of topical corticosteroids have a more powerful effect, but they can only be used sparingly and for a very short time because of the side effects that they can cause. For example, they can cause thinning of the skin and/or stretch marks. If overused, corticosteroids can actually make the symptoms of psoriasis worsen over time5.
Additional inverse psoriasis treatments
Other types of treatments include prescription medicinal creams that are similar to Vitamin D, such as calcipotriene cream. This is a common, safe, and often effective treatment for inverse psoriasis symptoms5. It is not linked to the same serious side effects that stronger corticosteroids are. Topical calcineurin inhibitors, such as tacrolimus ointment, are another topical treatment for inverse psoriasis symptoms.
For people who have inverse psoriasis as well as bacterial or yeast infections may be advised to add antiseptic and antifungal medicines to their treatment plans.