Inverse psoriasis: symptoms, treatment and self-care in skin folds

Psoriasis UK explains that psoriasis can affect sensitive areas of the body such as the face, armpits, genitals and skin folds. Where skin folds are involved, including the armpits, under the breasts, the groin, genitals and between the buttocks, you may hear it called flexural or inverse psoriasis.

It is often described as high impact, because it can affect daily life more even when only a small area is involved. The NHS says psoriasis in general is a common skin condition that causes itchy and painful patches of dry, flaky skin, that it cannot be cured, and that there are treatments to help manage symptoms. It also lists the folds of the body, such as the groin, genitals and under the breasts, as places where psoriasis can occur.

Psoriasis UK says psoriasis in flexural areas is described separately from plaque psoriasis because the appearance is very different. It is much less scaly and may look bright red on lighter skin tones, or darker in colour on deeper skin tones, often with a smooth and shiny surface. It is well demarcated, which means it is easy to tell where the psoriasis ends and normal skin begins.

Because it does not have the typical dry, silvery scales, it can often be mistaken for a fungal infection or another skin condition. It may be very uncomfortable and painful, and may make people feel embarrassed or avoid intimate situations. Psoriasis UK also says psoriasis in sensitive areas may be more prone to infection.

Psoriasis UK says treatments prescribed for psoriasis on another area of the body are not always suitable for sensitive areas, so a separate treatment plan may be needed. Suitable treatment may only be available on prescription, so a visit to a GP or dermatologist is essential.

It describes these options:

• Regular moisturising. This helps make the skin more comfortable and is thought to help some topical treatments work better.

• Topical steroids. Because skin folds are warm and moist, treatments are absorbed more easily, so different or milder steroid creams are sometimes recommended. They should not be used for long periods or without regular review, because the warm environment can increase strength and lead to side effects such as skin thinning. They should never be stopped abruptly, as that may trigger a rebound.

• Vitamin D creams and ointments, alone or with a steroid. Some are suitable for sensitive areas and some are not, so check with a GP or pharmacist.

• Calcineurin inhibitors, which reduce inflammation and may sometimes be prescribed off licence. They can be used for longer than topical steroids, but increase skin sensitivity to UV light, so sun, sunbeds and light treatment must be limited.

• Anti-fungal and anti-bacterial treatments, if infection is present, because infections are more common in sensitive areas.

Psoriasis UK says psoriasis in the armpits, other flexures and groin may sometimes get worse because of external factors. These include tight clothing rubbing the skin, deodorants or antiperspirants, sanitary towels or tampons, harsh toilet paper, thrush and sexual intercourse. It also says that friction and sweating can make sensitive psoriasis worse, so it can be particularly uncomfortable in hot weather.

For genital psoriasis, Psoriasis UK lists tips that some people find helpful:

• Avoid soaps, gels and scented products in the bath or shower; use a soap substitute or emollient to cleanse.

• Pat the area dry after bathing rather than rubbing.

• Wear cotton underwear and avoid tight-fitting jeans or trousers.

• Do not use treatments prescribed for other parts of the body unless your doctor says so.

• Condoms or lubricants may help reduce irritation. Topical treatments can reduce the effectiveness of latex condoms, and non-latex alternatives are available.

The NHS lists triggers for psoriasis as stress, drinking alcohol or smoking, living with obesity, being pregnant, certain medicines, infections such as strep A and HIV, cuts, scratches or grazes on the skin, and sunlight. It suggests a healthy, balanced diet, regular exercise, reducing stress, drinking less alcohol and stopping smoking if you smoke.

See a GP if you think you have psoriasis, if your treatment is not working or is giving you side effects, or if you have joint pain, stiffness and swelling that keeps coming back, because psoriatic arthritis can develop.

The NHS says to call 999 or go to A&E if you have psoriasis and your skin quickly turns red and you develop white, pus-filled bumps that join together, or you have patches on your feet that turn yellow-brown and are filled with pus, or red scaly pus-filled bumps on the tips of your fingers or toes. These can be signs of a more serious condition. Redness may be harder to see on brown or black skin.

On the NHS, a GP can prescribe many treatments for psoriasis in skin folds and refer you to a dermatologist if needed. Some people see a private dermatologist for faster review. Treatments such as steroids and calcineurin inhibitors should be reviewed regularly whichever route you use, and your GP should hold a copy of any plan.