Inverse Psoriasis (Flexural Psoriasis) – Causes, Symptoms & Treatment

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Flexural psoriasis is also known as inverse psoriasis and this type of psoriasis is one of the most painful forms of psoriasis. This type of psoriasis is characterized by fiery red and inflamed patches on the affected skin and mainly affects the folded skin like beneath the breast, around the groin part or armpits. It is not exhibited by scales, one of the peculiar characteristic of psoriasis. But inverse psoriasis causes more itching of the skin and is more painful. As it usually affects armpits or folded regions of the skin, it is usually misdiagnosed with fungal infections. If flexural psoriasis is not treated on time, then it can lead to fungal infections or other skin problems.

Inverse Psoriasis

 

Symptoms of Inverse Psoriasis

Inverse psoriasis is characterized by slightly different appearance from the other forms of psoriasis. This is because of the moisture present in the affected skin folds. The following are the characteristics of inverse psoriasis:

  1. Lack of scales on the affected area
  2. Presence of smooth and shiny layer on the affected skin.
  3. Presence of cracks or fissures in the depth of crease folds.
  4. Well demarcated and inflamed borders.
  5. Itching and pain on the affected area.
  6. If inverse psoriasis occurs on the circumcised penis, then scaly plaques may be present.

Treatment of Inverse Psoriasis

The treatment of inverse psoriasis includes:

  1. Topical steroids: Topical steroids along with an antifungal agent are advisable as first line of treatment for inverse psoriasis. Generally strong topical steroids like coal tar, salicylic acid ordithranolare prescribed as there are high chances of relapse if weak steroids are prescribed. These strong topical steroids can be used after diluting them as these steroids can cause irritation in sensitive areas. If the skin gives good response with topical steroid, then use of steroid cream should be stopped if healing of skin occurs. Overuse of steroid cream or use for longer time can cause thinning of the skin folds. This can further lead to stretch marks or can aggravate the disease as well.
  2. Vitamin D-like compounds: This is also one of the safe and effective treatments to deal with inverse psoriasis. Use of calcipotriol cream is prescribed to apply two times a day. In case of irritation caused by this cream, it is advised to use once daily.
  3. Topical calcineurin inhibitors: Ointments like tacrolimus or pimecrolimus can also be used as these ointments cause less thinning of the affected skin.
  4. Topical antifungal agents and Antiseptics: Along with combination of above treatment, antifungal agents are also prescribed to treat with bacterial or fungal infections.
  5. Phototherapy: It is usually not recommended to treat inverse psoriasis as the folds are not accessible by light exposure.

Complications of Inverse Psoriasis

If treatment of flexural psoriasis is not done at right time, may be due to misdiagnosis then following complications can occur:

  1. Development of fungal or yeast infections mainly Candida albicans(thrush).
  2. Irritation and pain due to infection and sweating in folded areas.
  3. Lichenification : this is a kind of eczema usually results due to scratching and rubbing on the affected area. This problem is mainly found around the anal region as faecal material causes irritation leading to more itching.
  4. Due to discomfort and embarrassment, the patients may also exhibit sexual difficulties.
  5. Thinning of skin due to use of strong topical steroid creams for longer time.

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