In inverse psoriasis, lesions develop in the natural folds of the body- armpits, under the breast, the genital area, groin and the buttocks crease. It can be quite painful, accompanied by extreme itching. The scaling would not be there due to body’s natural lubrication facility, but, the continuous stretching and friction can leave the skin highly inflamed and itchy. Except armpits, most of the these skin folds are hardly ever exposed to sunlight. It makes the things further worse.
In such cases, the holistic (natural) healing concept brings unimaginable joy when you see the lesions getting cleared by addressing the inner body matters.
Inverse psoriasis / Flexural Psoriasis / Intertriginous Psoriasis
Inverse psoriasis refers to the psoriasis lesions found in skin folds such as:
- Under the breasts
- Buttocks crease (between the buttocks)
- Around the genitals
- Behind the knees (backside of knees)
- Behind the ears
- On the eyelids
- Around the navel
- Other skin folds on the body
It is called inverse psoriasis because it is inverse (or opposite) to the most common plaque psoriasis which occurs mainly on the outer skin surfaces such as elbows, knees and limbs.
Inverse psoriasis is also known as flexural psoriasis because skin folds are called as flexures.
In medical terms, intertriginous area is where two skin areas touch or rub each other. Hence, inverse psoriasis is also known as intertriginous psoriasis.
Due to the positioning- in the skin folds- they remain covered and retain moisture to look bright red, shiny and smooth. Inverse psoriasis lesions don’t appear dry, thick and scaly as in case of psoriasis on other skin areas such as knees or elbows.
Inverse psoriasis is more common in people having deep skin folds such as:
- Overweight / obese people
- Middle-aged or old age people with loose (sagging) skin.
Inverse psoriasis affects around 3 to 7% of psoriatic people- it occurs alongside other forms of psoriasis such as plaque psoriasis on other body parts.
Conventional (pharma based) treatment options
Personally, neither I use nor I recommend any pharma based steroidal tablet, pill, injection, cream, ointment or shampoo because they do nothing to address the inside body matters. Rather, most of them just suppress the immune system temporarily to relive the symptoms. Moreover, long term use of these products can result in severe side effects. I have already discussed in detail about these risks in various articles.
However, before discussing the natural healing ideas, let’s quickly go through various pharma based options that are available for inverse psoriasis with their pros (so called) and cons.
It is highly recommended to use these medicines after proper diagnosis by a registered dermatologist. Self medication is not recommended considering the sensitive nature of the affected skin area.
- Carticosteroids– These topical (external application) drugs suppress the immune system and reduce inflammation to provide relief. Few examples are Betamethasone, clobetasol and hydrocortisone. The dermatologists often recommend anti-fungal or anti-yeast medications along with carticosteroids to address the fungal or yeast infection. Regular use of carticosteroids for a long time can make your skin thin which is a major concern because the skin located in skin folds is already quite thin and sensitive. It would make your skin more prone to bruising and tearing. Also, it can cause stretch marks in the armpits and groin area. In some cases, localized hair growth in the treated skin area is also observed.
- Calcipotriene– These topical creams (Brand name Dovonex) contain synthetic form of vitamin D that slows down the growth of skin cells to reduce inflammation and scaling. Overuse of these medicines can cause skin irritation to make your skin burn or sting. For genitals, you better avoid it. Even for other skin folds, use it with caution.
- Coal tar– This petroleum by-product is extensively recommended by dermatologists to reduce psoriasis scaling, redness and inflammation. Long term use can make your skin photosensitive- sensitive to sunlight. Also, it can make your skin brittle and less tolerable. Other risks of long term use are burning, irritation, itching and skin redness.
- Phototherapy– Exposing the affected skin area to ultraviolet rays under medical supervision is known as phototherapy or light therapy. Overuse can result in mild sunburn, hypersensitive skin, skin ageing, nausea and increased risk of skin cancer including melanoma.
- Systemic medications (oral medicines and injections)– Immunosuppressants such as methotrexate and certain biological drug injections (humira, cosentyx) comes under the category of systemic drugs. Overuse of methotrexate hampers the liver. It can have side effects like loss of appetite, nausea, vomiting, liver damage, hair fall, joint pain and many more. Your dermatologist would monitor your liver health through regular blood tests and adjust the methotrexate dosage accordingly. When it comes to biologics such as humira, you would be screened for tuberculosis or other infectious diseases before taking the drug as it involves increased risk of life threatening diseases including tuberculosis and certain types of cancer.
To sum up, all the above conventional medications don’t show much promise. The thin, sensitive skin located in the skin folds would readily absorb the topical medication and hence, overuse can cause further skin thinning and stretch marks.
Phototherapy and systemic drugs are used mostly in case of severe inverse psoriasis only considering the high treatment cost and risk of potential side effects.
Natural healing of Inverse Psoriasis
Psoriasis is an auto-immune skin disorder where the faulty immune system triggers rapid growth of skin cells to cause scaling, inflammation and itching. The exact cause is unknown, but, leaky gut is the root of the problem as per holistic healing approach.
Leaky gut means leakage in your gut!
In simpler terms, imagine that the walls of your small intestine have a net like structure with extremely small holes. These micro holes allow only specific stuff (simple dietary nutrients) to pass through and enter your blood stream. It restricts the body toxins (undigested food particles, disease causing bacteria, pesticides, heavy metals etc) from entering your blood stream. If due to some reason, this net structure gets damaged and the holes get bigger- then the above mentioned un-welcomed stuffs would seep through and mix into your blood stream. Your immune system doesn’t like these foreign invaders and becomes hyperactive. Such a furious immune system would register its protest by triggering an auto-immune reaction to cause inflammation and exponential growth of skin cells.
Various factors which can cause leaky gut are:
- Compromised gut health- Chronic constipation, indigestion, poor gut flora, nutritional deficiency, food intolerances
- Faulty genes (hereditary)
- Chronic stress and anxiety
- Infection such as strep throat
- Skin injury
- Poor lifestyle- Over consumption of processed and junk foods, obesity, improper sleep, skipping meals, too much consumption of alcohol and tobacco (smoking)
- Long term consumption of antibiotics, steroids and certain medications
Irrespective of the type of psoriasis- plaque, pustular, guttate or inverse; the healing process remains the same. It involves getting rid of the accumulated body toxins and then make sure not to add on any more toxins. At the same time, you have to strengthen the gut health to improve digestion and restore the integrity of gut walls. You know, more than 70% of the immune system lies in our gut. Hence, you just can’t treat an auto-immune disorder without improving your gut health.
The holistic healing of Psoriasis involves:
- Restricted, healthy diet
- Positive lifestyle
- Dietary supplements- probiotics, Omega 3 fats, Vitamin D3, glutamine, zinc, selenium
- Regular physical exercise– Gym workout, jogging, cycling, swimming, dancing etc.
- Stress management- Yoga, meditation, relaxation techniques etc.
- Natural / Herbal supplements- Turmeric (curcumin), milk thistle, slippery elm bark tea, saffron tea, spirulina
- Using natural / herbal topicals- creams, shampoos, soaps, oils. The natural products- based on aloe vera, virgin coconut oil, tea tree oil, neem oil, castor oil, shea butter, olive oil- would effectively manage the external symptoms without damaging your skin in the long term.
- Taking warm soaking baths with Dead sea salt or Epsom salt along with other additives like baking soda, ginger, lavender oil etc. Soaking baths detoxifies your skin; relieve skin inflammation, itching and scaling; relieves stress and improve sleep quality.
In short, the holistic healing process for inverse psoriasis is the same as for psoriasis on any other part of the body. Address the gut issues, sort out the inner mess and your skin would improve automatically.
Inverse Psoriasis- Triggers and Countermeasures
- Scratching– Scratching never helps. The more you scratch, the more intense the itching becomes to further aggravate the problem. Moisturize your skin to reduce the urge for scratching. Use a natural moisturizer immediately after bathing (and drying) to lock in the moisture. Use moisturizer several times a day during winter and cold weather. Relieving stress also helps to resist the urge to scratch. In her book Psoriasis Healing from Inside Out, Heather J. Ferris emphasized on the role of belly breathing technique to relax mind and suppress the urge for scratching.
- How water bath– It would strip the natural, intrinsic moisture of your skin to increase the skin dryness. Also, it irritates your skin to increase skin redness and inflammation. Opt for warm water bath, that too for a limited time. You can add some baking soda in your bath water as baking soda is an effective anti-itching agent. Also, once or twice a week, you can enjoy a soaking bath with Dead sea salt (or Epsom salt). Soaking baths would help to retain moisture and reduce inflammation and itching.
- Harsh soaps– Artificial soaps, loaded with chemicals, work harshly to rub off the psoriasis lesions stripping off the natural moisture from your skin. Also, if your skin has open sores (skin cracks), then these chemicals can enter your bloodstream to further complicate the things. A good natural/ herbal soap would be mild in nature and provide effective cleansing without making your skin dry and harsh. Even some natural soaps would improve the moisture level actually.
- Undergarments made from synthetic materials– Undergarments made from synthetic materials such as nylon have poor sweat absorbing properties. It would result in accumulation of sweat to induce itching. Also, aggravated sweat can promote fungal and yeast infections. Opt for clothing made from natural textiles such as cotton or linen as they have better sweat absorbing properties. It allows your skin to breathe and avoid excessive sweating and overheating of skin.
- Tight clothing– Tight clothing would rub against your affected skin more frequently to trigger itching. Opt for loose (easy fitting), comfortable clothing- they would be less restrictive and wouldn’t rub against your affected your skin more frequently. Wearing loose tops help greatly in case of inverse psoriasis occurring at armpits and under the breasts.
- Poor hygiene– It can lead to bacterial buildup. Take regular baths with mild soaps to keep the affected skin area clean and bacteria-free.
- Excessive sweating– Sweating is your body’s natural mechanism to get rid of body toxins. But, excessive sweating in the skin folds can take a toll on you if dealing with inverse psoriasis. Use sweat absorbent powder to keep the skin dry and reduce friction. Corn starch, baking soda, zinc oxide are some cheap alternatives. Even Johnson baby powder or Himalaya baby powder would also serve the purpose.
- Hot weather– Hot weather would induce more sweating, also, it increases the risk of dehydration to worsen inflammation. Hence, wear loose cotton clothing, drink enough water and stay inside.
- Smoking and alcohol– Smoking (tobacco) is a universal trigger for psoriasis. If you are really serious about healing psoriasis, smoking is a big NO for you. Alcohol is also a culprit. It dehydrates your body to increase skin dryness; damages your liver; causes nutritional deficiency; affects gut health and increases the risk of yeast infection. Ideally you should stay away from alcohol, if not possible, then drink sensible amounts occasionally, not frequently.
- Obesity– Get rid of some extra body weight, if necessary. Maintaining a healthy body is helpful in all auto-immune disorders including psoriasis.
- Perfumed / Scented products– The perfume or fragrance used in various cosmetic and personal hygiene products is a skin irritant. These artificial perfumes are derived from alcohol and phthalates and can make your skin dry and cause burning, itching and skin redness. Hence, better to go for natural / herbal products- they are either non-scented or naturally scented. Even if you are addicted to non-herbal cosmetics, use products labelled “fragrance free” or “perfume free” or hypoallergenic”.
Inverse Psoriasis- Useful tips and Home remedies
- The primary goal of topical treatments is to reduce inflammation and discomfort. Mix a small amount of virgin coconut oil and tea tree oil- 1 part of tea tree oil in 10 to 20 parts of virgin coconut oil. Use a cotton ball to apply this oil mixture on the affected area. Use them in the morning after bathing and then at night before going to bed. Virgin coconut oil is readily absorbed by your skin and have a pleasant smell with healing properties. Tea tree oil is a potent anti-microbial and anti-inflammatory oil, hence, mixing it with virgin coconut oil would help neutralize any fungal or yeast infection and reduce the skin inflammation. Don’t use tea tree oil alone as it can cause a burning sensation. Always dilute it with virgin coconut oil or any other healing oil such as olive oil, neem oil or castor oil. For Dr Pagano, the author of the famous book Healing Psoriasis: The Natural Alternative, a mixture of olive oil and peanut oil in equal proportions is the most effective topical oil for psoriasis. Hence, you can use this oil mixture with a few drops of tea tree oil on your inverse psoriasis lesions. Don’t use peanut oil if you are allergic to peanuts.
- For severe itching and discomfort, you can use ice cubes on the affected skin. Also, dilute some baking soda in water and apply it on the affected area to subside itching.
- Get some sunlight- 10 to 20 minutes of sunbathing, depending upon your location, skin color and age, during the peak hours- 10 am to 2 pm- is a wonderful way to get some required vitamin D. Avoid sunlight if you are photosensitive.