What it is

➝ Inverse psoriasis (also called flexural psoriasis) is a type of psoriasis that primarily affects skin folds and moist areas such as the armpits, under the breasts, groin, buttocks, and genital region.

➝ Unlike plaque psoriasis, inverse psoriasis usually appears as smooth, shiny, red patches without the thick scaling.

➝ The condition can be painful, itchy, and prone to irritation or infection, since affected areas often rub against each other and retain moisture.

➝ Management of inverse psoriasis requires a different approach than plaque psoriasis, as standard topical treatments can irritate sensitive skin folds.

Why it’s done

→ To relieve discomfort, itching, and burning sensations in affected areas.

→ To reduce the risk of secondary infections caused by yeast or bacteria, which thrive in moist environments.

→ To prevent skin breakdown and fissures, which can make daily movement painful.

→ To improve self-esteem, intimacy, and quality of life, as inverse psoriasis can be emotionally distressing.

→ In Korea, management is aimed at reducing inflammation safely in delicate skin areas while preventing infections.

Alternatives

→ Topical therapies:

• Low- to medium-strength corticosteroids (short-term use).
• Vitamin D analogs (used cautiously due to sensitivity).
• Calcineurin inhibitors (tacrolimus, pimecrolimus) – preferred for long-term use in folds.

→ Systemic therapies: Methotrexate, cyclosporine, apremilast, or biologics for severe or resistant cases.

→ Phototherapy: Not usually practical in skin folds, but may help if plaques occur in other areas simultaneously.

→ Lifestyle measures: Weight management, moisture control, avoiding friction, wearing loose clothing.

Preparation

→ A dermatologist will perform a thorough skin examination to confirm diagnosis and rule out fungal or bacterial infections that mimic inverse psoriasis.

→ If infection is suspected, skin swabs or cultures may be taken.

→ Patients are often advised to:

• Keep affected areas clean and dry.
• Avoid perfumed soaps and harsh cleansers.
• Use gentle, non-irritating moisturizers.

→ In Korea, dermatologists often integrate skin care counseling as part of preparation, ensuring patients know how to manage skin folds properly.

How it’s Done

→ Topical treatment is the first-line approach:

• Low-potency corticosteroids applied briefly to reduce inflammation.
• Calcineurin inhibitors are often prescribed for long-term maintenance to avoid steroid side effects.
• Antifungal or antibacterial creams if infections are present.

→ Systemic drugs or biologics may be introduced if inverse psoriasis is widespread, severe, or resistant to topical care.

→ Patients are taught application techniques to minimize irritation, such as applying a thin layer and allowing it to dry before covering with clothing.

→ Korean clinics may also use adjunctive therapies, like mild photodynamic therapy or hydrating programs, for resistant cases.

Recovery

→ Symptom relief (reduced itching, burning, and redness) often occurs within 1–2 weeks of correct topical therapy.

→ Long-term management focuses on flare prevention through careful skin care, infection control, and lifestyle adjustments.

→ With proper treatment, most patients maintain good control and can resume normal daily activities without discomfort.

→ Patients often experience improved confidence, comfort in social interactions, and quality of sleep once lesions are under control.

Complications

→ Skin thinning (atrophy) can occur with overuse of corticosteroids in sensitive folds.

→ Secondary infections (fungal or bacterial) are common if moisture is not controlled.

→ Misdiagnosis: Inverse psoriasis can resemble candida or eczema, leading to incorrect treatment if not evaluated carefully.

→ Resistance to topical therapies may occur, requiring systemic or biologic escalation.

Treatment Options in Korea

→ Korean dermatology centers use a stepwise management strategy for inverse psoriasis:

• Start with low-strength steroids or calcineurin inhibitors.
• Add antifungal or antibacterial creams if secondary infection is detected.
• Escalate to systemic therapy or biologics for resistant or severe cases.

→ Korean doctors emphasize gentle, non-irritating skincare routines, including hypoallergenic cleansers and fragrance-free moisturizers.

→ Clinics often provide patient education programs to teach proper hygiene, drying techniques, and safe topical application.

→ In some centers, integrated care includes dermatologists, dieticians, and lifestyle counselors to address weight management and flare triggers.

→ With Korea’s strong reputation in dermatology, many patients benefit from advanced biologic treatments (e.g., IL-23 or IL-17 inhibitors) when inverse psoriasis is severe.

→ Overall, treatment in Korea balances effectiveness with safety in sensitive skin areas, ensuring patients achieve long-term relief with minimal side effects.