Red plaques, white scales, itching … These different symptoms indicate that we are suffering from psoriasis. It is a chronic inflammatory disease that affects the skin. According to health insurance, this condition affects 2 to 3% of the population in France. The latter most often manifests itself between the ages of 20 and 40.
This pathology is benign most of the time but it has a strong impact on the quality of life of those who suffer from it. Psoriasis can be a difficult handicap to deal with on a daily basis and can have a significant impact on the mental health of the patient.
There are several types of psoriasis. The classic and most common forms are plaque psoriasis, guttate psoriasis, scalp psoriasis, and nail psoriasis. Among the rarer forms of the disease is reverse psoriasis.
What is reverse psoriasis?
Reverse psoriasis is also called “fold psoriasis”. This particular form of the disease does not develop in raised friction areas. It affects the folds of the body, ie “inverted areas” where surfaces of skin rub against each other. Clearly, it manifests itself at the inter-gluteal fold, inguinal folds (the root of the thighs), axillary hollows (under the arms), inframammary folds (under the breast), the hollow behind the knees as well than the navel.
According to the French Society of Dermatology, “this form is misleading, sometimes mistaken for a mycosis”. Inverted psoriasis is a type of the disease which is disabling and which can have consequences on the social life of the patient.
Reverse psoriasis: what are the causes?
The causes of reverse psoriasis are similar to those of classic psoriasis, or plaque psoriasis. “The exact origin of psoriasis is still unknown. However, the onset of the disease is due to the association between a genetic predisposition and certain contributing factors”, can we read on the Health Insurance website.
The France Psoriasis association explains that this condition is considered “an autoimmune disease” which develops in patients with a particular genetic background. “The often familial nature of psoriasis (30% of cases) has led to suspect a genetic predisposition and several genes have now been identified”, indicates the French Society of Dermatology.
Several factors can also cause the onset of psoriasis. Among those identified, we find physical or psychological stress, infections and the taking of certain drugs, such as beta-blockers, lithium or certain antihypertensives. The sun can also in some cases worsen the pathology, says Health Insurance.
On its website, the French Society of Dermatology specifies that “Alcohol and tobacco are not strictly speaking contributing factors, but they appear to be clearly aggravating factors and factors of poor response to treatment.”
What are the symptoms of reverse psoriasis?
Inverted psoriasis manifests as bright red patches. Lesions in the folds of the body are smooth, shiny and well demarcated. Unlike plaque psoriasis, they are little or no scaly. Itching can also occur when suffering from this pathology.
According to a thesis carried out in 2019 and published in the open multidisciplinary archive HAL, intended for the dissemination of scientific articles, an oozing, namely a discharge of a liquid substance, can occur at the level of the lesions. “This phenomenon is linked to maceration or painful cracks”, can we read in the thesis.
Geneva University Hospitals report that “Maceration of the skin promotes the growth of bacteria and fungi and can lead to infection.”
Reverse psoriasis: how to diagnose it?
Reverse psoriasis is a difficult disease to detect because it can be confused with a yeast infection. Its diagnosis is first of all based on a clinical examination. The doctor may then ask the patient to take a skin biopsy or a mycological sample to confirm the diagnosis.
How to treat reverse psoriasis?
So far, there is no cure for psoriasis. On the other hand, some allow to reduce the symptoms and improve the patient’s quality of life. This also applies to reverse psoriasis.
To treat this rare form of the disease, the doctor may prescribe local treatments for the patient. In this case, the person with psoriasis of the folds applies corticosteroid cream to the lesions. It is advisable to use this treatment with caution as it can be irritating.
Another treatment: phototherapy based on ultraviolet UVA and UVB. “The use of phototherapy is limited in time due to the acceleration of aging of the skin and the increased risk of skin cancer”, reports the Health Insurance.
The doctor may also prescribe immunomodulatory drugs to the patient when the patient suffers from a severe form of the condition and local treatments and phototherapy are not working.
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