Treatment of Inverse/Intertriginous Psoriasis: Updated Guidelines From the Medical Board of the National Psoriasis Foundation

J Drugs Dermatol. 2017 Aug 1;16(8):760-766.

Abstract

<p>Inverse or intertriginous psoriasis commonly involves skin fold areas including the axillae, perianal skin, intergluteal cleft, inframammary, genital/inguinal, abdominal, and retroauricular folds. After reviewing the literature for new treatments, a task force was convened to update a consensus on inverse psoriasis therapy. Short-term treatment continues to be low-potency topical steroids. In order to avoid steroid-induced adverse effects, long-term therapy includes topical immunomodulators, calcitriol, and calcipotriene. Second and third-line therapies include antimicrobials, emollients, and tar-based products. Inverse psoriasis resistant to topical therapy has been shown to respond to botulinum toxin injections, excimer laser therapy, and certain systemic agents (such as anti-TNF and anti-IL12/IL23 therapy). Based on promising results from case reports and prior clinical experience, these systemic agents should be strongly considered in inverse psoriasis resistant to topical therapy. However, they need further evidence-based evaluation. The use of randomized trials and objective severity indices may allow for more robust therapeutic data.</p> <p><em>J Drugs Dermatol. 2017;16(8):760-766.</em></p>.

Publication types

  • Practice Guideline

MeSH terms

  • Administration, Cutaneous
  • Calcitriol / analogs & derivatives
  • Calcitriol / therapeutic use
  • Dermatologic Agents / therapeutic use
  • Humans
  • Immunologic Factors / therapeutic use
  • Psoriasis / drug therapy*
  • Psoriasis / pathology
  • Randomized Controlled Trials as Topic
  • Tumor Necrosis Factor-alpha / therapeutic use

Substances

  • Dermatologic Agents
  • Immunologic Factors
  • Tumor Necrosis Factor-alpha
  • calcipotriene
  • Calcitriol