Inverse Psoriasis: What is it? Where it develops? Causes, Symptoms and Treatment

It is also known as flexural psoriasis because it forms in the folds of the skin.

It is called inverse psoriasis because it is the opposite of the more common plaque psoriasis that occurs mainly on the outer surfaces of the skin, such as the elbows, knees, and extremities.

In inverse psoriasis, lesions develop in the natural folds of the body such as:

  • The armpits.
  • The area under the breasts.
  • The groin.
  • The gluteal folds (between the buttocks).
  • The area around the genitals.
  • The area behind the knees (back of the knees).
  • Behind the ears.
  • On the eyelids.
  • Around the navel.
  • Other skin folds on the body.

In medical terms, the intertriginous area is where two areas of the skin touch or rub against each other.

So this type of psoriasis is known as intertriginous psoriasis.

Due to the positioning, in the folds of the skin, they remain covered and retain moisture so that they appear bright red and smooth.

Reverse psoriasis lesions do not appear dry, thick, and scaly like psoriasis on other areas of the skin, such as the knees or elbows. Inverse psoriasis is an autoimmune disease.

The immune system attacks, resulting in rapid growth of skin cells.

This causes red spots of smooth, shiny skin wherever there is skin-to-skin contact.

This type of psoriasis can lead to plaque psoriasis, which causes large, dry, scaly lesions on large parts of the body.

This condition can be quite painful, accompanied by extreme itching.

The flaking wouldn’t be there due to the body’s installation of natural lubrication, but continued stretching and friction can leave the skin very inflamed and itchy.

Except for the armpits, most of these skin folds are hardly ever exposed to sunlight.

Causes of inverse psoriasis

When our immune system malfunctions and attacks healthy skin cells, psoriasis can develop.

The reason behind psoriasis and all its various forms has been linked to an inherited gene. However, it should be noted that not everyone with the gene will have a psoriasis flare.

Each individual case of the skin condition can be triggered by different factors.

Common stimulators of active cases of inverse psoriasis include:

  • Antimalarial drugs, lithium, inderal, quinidine, and indomethacin.
  • The stress .
  • An emotional trauma.
  • The Koebner phenomenon of injuries, injections, sunburns and scratches.
  • Respiratory infections
  • Allergies, dirt, and weather have also been linked to some cases of inverse psoriasis, although there is no current scientific research to back this up.

Despite the common myth, psoriasis cannot be transmitted sexually.


As with many forms of psoriasis, inverse psoriasis presents as patchy red skin lesions, but with a distinct difference of smooth rather than scaly surfaces.

This is due to humidity and rubbing of the contact skin. Symptoms of inverse psoriasis include:

  • Presence of deep red patches.
  • The lesions are smooth and shiny.
  • The affected skin surface causes pain and sensitivity.
  • Bleeding may occur from cracked lesions.

The skin affected by this condition can quickly allow the development of complications due to the thin and sensitive areas.

Continual friction from skin lesions can cause them to crack, break, and bleed.

This is a major source of bacterial or fungal infections in the body.

Some prescription drugs for the treatment of inverse psoriasis can also have the side effect of thinning the skin, increasing the risk of infection.

Inverse psoriasis treatment

Conventional treatment options (based on pharmacology)

There are several pharmacology-based options that are available for inverse psoriasis with their pros and cons.

Corticosteroids: These topical medications suppress the immune system and reduce inflammation to provide relief. Some examples are betamethasone, clobetasol, and hydrocortisone.

Dermatologists often recommend antifungal medications along with corticosteroids to treat fungal or yeast infection.

Regular use of corticosteroids over a long period of time can cause your skin to become thinner, which is a big concern because the skin in the skin folds is already quite thin and sensitive.

The skin becomes more prone to bruising and oozing. Also, it can cause stretch marks in the armpits and groin area. In some cases, localized hair growth is also seen in the treated skin area.

Calcipotriene: These topical creams (such as Dovonex) contain a synthetic form of vitamin D that slows the growth of skin cells to reduce inflammation and flaking.

Overuse of these medications can cause skin irritation and cause the skin to burn or itch. It is not recommended for use on genitals, even for other skin folds, it should be used with caution.

Coal tar: This petroleum by-product is widely recommended by dermatologists to reduce the flaking, redness, and inflammation of psoriasis.

Long-term use can make your skin sensitive to sunlight. Also, it can make your skin brittle. Other risks of long-term use are burning, irritation, itching, and redness of the skin.

Phototherapy : Exposing the affected skin area to ultraviolet rays under medical supervision is known as phototherapy. Overuse can lead to minor burns, hypersensitive skin, aging skin, nausea, and an increased risk of skin cancer, including melanoma.

Systemic drugs (oral and injectable drugs): Immunosuppressants such as methotrexate and certain biological drug injections (humira, cosentyx) fall under the category of systemic drugs.

Overuse of methotrexate affects the liver. It can have side effects like loss of appetite, nausea, vomiting, liver damage, hair loss, joint pain, and many more.

Your dermatologist will monitor your liver health through regular blood tests and adjust your methotrexate dose accordingly.

When it comes to biologics like humira, tests for tuberculosis or other infectious diseases will be done before taking the drug, as it carries an increased risk of life-threatening diseases, such as tuberculosis and certain types of cancer.

Natural treatments for inverse psoriasis

There are medications for inverse psoriasis that can inhibit treatment and potentially create a more serious infection problem.

There are lifestyle changes and some natural therapies that can lessen symptoms.


Wear clothing made with natural fibers such as cotton, to allow the skin to breathe and not be restricted.

If you have an outbreak in the armpit or chest area, wear loose tops for comfort.

You can also use baking soda, cornstarch, or zinc oxide on the surface of your skin to absorb moisture.


Maintaining good hygiene with inverse psoriasis is key to achieving greater comfort and keeping the flare-up at bay.

Wash affected areas daily with mild soap and warm water only, hot water or scented soaps should not be used.

Moisturize your skin every day and add a mild bath oil or Epsom salts to your bath.

Self care

To avoid common disease triggers, a stress relieving technique must be found. Fresh air and sunshine should be enjoyed, but only in small amounts.

Obese patients should participate in a physical conditioning program to tone the body and avoid excessive skin folds.

Alcohol should be avoided as it can make some treatments difficult.

As there is no cure for any form of psoriasis, the symptoms of inverse psoriasis can be alleviated by using traditional methods.

  1. Aloe vera has incredible anti-inflammatory properties and its fresh gel can soothe sensitive and painful skin lesions. Apply several times a day for several weeks.
  2. Fish oil is rich in omega-3 fatty amino acids, which have been shown to help treat inflammation. Consume three grams of fish oil daily.
  3. Oregon grape or barberry can be applied directly to the affected areas, to relieve inflammation.