Reverse Psoriasis

Generality

Inverse psoriasis is a particular type of psoriasis, which causes, at the typical skin folds of areas such as the armpits, the groin or genitals, to have the characteristic red spots or blotches, with a shiny and smooth feel.

Inverse psoriasis is a disease whose causes are unclear; according to one of the most accredited causal theories, it would be a condition of genetic mold, which would manifest itself only when certain events or circumstances occur (the so-called triggers of reverse psoriasis).

The diagnosis of reverse psoriasis does not require special tests, but only an accurate analysis of the symptoms and a thorough evaluation of the clinical history.

Currently, the only treatments available to those suffering from reverse psoriasis are symptomatic treatments, ie treatments that allow symptom management to improve the patient's general health.

Brief review of psoriasis

Psoriasis is a chronic-recurrent inflammatory pathology of the skin, of a non-contagious nature, which occurs as a result of hyperproliferation of epidermal keratinocytes and is the cause of distinctive rashes (eg scales, silvery plaques, reddish patches, etc.) in various parts of the body, including in particular: scalp, armpits, elbows, hands, knees and feet.

Psoriasis belongs to the category of autoimmune diseases, that is diseases characterized by an exaggerated or improper response of the immune system, towards the body that the immune system in question should instead protect.

What is Reverse Psoriasis?

Inverse psoriasis is a type of particular psoriasis, whose peculiarity consists in causing plaques and patches of reddish color at the skin folds ; the skin folds (or folds of the skin) are those particular areas of the human body, in which two contiguous regions of skin are arranged in such a way as to be able to rub against one another.

Did you know that ...

Doctors and experts in the field of pathology recognize the existence of 5 types of psoriasis : plaque psoriasis (the most common type of all), guttate psoriasis, erythrodermic psoriasis, pustular psoriasis and the subject of discussion of this article, reverse psoriasis.

What areas of the body affect reverse psoriasis?

Going into more detail, reverse psoriasis mainly affects the armpits, the groin region, the navel, the genital area, the perianal region and, in women, the area below the breast; all these districts are home to characteristic skin folds.

Other names of reverse psoriasis

Inverse psoriasis is also known as inverted psoriasis, reverse acne, fissure psoriasis and intertriginous psoriasis .

Causes

Inverse psoriasis is an autoimmune disease whose causes are unclear; in other words, what triggers the malfunction of the immune system typical of the condition in question is not fully known.

Obviously, there are several theories on the subject; among these, one of the most reliable believes that reverse psoriasis (as well as other types of psoriasis) is a pathology of genetic mold, whose manifestation would occur only when certain events occur; in essence, according to this theory, to suffer from reverse psoriasis it is not enough to be the bearer of a certain genetic alteration, but you must also be involved in specific events or situations.

In the list of such events / situations - which the experts define with the English term triggers - are:

Periods of high stress;
Sunburns, scratches, burns and injections. In a context of reverse psoriasis and other related diseases, when an insult or injury to the skin triggers the typical rash of the present condition, the doctors talk about Koebner 's phenomenon ;
The use of drugs such as lithium-based medicines, antimalarials, indomethacin, quinidine and inderil;
Particular streptococcal infections;
The presence of allergies;
Particular climatic conditions;
Certain eating habits.

Based on what the supporters of the theory under examination report, the triggers would not have the same impact on every person predisposed to reverse psoriasis; this means that a trigger capable of triggering the typical rash in an individual could be completely without consequences in another subject.

Risk factors

In people with a predisposition to psoriasis, the presence of obesity is an important factor favoring reverse psoriasis; this is explained by the large number of skin folds that characterize the body of the obese, especially at the level of the abdomen and neck.

In people suffering from obesity, inverse psoriasis affects not only the classic anatomical areas (axillae, groin, etc.), but also the neck and abdomen, as they present various skin folds.

Symptoms and Complications

The typical signs of reverse psoriasis are reddish spots or patches, completely smooth and shiny looking. If they are of limited extension, these spots / patches could be not very evident, as they are hidden inside the skin fold (in which they reside); if instead they are very large, they are easily visible even around the fold of the skin from which they originate.

Inverse psoriasis is unique because, unlike all other types of psoriasis, it does not produce rough patches, scales, crusted skin and / or pustules; according to experts, this peculiarity would be due to the affected anatomical areas, which are typically wet areas.

Associated diseases

Inverse psoriasis is often associated with another type of psoriasis: plaque psoriasis .

Present in about 80% of psoriasis cases, plaque psoriasis mainly affects elbows, knees, scalp and part of the back, and is responsible for raised and well-defined red patches, on which silvery-white, thick scales emerge. dry.

Complications

Several complications may arise from the presence of extensive reverse psoriasis, including:

Irritation from heat or sweat . To this phenomenon contributes the rubbing to which the skin folds present in the human body are subjected;
Secondary fungal infections . In particular, secondary infections with Candida albicans are reported;
Bacterial infections . They can occur if the affected skin folds, also due to repeated rubbing, are the object of injuries.
Lichenification . It consists of a thickening of varying degrees of the skin, which makes the latter harder and drier.
In a context of inverse psoriasis, lichenification is due to the repeated rubbing of the skin folds subjected to rash;
Difficulties in the sexual sphere . They are the result of discomfort and embarrassment deriving from a serious form of inverse psoriasis, which is responsible for patches and spots of considerable extension;
Thin skin . It is a consequence of the prolonged use of topical corticosteroids for the management of the effects of reverse psoriasis.
Stretch marks . It is another consequence attributable to drugs for the treatment of reverse psoriasis.

When should I go to the doctor?

In general, the formation of patches or spots on the skin without explanation for reasons is always a good reason to contact the attending physician and arrange a visit to him, to investigate the situation.

The timely recognition of reverse psoriasis is useful, because it allows to act on the disease when the extent of its patches is still contained and when the risk of infection is low; moreover, it allows the patient to inform himself on time about the remedies and the effective behaviors to control the symptomatology (ex: in the presence of obesity, a good behavior is to lose weight).

What to do in case of infection?

If signs of infection appear in the areas subject to reverse psoriasis, the affected individual should contact their treating physician immediately to receive instructions regarding the most appropriate treatment.

In such circumstances, carelessness can have unpleasant consequences.

Diagnosis

In general, doctors reach the diagnosis of inverse psoriasis after the patient tells the symptoms, and after a thorough physical examination and a scrupulous medical history .

In order to talk about reverse psoriasis, the presence of reddish, smooth to the touch and glossy spots or patches in the skin folds is essential.

Is it possible to confuse reverse psoriasis with some other illness?

Reverse psoriasis produces skin eruptions similar to those of seborrheic dermatitis, so doctors may confuse it for the latter.

Some subtleties such as: distinguishing psoriasis inverse from seborrheic dermatitis

The color of the spots / patches, which in the case of inverse psoriasis is reddish, while in the case of seborrheic dermatitis it tends to salmon;
The definition of spots / patches, which is greater in reverse psoriasis than in seborrheic dermatitis.

Did you know that ...

Seborrheic dermatitis, or seborrheic eczema, is an inflammation of the skin, which mainly affects the scalp and, secondly, other areas of the body, such as the groin, chest, eyebrows and sides of the nose.

Therapy

As for the other types of psoriasis, even for reverse psoriasis there is not yet a specific cure, through which to achieve healing, but there are only symptomatic treatments, ie therapies aimed at controlling the symptomatology in order to relieve the patient and make it less annoying the presence of the condition in question.

Among the various symptomatic treatments indicated in the case of reverse psoriasis, include:

Topical corticosteroids;
Phototherapy;
Immunosuppressive drugs.

Furthermore, these therapeutic remedies must be accompanied by the countermeasures to be adopted in the case of skin infections, countermeasures consisting of antibiotics or antifungals, depending on the causative agent.

Topical corticosteroids

Corticosteroids are powerful anti-inflammatory drugs.

In the presence of reverse psoriasis, the indicated corticosteroids are in the form of a cream, which the patient must spread where there are reddish spots and patches (topical use).

These drugs are very effective and represent the first line treatment of reverse psoriasis; however, if used for long or inappropriately, they are responsible for several adverse effects, including thin skin, appearance of stretch marks, telangiectasia and excessive growth of body hair.

The use of corticosteroids always requires some caution; therefore, before using them or if the dose seems ineffective, it is always a good idea to consult your doctor and rely on his instructions.

Phototherapy

Phototherapy is a therapeutic technique based on the use of a light source, which emits UVB radiation.

In a context of inverse psoriasis, the patient's exposure to these radiations slows down the growth of the cells that characterize the spots and the typical patches of the present condition.

The use of phototherapy, as a remedy for the control of the symptoms of reverse psoriasis, occurs only in clinical cases of medium / high severity.

For reasons still unknown, phototherapy is effective only on a certain percentage of patients with reverse psoriasis.

Immunosuppressive drugs

Immunosuppressants are medicines that can reduce the effectiveness of immune defenses.

In the presence of an autoimmune disease such as inverse psoriasis, the properties of immunosuppressants are useful, because they alleviate the effects deriving from the malfunctioning of the immune system.

Used only when corticosteroids and phototherapy are ineffective, the immunosuppressants most used in the control of reverse psoriasis are: ciclosporin (systemic administration), methotrexate (systemic administration), pimecrolimus (topical administration) and tacrolimus (topical administration).

Home remedies and lifestyle

To better control the symptoms of reverse psoriasis, some home remedies and some precautions are also important, such as:

Pay constant attention to personal hygiene, so as to prevent any infections;
Make hot baths with delicate soaps;
Use moisturizing and emollient creams, especially when the environmental climate is dry and cold;
Avoid the use of aggressive soaps;
Learn and practice one of the many techniques for stress management, clearly where it is associated with the onset of symptoms;
Lose weight, if there is a problem of overweight or obesity;
Expose yourself daily to sunlight for 10-20 minutes. If reasonable, sun exposure brings benefits to the reverse psoriasis patient;
Avoid the consumption of alcoholic substances, because they reduce the effectiveness of some drugs used in the control of reverse psoriasis;
Pin up on a personal diary all those circumstances or events, whose occurrence involves the reappearance or aggravation of the symptomatology;
Avoid scratching the affected areas, because the resulting excoriations increase the risk of infection.

Prognosis

With the appropriate treatments and the right precautions during everyday life, reverse psoriasis is a condition that is largely controllable in symptoms in most clinical cases.

This certainly positive aspect, as far as the prognosis is concerned, does not however cancel the fact that reverse psoriasis is a chronic and (at least for the moment) incurable disease.