INVERSE PSORIASIS
Description
🔹 Definition:
~Intertriginous (skin fold) areas or areas where skin rubs against skin are the main targets of inverse psoriasis, a chronic inflammatory skin disease.
~ Although it is thought to be a variation of psoriasis vulgaris, the moist environment of body folds causes it to manifest differently.
🔹 Commonly Affected Areas:
•Axillae (armpits)
•Inframammary folds (under breasts)
•Umbilicus (navel)
•Inguinal folds (groin)
•Intergluteal cleft (between buttocks)
•Areas retroauricular (behind the ears)
•Interdigital spaces (also known as "psoriasis alba") between fingers or toes
•The genital area
🔹Clinical Features:
#Appearance:
•Erythematous, smooth, glossy, and well-defined plaques (since there isn't any scaling from moisture).
• In contrast to normal psoriasis, there is little to no scaling.
•Lesions could seem wet or macerated.
#Symptoms:
•Usually not itchy or irritated. •Particularly when there is friction or perspiration, pain, discomfort, or burning may occur
•Persistent and recurring.
🔹Pathophysiology:
•The pathophysiology is the same as that of psoriasis vulgaris.
• T-cell activation and cytokines (e.g., IL-17, IL-23, TNF-α) drive immune-mediated inflammation.
• Koebner phenomenon: Traumatic or frictional sites may become lesions.
• Normal scaling is changed by the moist environment of folds, which may also encourage secondary infections (like Candida).
🔹Distinguishing Diagnoses: #Inverse psoriasis can resemble or be confused with:
• The candidacies
•Corynebacterium minutissimum, or erythrasma Irritant or allergic contact dermatitis
•Seborrheic dermatitis
•Tinea corporis/tinea cruris (fungal infection)
•Erosion of the interdigitalis blastomycetica .
🔹 Clinical examination:
Based on appearance and distribution of characteristics-
# Genetic predisposition: common in family history.
# Biopsy: If in doubt, it displays the normal histology of psoriasis (acanthosis, parakeratosis, Munro microabscesses).
# In inverse psoriasis, mycological tests are negative (essential for ruling out fungal infection).
🔹 Treatment:
1. Topical treatments:
• Corticosteroids with low to moderate potencies.
• Analogs of vitamin D, such as calcipotriol.
•Tacrolimus and pimecrolimus are examples of calcineurin inhibitors that are safe for long-term use in folds.
•Combination therapy is frequently chosen.
2. Adjunct measures:
• Maintain a cool, dry environment. • Loss of weight if obese.
• Steer clear of tight clothing and friction.
• If secondary infections are present, treat them.
3. Systemic therapy:
•Methotrexate, cyclosporine, and acitretin (for severe or resistant instances).
• Biologic medicines that target TNF-α, IL-17, and IL-23, such as secukinumab and adalimumab.
🔹 The prognosis:
The prognosis is typically chronic and recurrent, but it is controllable with regular treatment.
• Reacts favorably to topical therapies.
• If infection, dampness, or friction continue, recurrence is likely.
🔹 Important Takeaway:
•Inverse psoriasis is a type of erythematous psoriasis that affects skin folds and is non-scaly and glossy.
• Because it is frequently misdiagnosed as dermatitis or infection, which delays necessary treatment, awareness is essential.
🔹Case presentation:
•Patient: a girl aged six.
• Presentation: Nonpruritic erythematous plaques in the interdigital spaces of all toes that are clearly defined and have been there for three years.
• Several mycological tests came out negative in the first workup. Treatments using antifungal and antibacterial agents are unsuccessful.
• Additional observations: The axillae, umbilicus, intergluteal cleft, and postauricular regions also exhibit erythematosquamous lesions.
• Inverse psoriasis is the clinical diagnosis.
• Family history: Mother suffered from the same illness. Topical vitamin D analogs are used as a treatment.
•Result: Within eight weeks, all lesions have completely disappeared.
• Diagnosis: "Psoriasis alba," or interdigital psoriasis, a type of inverse psoriasis.
• Clinical significance:
~Frequently overlooked or misidentified.
~May be mistaken for irritating contact dermatitis, erythrasma, tinea pedis, or erosio interdigitalis. ~Unnecessary antifungal or antimicrobial treatments are avoided by awareness.
Protocol
🔹 Nursing Issues:
1. Reduced Skin Integrity: •Associated with: Prolonged inflammation, friction, wetness, and itching.
•Lesions in skin folds that are red, glossy, inflammatory, or macerated serve as evidence.
2. The risk of secondary infection :
•It is associated with the use of occlusive topical medicines, disturbance of the barrier, and moist environments in skin folds.
3. Acute or Chronic Pain or Discomfort:
•Associated with: Sweating, friction, and skin irritation.
•Proved by: Patient complaints of discomfort, burning, or soreness.
4. Disturbed Body Image: •Associated with: Chronic form of disease and visible lesions in sensitive places.
•Shown by: Withdrawal, shame, and appearance-related anxiety.
5. Inadequate Knowledge:
•Associated with: Insufficient understanding of the chronic progression, causes, and treatment of psoriasis.
6. Ineffective Management of Therapeutic Regimens:
•This might be attributed to a complicated topical regimen, adverse effects, or a failure to understand treatment instructions.
🔹Nursing Management / Interventions:
1. Encourage Skin Integrity:
• Examine skin every day for lesions that have appeared or are getting worse.
•Maintain the impacted regions aerated, dry, and clean.
•Steer clear of tight clothing and friction by wearing soft, absorbent clothing instead.
•As indicated, apply topical drugs (such as calcineurin inhibitors, corticosteroids, or vitamin D analogs) as recommended.
• Steer clear of irritants, alcohol-based cleaners, and harsh soaps.
• Promote the use of emollients to prevent overhydration and preserve moisture balance.
2. Prevent and Control Infection:
• Keep intertriginous spaces strictly hygienic.
• Keep an eye out for symptoms of a secondary infection, such as pus, odor, exudate, or increasing pain. •Teach patients the value of taking their medications as directed and to avoid using antifungals on their own without a prescription.
•If an infection is suspected, work with doctors to determine the best antibiotic treatment.
3. Reduce Pain and Discomfort:
•To lessen friction, promote loose cotton clothing.
• To relieve symptoms, apply cool compresses or topical medications as directed.
• To reduce perspiration, keep the room at a comfortable temperature. • Teach people how to manage their stress because it can make psoriasis worse.
4. Encourage Positive Body Image and Emotional Health:
• Offer consolation and emotional support regarding the fact that psoriasis is not communicable.
• Promote candid discussions regarding embarrassment or problems with self-esteem.
•If there is a lot of distress, suggest counseling or psoriasis support groups.
5. Patient Education:
•Describe how the illness is chronic and recurrent.
• Teach how to apply topical drugs correctly (thin layer, avoid occlusion unless required).
• Provide education on avoiding stress, friction, infections, and obesity as triggers.
•Insist on routine dermatologist follow-up for monitoring.
•Teach people how to spot early relapses and get help when they need it.
6. Cooperation and Health Promotion:
• Work together to create customized treatment regimens with dermatologists.
• Promote eating a well-balanced diet and drinking enough water.
• Encourage weight control to lessen friction in the skin folds.
• Educate the family, particularly if there is a genetic background.
Notes
https://doi.org/10.1093/bjd/ljae500