Abstract representation of inverse psoriasis with bunch of question marks overlaid on the image.

What Is Inverse Psoriasis?

Recently I had a health scare and ended up in the hospital with a skin infection. When I asked my rheumatologist what happened, he reminded me that my rheumatoid arthritis treatment that suppresses my immune system made me more susceptible to severe and fast infection.

I had been treating a small fungal rash that was being slow to respond to the usual medication, as well as an ear infection with antibiotic drops. Then over a weekend, the rash spread quickly and grew infectious and very uncomfortable. I had planned on seeing the dermatologist because the urgent care clinic didn’t know what to do. But my rheumatologist was rightly concerned how fast the problem was growing, so he urged me to go instead to the emergency room and be admitted at the hospital for treatment.

Was it an infection?

The hospital started me on oral antifungal medication and powder to use on my skin. Thankfully, my stay was only a couple days, and I continued treatment at home where I was more comfortable. It was also important to frequently wash, gently dry, and air my skin.

Progress was slow. While the worst infectious symptoms cleared in a couple of days, there was little change in the size of the rash even after a week. My infectious disease doctor was truly puzzled and I was a bit concerned. He extended the antifungals and added an antibiotic, while  I continued to hope for faster progress.

What is inverse psoriasis?

I was then able to see my dermatologist and he had a completely different idea. I told him the whole story and he took one look at me and said, "I think this is inverse psoriasis." To which I said, what the heck is that? (Bonus points to the hubby — he knew of it!)

It's not an infection

Inverse psoriasis is an inflammation skin condition that occurs in the folds of the skin. It looks red and inflamed in areas like the armpits, buttocks, groin, stomach, and under the breasts. It is also rare — only 3-7 percent of people with psoriasis have this type. (See the Medical News Today summary of this condition.)

What are triggers for psoriasis?

I have family members who have the traditional form of psoriasis that appears as dryness and scales in patches on the skin, but I was previously unaware of this form. My research reveals that some people have both, as I think I do have some regular psoriasis now on my scalp.

Stress and other possible factors

Stress, injuries, and infection can cause inverse psoriasis to flare. We think that mine may have been triggered by a small ear infection I had shortly prior. I also think that autoimmune conditions can co-occur so it doesn’t surprise me, as someone with RA, to experience another autoimmune issue. I’ve also seen this happen in my family.

I wondered if my biologic medication may play a role, but I am not sure and there is really no way to tell. Looking back, I may have had smaller flares of inverse psoriasis that went unrecognized. But I do wonder if my biologic is so effective at suppressing my RA that my immune system response was to attack with inflammation in another way. A recent study found that a small percentage of RA patients taking anti-TNF medications experienced new onset of psoriasis. Again, it is rare but seems to be a possible side effect either of RA or treatment (or possibly a combination of both).

Watch and wait

Now that I know about the inverse psoriasis, I can better watch for it and treat it. My dermatologist prescribed topic steroid creams and it immediately started quickly improving. Unfortunately, because I didn’t recognize it before, it got inflamed and infected. Now that I know what to look for, I can take some preventative steps (like using moisturizer) and jump on symptoms with steroid creams to prevent bad flares.

I'm always learning something new about RA

I’m more than 40 years into living with rheumatoid arthritis and I am still learning! Inflammation can attack and present in the strangest, most unexpected ways. And infections can move way too fast. I’ve learned to be even more vigilant and keep my mind open because it’s still possible for me to be surprised.

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