Inverse psoriasis is the label given to psoriasis affecting the intertriginous areas. There are numerous therapeutic options for treating psoriasis, which is a therapeutic challenge when it is limited to intertriginous areas such as genital skin flexion folds. In fact, only six casuistic reports and one open-label study have described the effects of therapies used 1, and 24 articles, selected by the only systematic literature review available, reflected the opinion of experts on the preferred treatment for genital psoriasis 1. Psoriasis is an autoimmune disease that causes raised, red, scaly patches to appear on the skin. It typically affects the outside of the elbows, knees or scalp, though it can appear on any location. (The surface area of the hand equals about 1 percent of the skin.) However, the severity of psoriasis is also measured by how psoriasis affects a person’s quality of life.
Patients with more than 5 to 10 percent body surface area affected are generally candidates for phototherapy or systemic therapy, since application of topical agents to a large area is not usually practical or acceptable for most patients. In choosing UV therapy, consideration must be given to the potential for UV radiation to accelerate photodamage and increase the risk of cutaneous malignancy. Range in number from a few to many at any given time. Inverse psoriasis – A variant of psoriasis that spares the typical extensor surfaces and affects intertriginous areas (ie, axillae, inguinal folds, inframammary creases) with minimal scale. Mease PJ, Reich K. Alefacept with methotrexate for treatment of psoriatic arthritis: open-label extension of a randomized, double-blind, placebo-controlled study. Studies in inverse psoriasis are summarized in Table 7.2.
Other off-label possibilities are methotrexate, cyclosporine, and infliximab (Remicade).5 Repetitive incision and drainage causes scaring. This is in contrast to the thick scales seen with psoriasis elsewhere. It can be severely pruritic at onset, often appears in areas not exposed to sun, such as the buttocks, and can affect all skin types. Psoriasis inversa occurs in intertriginous areas and is usually devoid of scales (I). They are applied twice daily and mostly used for disease on the face and intertriginous areas, for inverse psoriasis, or used anywhere on the body as a steroid-sparing or maintenance therapy. These preparations are off-label, generally safe, and are recommended for use in children 2 years old. Injections should be limited to no more than 6 to 8 weeks apart and given only if necessary.
Treatment Of Psoriasis
Some authors have stated that, given orally, pimecrolimus is as potent as or superior to tacrolimus in treating allergic contact dermatitis in mice and rats. Acrodermatitis continua of Hallopeau (ACH) is a rare type of pustular psoriasis affecting the digits. Review Article from The New England Journal of Medicine Psoriasis. 5 The illness develops in as many as half of the siblings of persons with psoriasis when both parents are affected, but prevalence falls to 16 percent when only one parent has psoriasis and to 8 percent when neither parent is affected.6 The concordance rate for monozygotic twins is around 70 percent, as compared with some 20 percent for dizygotic twins, a finding that further supports the concept of genetic predisposition. An inverse type of psoriasis spares these sites and instead appears in intertriginous areas, where scaling is minimal (Figure 1E). Overall, given the central role of T lymphocytes in the pathogenesis of psoriasis, agents that would influence the function or recruitment of leukocytes are appealing therapeutic compounds. It presents a genetic basis, affecting 1 to 3 of the white population. Two other studies showed that pimecrolimus is effective for inverse psoriasis. Pimecrolimus (1 ) cream, with or without occlusion, is used off-label for the treatment of intertriginous inverse psoriasis.17,23,24 The adverse effects of pimecrolimus are the same as those of tacrolimus; however, they are less severe and usually do not cause discontinuation of therapy. Efalizumab, like alefacept, inhibits T-cell activation, migration to affected skin, and adherence to keratinocytes. Patients with multiple sclerosis should not be given the drug, and treatment should be discontinued if neurological symptoms develop. It describes the pathogenesis of psoriasis and psoriatic arthritis and the role of TNF. They were given four or five infusions over 5 weeks.
Psoriasis in the scalp, palms and soles, and intertriginous areas differ from disease on other body parts, and treatment regimens must be tailored to these areas. Skin in the body’s intertriginous areas is often thin, limiting treatment options for inverse psoriasis. 1,2 Plaque-type psoriasis is the most common form, affecting 80 percent of psoriasis patients. Given the paucity of officially approved therapies, the very limited evidence-based data from randomized controlled trials, and the absence of standardized guidelines, physicians must rely on published experience from case reports both from the field of dermatology as well as from the application of these drugs for other pediatric conditions coming from the disciplines of rheumatology, gastroenterology, and oncology. Psoriasis is a chronic inflammatory cutaneous disorder affecting 2 –4 of the world& 39;s population. Erythrodermic, pustular, and inverse psoriasis may also occur in adolescents, but less frequently. Application on the face, genitalia, and intertriginous areas could be problematic, with mild local irritant reactions and itching being the most common side effects.