Authors:  Hilda Brigitta, Farida Tabri, Faridha Ilyas, Nurelly N. Waspodo, Sri Rimayani


Introduction: Psoriasis is an inflammatory skin disease with complex etiology which is an interaction between genetic and environment factors. Inverse psoriasis is a rare clinical pattern of psoriasis where the lesion is localized to the major fold area. It is common and more severe in patients with obesity which reported 13% in obese patients, since the skin folds are susceptible to irritation caused by friction and sweat. The lesions show a glossy sharply demarcated erythema, scaling is usually minimal or absent, that is often misdiagnosed. Treatment of inverse psoriasis is a challenge not only because of the difficulty of making the correct diagnosis but also because of the sensitivity of the skin involved.

Case summary: Here we report a case of a 54-year-old obese woman (BMI: 27.4) who suffered for inverse psoriasis for 3 months. The lesions appear on the major fold which are retro-auricular region, axillae, inframammary area, lower abdominal fold, umbilical region, groin and also in sclap and back of the neck. Biopsy showed typical features of psoriasis, mainly the psoriasiform reaction pattern. The patient was treated with cetirizine 10 mg once daily and topical combination of salicilyc acid and betamethasone diproprionate with significant clinical improvement.

Conclusion: Inverse psoriasis is a rare form of psoriasis with obesity seemed to be an aggravating factors. Its appearance and distribution in the flexural skin folds makes it a difficult disease to diagnose, yet there are very few studies that deal with it exclusively. Therefore, further studies are needed.




flexural, inverse, obese, psoriasis



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