Inverse Psoriasis 101

There is no “good” type of psoriasis to have. But if you’ve got psoriatic plaques hidden in the folds of your skin, rubbing every time you move, creating additional friction and discomfort, you know that inverse psoriasis can be among the most painful kinds.

According to the National Psoriasis Foundation, it’s not uncommon for people with inverse psoriasis to also have other types of psoriasis elsewhere on the body. But what, exactly, constitutes inverse psoriasis—and how can you treat it? Here are all the basics you should know.

What Is Inverse Psoriasis?

While inverse psoriasis typically presents in conjunction with other forms of psoriasis, it is defined primarily by where on the body it is found: in creases, where skin rubs on skin. “Inverse psoriasis presents as red plaques, or as a shiny smooth rash, confined to the folds of the body,” explains board-certified dermatologist Peterson Pierre, M.D., of Pierre Skin Care Institute in Westlake Village, California.

Inverse psoriasis can develop anywhere you have skin folds, or where the skin rubs against itself. Common areas include the underarms, groin, buttocks, behind the knees and inner thighs, and under breasts says board-certified dermatologist Rhonda Klein, M.D., of Modern Dermatology of Connecticut in Westport.

What’s Different About Inverse Psoriasis?

Because it occupies those hidden creases and skin folds, inverse psoriasis presents a little differently from other forms of psoriasis.

“Unlike the scales, pustules, and crusting associated with other forms of psoriasis, inverse psoriasis appears shiny and feels moist to the touch,” Klein explains. Plaques tend to be red, shiny, and smooth.

“Just like other types of psoriasis, inverse psoriasis is caused by an autoimmune response in the body,” says Klein. “This form is triggered by moisture and friction of the skin folds.”

How Common Is Inverse Psoriasis?

According to Pierre, inverse psoriasis occurs in about two to six percent of people with psoriasis. He says these patients also tend to have plaque psoriasis and that it’s more common in patients who are obese or have deep skin folds.

What Treatment Options Are Available for Inverse Psoriasis?

Treating inverse psoriasis is very similar to treating other forms of psoriasis, according to Pierre. Effective treatments may include:

  • Topicals, such as steroid creams and coal tar
  • Phototherapy with UVA and/or UVB rays
  • Oral medications, such as Cyclosporine, Methotrexate, and Soriatane
  • Biologic medications, such as Cosentyx, Enbrel, and Humira

But treating inverse psoriasis can be especially difficult, since the areas most impacted tend to be very sensitive. Plus, the skin tends to be thinner in these areas, and so topically applied medications can sometimes carry more risks. If you’re prescribed a topical medication for inverse psoriasis, report any side effects to a doctor right away.

Klein says that inverse psoriasis is often associated with an increased risk of a yeast or fungal infection. “Sometimes, we need to add an antifungal medication to the treatment protocol to tackle that component,” she says.

If you have concerns you may have developed a yeast or fungal infection, talk to your doctor about testing and treatment options.

When Should I Seek Medical Treatment?

“Due to the constant friction and irritation in the affected areas, as well as the associated discomfort, you should treat inverse psoriasis sooner rather than later,” Pierre advises. “Don't feel shame or embarrassment because of the location. Inverse psoriasis is a medical condition just like any other and your board-certified dermatologist can get you on the appropriate treatment plan and provide some relief.”

It’s important to know you’re not alone in battling inverse psoriasis and you don’t have to suffer in silence. Help is available and finding the right dermatologist can get you on the path to finding relief.