Inverse Psoriasis
Inverse psoriasis (also known as flexural psoriasis) affects areas where the body folds, such as the skin in the armpits, groin, under the breasts, and in the perianal location. This type of psoriasis usually occurs in conjunction with plaque-type psoriasis, but can also occur on its own. It differs from other types of psoriasis because rather than appearing scaly, the skin is smooth, moist, and salmon-colored. Inverse psoriasis can be confused with a yeast (candida) or fungal infection (jock itch).
People with inverse psoriasis can feel extremely uncomfortable because their skin is often raw, tender, or itchy, which is most distressing for those affected as scratching these areas in public is embarrassing. Sweating can irritate the skin further. Inverse psoriasis can usually be controlled with topical corticosteroids. A mild to mid-potency topical steroid is usually tried first as the skin in these locations is thinner and more likely to develop local side effects from topical steroids (thinning of the skin, stretch marks). As noted earlier, a new kind of topical nonsteroidal therapy is now available and is also used to treat psoriasis in these locations. The new therapies are available in cream formulations.
Erythrodermic Psoriasis
Erythrodermic psoriasis is a severe form of psoriasis. Also known as exfoliative psoriasis - because scaly lesions cover all or almost all of the body and the skin can be scaling and peeling - it is characterized by widespread, extremely red, itchy, and swollen skin. For some, the skin can be very red with minimal scaling. In areas of raw skin, pustules might be present and pus can ooze from these lesions. The eyes, the lining of the mouth, and the inside of the nose can also be affected.
Erythrodermic psoriasis usually appears in one of two forms. First, a chronic, long-standing plaque-type psoriasis may gradually progress so that increasing areas of skin become involved. Second, erythrodermic psoriasis can occur in people with unstable psoriasis and can be triggered by several factors, including illness, emotional stress, alcoholism, and the withdrawal of potent topical, oral, and/or injected corticosteroids.
Those with erythrodermic psoriasis can be quite sick (possibly with fevers and chills), are prone to infection in the involved skin, and might have difficulty maintaining normal levels of fluids and body temperature. As a result of the increased volume of blood flowing through severely inflamed skin, the patient can develop an increased heart rate, particularly those who are elderly or who have prior heart disease, and this can ultimately lead to heart failure.
Those presenting with erythrodermic psoriasis should be referred to a dermatologist. Basic principles of care include maintaining normal levels of fluids and the liberal use of a moisturizer and/or topical steroids. In order to restore normal levels of fluids and nutrients, some cases will require hospitalization. Once a patient is stabilized, typical treatments such as topical therapy, phototherapy, oral medications, or biologic therapy can be used to control the disease.
Pustular Psoriasis
Pustular psoriasis is characterized by the appearance of small blister-like areas on the skin. Pustular psoriasis can be separated into two forms: localized (often only the hands and feet) and generalized (extensive areas of the body). Localized, or palmoplantar pustulosis (PPP), is the most common pustular variant. Those with generalized pustular psoriasis (GPP) are among the most seriously ill and will usually require hospitalization until the psoriasis is controlled.
The blister-like lesions of pustular psoriasis are usually small and raised. These lesions are filled with noninfectious pus (white blood cells, cellular debris, and dead tissue) and are surrounded by reddened skin. The skin may be painful, which makes manual labor or walking difficult. Pustular psoriasis can be triggered by infections, stress, or certain medications. Smoking may also play a role. To find out more, you can check out Different Types Of Psoriasis.