“My wife has been suffering from inverse psoriasis that was originally diagnosed as intertrigo,” one MyPsoriasisTeam member said. “We just learned of the correct diagnosis today. She is living in misery and is ready to get the proper treatments.”

Inverse psoriasis is a rare and often painful form of psoriasis. It causes smooth, shiny patches of discolored skin — which may appear red, purple, or dark brown, depending on your skin tone — to form in areas where skin folds rub together. Its symptoms can look a lot like other skin conditions, such as intertrigo, which is a rash caused by skin rubbing together.

If you have new or worsened symptoms of either skin condition, talk to your healthcare provider or a dermatologist. They can help find the cause of your symptoms and recommend the best treatment.

Keep reading to learn about these conditions and to see pictures of inverse psoriasis and intertrigo.

What Are Inverse Psoriasis and Intertrigo?

Inverse psoriasis, also known as flexural or intertriginous psoriasis, affects between 21 percent and 30 percent of people with psoriasis. As with other forms of the skin disease, inverse psoriasis is a long-term inflammatory condition that can occur throughout your life. It causes lesions to form in areas where skin folds rub together, such as the armpits, buttocks, and under the breasts. These areas, known as intertriginous areas or skin folds, may rub together, causing irritation and inflammation.

Psoriasis and other rashes may look different depending on your skin tone. While redness is common in lighter skin, inflammation may appear purple, gray, or dark brown in medium to darker skin tones.

Inverse psoriasis happens when the immune system doesn’t work the way it should – it attacks healthy skin by mistake. But intertrigo is caused by friction between skin folds. It occurs when skin rubs together, resulting in irritation and discoloration. These areas of skin may trap moisture. The trapped moisture can cause the skin to break down and lead to fungal or bacterial infections.

Inverse psoriasis may be mistaken for candidal intertrigo. Candidal intertrigo happens when a person with intertrigo gets a second infection from the fungus candida. It’s the most common secondary infection seen in people with intertrigo.

Signs and Symptoms of Inverse Psoriasis and Intertrigo

Inverse psoriasis usually causes bright red, purplish, or brown lesions, depending on your skin tone. These lesions can feel inflamed and painful. The symptoms of inverse psoriasis may get worse due to warmth, moisture, and friction, as is the case with intertrigo. Common inverse psoriasis signs and symptoms include:

• Discolored lesions
• Shiny, smooth patches on the skin
• Cracked or ulcerated skin
• Severe itching
• Plaque psoriasis elsewhere on the body

The symptoms of intertrigo may be acute (short-lived), relapsing (come and go repeatedly), or chronic (remain for more than six weeks). Like psoriasis, intertrigo develops in the skin folds.

When skin folds rub together, the friction can cause discolored, inflamed, or painful patches of skin. These patches may crack, peel, and begin to wear down due to excess moisture. If a bacterial infection develops, intertrigo may also cause an unpleasant odor.

What Causes Inverse Psoriasis and Intertrigo?

Like other types of psoriasis, inverse psoriasis is typically classified as an autoimmune condition. It happens when an overactive immune system begins attacking healthy skin cells. The exact cause of autoimmune conditions isn’t known, but they may be linked to genes, infections, or other triggers. These attacks cause your body to make new skin cells too quickly. When the extra cells build up on the surface of your skin, a new rash or lesion forms.

Scientists believe that inverse psoriasis may be caused by a mix of genetics and environmental factors. According to the American Academy of Dermatology, people who already have plaque psoriasis and have a higher body weight may be more likely to have inverse psoriasis.

Some factors may trigger inverse psoriasis symptoms. These include taking certain medications, stress, infections, and skin injuries.

Both infections and skin inflammation can cause a person to develop intertrigo, including inverse psoriasis. As with inverse psoriasis, several genetic and environmental factors are linked to intertrigo. Living in a hot, humid climate and friction from skin-on-skin contact can cause intertrigo to develop.

Like inverse psoriasis, intertrigo is more common in people who have a higher body weight. Diabetes, smoking cigarettes, and excessive alcohol consumption can all increase the risk of developing intertrigo.

Distinguishing Inverse Psoriasis From Intertrigo

The symptoms of inverse psoriasis can be very similar to those of other skin diseases, so it’s often hard to diagnose. Smooth discolored patches from skin-on-skin friction can be a sign of inverse psoriasis. Other factors that point to inverse psoriasis include a family history of the condition, psoriatic plaques on the body, and changes to the nails or nail beds.

To confirm a diagnosis of inverse psoriasis or intertrigo, a dermatologist will perform a physical exam. If they think you may have an infectious form of intertrigo, they’ll take skin samples to test for an infection.

If you think you have inverse psoriasis or intertrigo, talk to a dermatologist. They can give you the right diagnosis and help you find the best treatment.

Treatment for Inverse Psoriasis and Intertrigo

There's no cure for inverse psoriasis. But you can manage inverse psoriasis symptoms and improve your quality of life using medical and at-home therapies.

Treatment options for inverse psoriasis include topical medications (placed on the skin), biologic drugs (made from living cells), and phototherapy (light therapy). Topical corticosteroids are often the first therapy doctors prescribe for inverse psoriasis.

Treatment for intertrigo depends on the cause of the condition. The fungal infection candida may be treated with topical or oral antifungal medications. Topical or oral antibiotics are used to treat bacterial intertrigo. As with inverse psoriasis, topical steroids can help control inflammatory symptoms in intertrigo.

Managing Inverse Psoriasis and Intertrigo Symptoms

There are several ways to manage the symptoms of inverse psoriasis and intertrigo at home. Dermatologists generally recommend following a regular home-care practice that helps protect skin against irritation and injury.

Moisture Reduction

Intertrigo may improve when the affected skin is kept consistently clean and dry. Taking a shower right after exercise and using antiperspirant in areas like underarms or under-breast folds can help reduce moisture.

Your dermatologist may also recommend wearing loose-fitting clothing. This can help reduce irritation in both inverse psoriasis and intertrigo.

Skin with inverse psoriasis or intertrigo can easily trap moisture, which may lead to bacterial growth and unpleasant odor. People with inverse psoriasis are often encouraged to take short, warm baths or showers. Ask your doctor whether any special bathing routines may help you manage intertrigo.

Moisturizers

Dermatologists recommend moisturizing after bathing, as well as periodically when skin areas feel dry. Make sure to use products without dyes, alcohol, or fragrances if possible. If you have incontinence (trouble controlling your bladder or bowels), consider applying a skin barrier ointment to keep moisture away from the body. This is important if you have genital psoriasis or intertrigo.

Soft Clothing

Light, breathable underwear and clothing can help prevent skin irritation and discomfort. Soft, natural fibers such as cotton help prevent moisture from building up in the skin folds. Wash clothing in fragrance-free cleanser and double rinse to ensure all soap has been removed.

Safe Hygiene

Soft, high-quality toilet paper helps reduce irritation. This is especially helpful if you have intertrigo or psoriasis on the buttocks. Wiping the groin area gently but completely keeps genital lesions free of the bacteria in urine and feces. These bacteria can cause inverse psoriasis flare-ups.

Itch Control

Itching is one of the most challenging symptoms of inverse psoriasis to manage. But it’s important to address itching, since scratching the affected areas can create skin injuries, triggering flares and leading to infection.

Treating the underlying condition (inverse psoriasis or intertrigo) can help you control itching. You should also take short, warm baths or showers, and moisturize your skin after it gets wet. When itching gets severe, apply an over-the-counter itch relief product or use a damp, cool washcloth on the itchy skin.

Lesion Care

Inverse psoriasis lesions may be hard to keep dry. Doctors often recommend using talcum powder to absorb moisture, though some suggest a cornstarch-based alternative to avoid safety concerns. Before applying these powders, soak up the moisture with a tissue to prevent caking and build-up.

Talk to Your Doctor

If you’re noticing shiny or irritated, discolored patches in sensitive areas like your underarms, groin, or under the breasts, it’s important to talk to a dermatologist. Inverse psoriasis and intertrigo can look very similar, but they need different types of treatment. Getting the right diagnosis can bring relief faster and stop symptoms from getting worse. A dermatologist can help you understand what’s causing your symptoms and work with you on a treatment plan that helps you feel more comfortable.

Find Your Team

On MyPsoriasisTeam, the social network for people with psoriasis and psoriatic arthritis and their loved ones, members come together to ask questions, give advice, and share their experiences of life with psoriasis.

Do you have inverse psoriasis or intertrigo? How do you manage your skin condition? Share your story in the comments below or by posting on your Activities page.