MyPsoriasisTeam members sometimes report that their inverse psoriasis has a bad smell. Inverse psoriasis is a type of psoriasis that usually occurs in areas of the body where there are skin folds — such as armpits, the groin area or genitals, navel (belly button), and under the breasts. An unpleasant odor in these areas of the body can be upsetting and embarrassing.
“Ugh! I have no outbreaks that I can see, but since I get it in my armpits even when I don’t have a visible outbreak, I can get an outbreak of odor. Not B.O. [body odor] but from my psoriasis,” a team member wrote.
Another member said, “I have been so embarrassed that I don’t take off my clothes in front of my husband. Eighty percent of my body is flaky and itchy. And now the odor from the burning of the skin.”
Inverse psoriasis — also called flexural psoriasis or intertriginous psoriasis — usually occurs in people who already have another form of psoriasis. Symptoms include discolored patches of skin that appear shiny and smooth and can be itchy or painful. On light skin, lesions are typically red. On darker skin, lesions may be purple or brown.
Unlike plaque psoriasis, inverse psoriasis does not produce thick, flaking lesions. But like other types of psoriasis, inverse psoriasis is caused by an abnormal buildup of skin cells due to an overactive immune system.
Because inverse psoriasis is primarily found in skin folds, lesions can become irritated by moisture and friction that can occur in affected areas. People of higher weight and with deeper skin folds have a greater risk of developing inverse psoriasis.
Psoriasis itself, including inverse psoriasis, is not known to have an odor. However, inverse psoriasis occurs in areas of the body that are prone to perspiration (sweat), which can cause odor in the skin due to the interaction of sweat with bacteria and fungus on the skin. Sweat and friction in skin folds can irritate inverse psoriasis and potentially worsen it, possibly leading to an infection.
Inverse psoriasis is commonly found in creases of sensitive, moist, and thin skin, which can attract microorganisms such as bacteria and fungus, including yeast. A foul odor can indicate an infection caused by bacteria or fungus and may coincide with other symptoms, such as pustulent bumps (small elevations of the skin, containing pus), very small cuts in the skin, and tenderness or swelling.
Fungal infection and bacterial colonization are both believed to be possible triggers for psoriasis, including inverse psoriasis. These types of infections frequently occur with inverse psoriasis because fungus and yeast easily grow in moist environments.
You can take steps to reduce or eliminate odor associated with psoriasis:
Although there is no cure for inverse psoriasis, treatment plans are aimed at reducing symptoms and clearing skin when possible. Effective treatment of inverse psoriasis symptoms can help prevent secondary bacterial or fungal infections and odor that may develop with these infections. Your treatment plan may include a combination of therapies, such as systemic drugs, anti-inflammatory topicals such as corticosteroids, or phototherapy (ultraviolet light therapy). Your doctor may prescribe topical immunomodulators such as pimecrolimus (Elidel) or tacrolimus (Protopic). Newer nonsteroidal topicals such as tapinarof (Vtama) or roflumilast (Zoryve) may also be helpful. If the topicals are not helping, using biologics is another option.
Stick with your psoriasis treatment plan and let your dermatologist or health care provider know if you are not happy with the results and would like to discuss other treatment options. Some treatments, like biologic drugs, can stop being effective over time and may need to be switched.
Communicate openly with your doctor if you are experiencing a bad smell from your psoriasis. It’s understandable if you feel self-conscious about discussing smells in intimate areas of your body, but it’s important to let your doctor know. That information can help your doctor determine if you have an infection that needs treatment. Your health care provider may recommend prescription or over-the-counter (OTC) antimicrobial or antifungal medication that can fight a skin infection.
Home skin care is an essential part of managing psoriasis symptoms. Follow recommended practices for cleaning, moisturizing with appropriate lotions or creams, and applying any topical medications that may be a part of your treatment plan. Avoid clothing that is too tight, and be aware that some synthetic fabrics and scratchy materials, such as wool, can irritate inverse psoriasis.
Talk to your health care team if you have questions about how to care for skin that is affected by inverse psoriasis. Maintaining consistent skin care and good hygiene can help to reduce the risk of bad-smelling sweat and secondary infections that can produce odors.
Because inverse psoriasis tends to occur in sensitive skin, always get medical advice before trying a product. Be sure to test new OTC products on a small area of affected skin to see if you have an adverse reaction or any side effects. For instance, coal tar products, which can help reduce plaque psoriasis symptoms in some people, may be too strong for inverse psoriasis.
“I can’t wear deodorant, which is a nuisance because my underarms are very bad,” a MyPsoriasisTeam member wrote.
Ask your doctor to recommend deodorants or skin cleansers that are appropriate for people with inverse psoriasis to help you reduce skin odors. You may want to refer to the National Psoriasis Foundation’s listing of products that have their Seal of Recognition and are recommended for sensitive skin affected by psoriasis.
Many other skin disorders can look like inverse psoriasis. It’s important to have an accurate diagnosis in order to find appropriate treatment for your condition.
These are some of the more common skin conditions that may be mistaken for inverse psoriasis and can also produce a bad smell due to an infection or sweat.
Intertrigo is a skin condition that is caused by skin rubbing together in skin folds. Humidity, sweat, irritating fabrics, bacterial infections, and poor hygiene can trigger intertrigo and cause inflammation and abrasions that may appear similar to inverse psoriasis. A combination of anti-inflammatory creams and topical antifungals should help. Powders that help keep the area dry are also commonly used.
Seborrheic dermatitis, a type of eczema, can also look like inverse psoriasis. A key difference is that seborrheic dermatitis can have greasy, yellowish flakes. However, flaking is not always present. The treatment for this is similar to the topicals mentioned for psoriasis.
Contact dermatitis is skin inflammation caused by allergic reactions or irritating chemicals, synthetic fabrics, and other irritants.
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Have you had a problem with unpleasant odor from inverse psoriasis? Did you find an effective way to manage this symptom? Share your experience in the comments below, or start a conversation by posting on your Activities page.