Inverse psoriasis is a less common but highly uncomfortable form of psoriasis that affects skin folds and areas where skin rubs against skin. While it’s not as widely recognized as plaque psoriasis, it can significantly impact quality of life due to its location, discomfort, and frequent misdiagnosis.
In this article, we’ll explain what inverse psoriasis is, how it differs from other types, what causes it, and how to manage it effectively.
What is Inverse Psoriasis?
Inverse psoriasis (also called flexural psoriasis) is a chronic autoimmune skin condition that causes smooth, red, inflamed patches in intertriginous areas—that is, areas where skin touches skin, such as:
- Armpits
- Under the breasts
- Groin and genitals
- Inner thighs
- Behind the knees
- Buttocks or skin folds of the abdomen (especially in overweight individuals)
Unlike the scaly patches seen in plaque psoriasis, inverse psoriasis lesions are typically shiny, smooth, and moist, due to the damp environment in skin folds.
What Causes Inverse Psoriasis?
Like other forms of psoriasis, inverse psoriasis is caused by a malfunction in the immune system, where skin cells reproduce too quickly and trigger inflammation. The exact cause is unknown, but several factors contribute, including:
- Genetic predisposition
- Immune system dysfunction
- Environmental triggers
The location-specific nature of inverse psoriasis means that friction, moisture, heat, and sweating often worsen symptoms.
Inverse Psoriasis vs. Other Skin Conditions
Inverse psoriasis is often mistaken for:
- Fungal infections (like candidiasis)
- Intertrigo (irritation due to moisture/friction)
- Contact dermatitis
However, incorrect treatment—like using antifungal creams when it’s not a fungal issue—can delay relief. A dermatologist can provide an accurate diagnosis through visual examination, history, and sometimes skin biopsy.
Symptoms of Inverse Psoriasis
Common signs include:
- Smooth, shiny red patches
- Inflammation and tenderness
- Itching or burning
- Raw or irritated skin
- Worsening with heat or sweat
- Sometimes cracked or bleeding skin in severe cases
- Inverse psoriasis does not usually have thick scales—moisture in skin folds prevents the buildup of dead skin.
Is Inverse Psoriasis Linked to Other Psoriasis Types?
Yes. Many people with inverse psoriasis also have plaque psoriasis on other parts of the body. In fact, up to 30% of patients with inverse psoriasis have it as part of a broader psoriasis diagnosis.
Additionally, inverse psoriasis can coexist with fungal infections, especially due to the warm, moist environment of skin folds—so treatment may sometimes involve addressing both conditions simultaneously.
Triggers That Can Worsen Inverse Psoriasis
Like other forms of psoriasis, flare-ups can be triggered by:
- Sweating and friction
- Obesity (due to deeper skin folds)
- Tight clothing
- Hormonal changes
- Stress
- Certain medications
- Infections (bacterial, viral, or fungal)
Managing these triggers is crucial for keeping symptoms under control.
Diagnosis
A dermatologist can usually diagnose inverse psoriasis through:
- Physical examination
- Reviewing personal and family medical history
- Rule-out tests for fungal infections (e.g., KOH test)
- Biopsy in uncertain cases
Prompt diagnosis is essential to differentiate it from similar-looking skin conditions and start appropriate treatment.
Treatment Options
While there’s no permanent cure, inverse psoriasis is treatable with a range of therapies aimed at reducing inflammation, controlling symptoms, and preventing flare-ups.
1. Topical Treatments
- Low-potency corticosteroids: Reduce inflammation but must be used sparingly to avoid thinning of delicate skin.
- Vitamin D analogues (e.g., calcipotriol): Help slow down skin cell turnover.
- Calcineurin inhibitors (e.g., tacrolimus, pimecrolimus): Ideal for sensitive areas like the groin or underarms with less risk of skin thinning.
2. Moisturizers and Barrier Creams
- Soothing emollients help reduce friction and restore the skin barrier.
- Zinc oxide–based creams or petroleum jelly can prevent skin breakdown.
3. Systemic Treatments
For moderate to severe cases or when inverse psoriasis is part of widespread psoriasis:
- Oral medications like methotrexate, acitretin, or cyclosporine
- Biologic therapies (e.g., adalimumab, etanercept, secukinumab): Target specific immune pathways and offer long-term control
4. Hygiene & Lifestyle Management
- Keep affected areas dry and clean
- Use soft, breathable fabrics
- Avoid harsh soaps and tight clothing
- Lose weight (if needed) to reduce skin folds
- Manage stress, which can worsen flare-ups
Inverse Psoriasis in Children
While less common, inverse psoriasis can affect children, especially in diaper areas (sometimes mistaken for diaper rash). Pediatric dermatologists may recommend milder treatment options and focus on gentle skin care.
When to See a Dermatologist?
If you have a persistent rash in a skin fold area that doesn’t respond to over-the-counter treatments, is painful, itchy, or spreading, or if you’ve been previously diagnosed with psoriasis and notice new symptoms in folds—book an appointment with a dermatologist.
Expert Care at Athena Skin Clinic
At Athena Skin Clinic, we specialize in diagnosing and treating all types of psoriasis, including challenging cases like inverse psoriasis. Our team provides personalized treatment plans, combining medical therapy with lifestyle support to help you manage your symptoms and regain skin confidence.
Schedule a consultation with one of our dermatology experts today and get the answers—and relief—you deserve.