PHOTO ROUNDS FRIDAY

FIGURE 1	FIGURE 2
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The diagnosis

The physician diagnosed the patient with inverse psoriasis. Inverse psoriasis is found in the intertriginous areas of the axilla, groin, inframammary folds, and intergluteal fold. (See FIGURE 2 for an example of inverse psoriasis in the inguinal area.) Inverse psoriasis can also be seen below the pannus or within adipose folds in obese individuals.

The name “inverse” refers to the fact that the distribution is not on extensor surfaces, but in areas of body folds. Morphologically, the lesions have little to no visible scale and therefore are not easy to recognize as psoriasis. The color is generally pink to red but can be hyperpigmented in dark-skinned individuals. Most importantly, the condition often mimics Candida and tinea infections in the body folds. When antifungal medicines are not working, always consider inverse psoriasis.

Treatment consists of a mid- to high-potency topical steroid—even though the disease occurs in skinfolds. Both creams and ointments work, and the choice of the vehicle can be based on patient preference. Topical tacrolimus ointment before bedtime is an alternative treatment, given alone or with a high-potency topical steroid in the morning.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Psoriasis. In: Usatine R, Smith M, Mayeaux EJ, Chumley H, Tysinger J, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:620-629.

To learn more about The Color Atlas of Family Medicine, see:
* http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
* http://www.mhprofessional.com/product.php?isbn=0071474641

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