Inverted psoriasis L40.83

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Inverse psoriasis

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Manifestation form of psoriasis with predominantly or exclusively flexural and/or intertriginous(intertriginous psoriasis) patterns.

Clinical features
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As the herds occur in the occluded large body folds, the typical surface scaling is missing due to the constant maceration. The lesions impress as light or deep red, sometimes even wetting, sharply edged plaques.

Differential diagnosis
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Tinea corporis: In the first diagnosis this shows one or more inflammatory reddened, slightly scaly plaques with a central healing and centrifugal expansion tendency. There is almost always a marked itching. Mycological proof!

Candidosis, intertriginous: Sharply defined, peripherally scaly erythema and plaques. Frequently pustule fringe or splashes of papulovesicular to pustular satellites in the surroundings. Mycological evidence!

Intertrigo: Mostly obese patients; clinical signs: Bright red, usually sharply defined (satellite foci indicate intertriginous candidiasis or contact allergic eczema), extensive, itchy or painful erosions, spots or erosive plaques and often rhagades. An unpleasant sweetish fetus indicates a bacterial superinfection.

Pemphigus chronicus benignus familiaris: Long-standing finding; more frequent in the intertrigines; familial accumulation. Itchy, reddened, roundish, oval or circulatory plaques covered by greasy scaly crusts, usually sharply defined, with typical transverse fissures (typical sign); often secondary infections (e.g. with Candida). Nikolski phenomenon are positive.

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External therapy
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In individual cases, patients have been treated topically with Tacrolimus or Pimecrolimus successfully ( off-label-use) (see calcineurin inhibitors).

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  1. Omland SH et al (2015) Psoriasis inversa: A separate identity or a variant ofpsoriasis vulgaris? Clin Dermatol 33:456-461
  2. Wohlrab J (2006) Calcineurin inhibitors for the topical therapy of psoriasis. dermatologist 57: 685-689


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020