Inverse Psoriasis masquerading as cutaneous candidiasis

Dermatology

Psoriasis is a chronic skin disorder affecting approximately 2% of the European and American population. The most common form of psoriasis is the chronic plaque type. Inverse psoriasis is a rare form of psoriasis that affects between 3% and 7% of the patients with psoriasis. It can comprise genital skin folds as part of genital psoriasis, and it is one of the most commonly seen dermatoses of this area. The skin at the inverse body sites differs from skin at extensor sites with less epidermal keratinization and more sweat glands. The differential diagnosis of inverse psoriasis includes any erythematous rash with or without pruritis that appears in the intertriginous areas of the body. The most immediate dermatologic diseases that come to mind are bacterial and fungal infections. The lack of scaling in inverse psoriasis can easily mislead physicians away from a psoriatic etiology and towards an infectious one most probably cutaneous candidiasis. We report one such case of inverse psoriasis presenting as a diagnostic dilemma. Therefore a lack of response to antifungal drugs and persistence of lesions should point towards the most important differential diagnosis that is inverse psoriasis which can easily be proven by a histopatholgical examination. Treatment of inverse psoriasis includes mild topical corticosteroids, topical calcineurin inhibitors such as tacrolimus and pimecrolimus, topical vitamin D3 analogues such as calcipotriol and oral agents like Adalimumab and dapsone have also been tried.

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