Inverse psoriasis is a rare type of psoriasis that occurs in the skin folds, including the armpits, the area surrounding the groin, and the areas of skin that touch the skin. Approximately 3% of Americans suffer from psoriasis, and 3% to 7% of these individuals develop inverse psoriasis. [1]
One of the questions people most often ask about it is: Does inverse psoriasis have a smell? The simple answer is no, inverse psoriasis itself does not cause a smell, but the skin that gets the condition does sometimes smell bad. Let’s see why that happens, the reasons for the smell, and the ways by which it can be managed.
What Is Inverse Psoriasis?
Inverse psoriasis, also called flexural psoriasis, is a chronic skin disease that appears in skinfolds under increased friction and moisture. As opposed to the dry, scaly plaques resulting from plaque psoriasis, inverse psoriasis causes red, shiny, and smooth rashes that are aggravated by friction and sweating. [2]
Typically affected areas with inverse psoriasis are:
- Armpits
- Groin
- Genital area
- Between the buttocks
- Under the breasts
These areas are more prone to become irritated and secondarily infected due to the fact that they are warmer and remain moist compared to the surrounding tissue.
Does Inverse Psoriasis Have a Smell?
Inverse psoriasis itself does not have a smell. But since it happens within the skin folds, the area gets moist and creates the perfect conditions for the secondary infections of bacteria and fungus that cause the area to smell. [3]
Why Inverse Psoriasis Doesn’t Smell on Its Own
Inverse psoriasis, much the same as with the various types of psoriasis, is an autoimmune condition. That is, it happens due to the immune system improperly attacking normal skin cells, causing inflammation and rapid skin growth. [4]
Red, shiny areas of inverse psoriasis are caused by this inflammation — neither by infection nor by bacteria. Because the condition of psoriasis isn’t caused by fungus or bacteria, it isn’t something that should smell bad by nature. The skin changes are caused by the body’s internal immune response, so by itself, inverse psoriasis isn’t offensive smelling.
What Causes Inverse Psoriasis to Smell Bad?
Psoriasis itself isn’t bad smelling but secondary conditions of the disease including sweat, friction, and infection cause the bad smell.
Sweat and Skin Folds
Inverse psoriasis tends to arise in areas that are warm and moist with skin rubbing together — such as the armpits, under the breast area, and the groin area. These areas retain heat, moisture, and sweat.
If sweat interacts with the normal bacteria present on the skin, it may give off a sour or musty smell. Psoriasis inflammation makes the skin more sensitive and it may over-secrete the normal amount of sweat that it should be secreting, adding to the problem.
Yeast and Fungal Infections
It is the moistness of the skin folds that provides the perfect conditions for yeast and fungus to thrive, most notably a type known as Candida. In fact, half of people with inverse psoriasis are likely eventually to catch a yeast infection.
These infections can cause:
- A foul-smelling odor
- White or yellowish discharge
- Inflamed soft tissue
- Redness and increased tenderness
Yeast infections are not caused by the presence of psoriasis but by the damaged skin surface and constant dampness that allow the fungus to thrive more readily.
Bacterial Infections
In occasional instances, bacterial infections are also complicated by inverse psoriasis. If the skin cracks or breaks up due to the condition itself or due to scratching, it creates openings for the bacteria to penetrate and infect the area.
Symptoms of bacterial infection include:
- Purulent discharge
- A bad smell
- Discharging or draining
- Redness that worsens
- Swelling that increases
If you experience any of these symptoms, it’s essential to visit a doctor immediately.
Poor Hygiene or Lack of Airflow
Since inverse psoriasis affects areas where skin touches the skin, keeping the area clean and dry can be challenging. Poor hygiene or tight clothing that traps sweat can worsen the smell.
Despite frequent washing, the friction and moisture that accumulate between the skin folds over the years cause the area to smell unpleasantly over time.
How To Manage the Smell of Inverse Psoriasis
If it’s the smell of inverse psoriasis that you’re coping with, the good thing is that it can be managed. Here are the ways it can be done:
Stick With Your Treatment Plan
There is no cure for inverse psoriasis, but treatment can help manage the symptoms and prevent the infections responsible for the smell. Your doctor may prescribe:
- Topical treatments like corticosteroids, tacrolimus, or Elidel
- Newer nonsteroidal creams like tapinarof (Vtama) or roflumilast
- Phototherapy (ultraviolet light therapy)
- Biologic medications if other treatments don’t work
If the treatment that you are receiving now isn’t successful, talk with your doctor about alternatives. Some of the treatment gradually ceases to be effective and needs to be altered.
Keep Skin Clean and Dry
- Bathe the affected areas with a fragrance-free gentle cleanser daily. [5]
- Pat the area with a soft towel and avoid rubbing it since rubbing the skin irritates it.
- Try using the cool setting of the hairdryer to completely dry the skin folds after the shower.
Treating Infections
If the smell coming from your psoriasis is unpleasant, it could be due to infection. Don’t hesitate to bring it up with your doctor. Your doctor may prescribe:
- Anti-fungal yeast infection creams or powders
- Treatment of bacterial infections with antibiotics
- Over-the-counter (OTC) medications that help to keep the skin dry and clean
Wear Breathable Clothing
Loosen up and wear comfortable well-ventilated clothing of cotton or moisture-repelling fabric that minimizes perspiring. Avoid tight synthetic fabrics that retain heat and dampness.
When to See a Doctor
While most cases of slight smell are treatable at home, seek the doctor if you find that you are experiencing:
- A bad smell that does not disappear with good hygiene practices
- Discharge of ooze of pus from the infected tissue
- Redness, increased swelling, or increased pain
- White discharge, itching, and white patches are the symptoms of a yeast infection.
These are symptoms of an infection that should be treated by a doctor.
In Summary
Inverse psoriasis by itself does not smell. The areas where it occurs are warmer and more moist, but they are the perfect conditions for sweat, fungus, and bacteria that are responsible for the smell.
Treating the smell involves keeping the skin dry and clean, using medicated treatment if needed, and taking care of the cause of the psoriasis itself.
If you ever notice a strong odor, discharge, or signs of infection, don’t hesitate to talk to your doctor. With the right care, you can control both your psoriasis symptoms and any unpleasant smells that come with them.
