Inverse or Flexural psoriasis is localized in the flexural surfaces of the skin or skin folds. This type of psoriasis is often white in color, appears softened as if soaked by water, and may resemble a fungal infection. There is very little scaling, although the patches are inflamed and can be very sore. Appearing as it does in the folds of the skin, it is moister than other forms of psoriasis, and can be more uncomfortable physically. Flexural psoriasis rarely occurs by itself. It is more likely to accompany common plaque psoriasis. Psoriasis sufferers in their middle years or old age are more susceptible to this type of psoriasis as are people who are overweight and have more folds of skin.
The goal of psoriasis treatment is to reduce inflammation and to control flaking of the skin. Psoriasis treatment is based on the affected person’s health, age, lifestyle, and the severity of the psoriasis. A number of different psoriasis treatments are normally employed to determine which is the most effective.
Treatment can be difficult due to the sensitivity of skin in these fold areas. Steroid creams and ointments are considered very effective, but they should not be occluded (covered) with plastic dressings. Overuse or misuse of steroids, particularly in skin folds, can result in side effects, especially thinning of the skin and stretch marks. Because these areas are prone to yeast and fungal infections, doctors may test for infection and then may use diluted topical steroids in combination with other medications, for example, 1% or 2% hydrocortisone with anti-yeast or antifungal agents.
Other topical agents, such as Dovonex, coal tar or anthralin, can be somewhat effective in treating psoriasis in skin folds, but they may also be irritating. They should be used with caution and under the direction of a doctor. People with severe inverse psoriasis may occasionally require systemic drugs, such as methotrexate, to control the condition.
In December 2000, the U.S. Food and Drug Administration approved a drug called Protopic (also known by its generic name tacrolimus) for eczema. Many dermatologists have found it works well for psoriasis lesions in skin folds. Elidel (also known by its generic name pimecrolimus) can also be used for inverse psoriasis. Elidel is generally not as effective as Protopic but is less greasy.
Sometimes a product called Castellani's Paint (prescribed by a doctor and compounded by a pharmacist, or bought over the counter as brand name Castederm) is used to treat inverse psoriasis. It is a liquid that can be painted on the affected skin and can help to dry moist lesions of psoriasis in folds, as can the use of various powders. Some people will use creams at night and powders in the morning. Zeasorb and Zeasorb AF may be effective powders to use for inverse psoriasis.