CASE 2: Localized Inverse Psoriasis

A 46-year-old man complains that his"jock itch" failed to respond to antifungalcreams. The patient has hadpsoriasis on his elbows and knees formany years.The history and the strikingsalmon pink color of the eruptionsuggest inverse psoriasis of the groin.(Case and photograph courtesy of Joe Monroe, PA-C.)What treatment would youprescribe?A REVIEW OF THE OPTIONSInverse psoriasis is characterizedby smooth, glistening, and sometimesmoist and macerated plaques thataffect intertriginous skin. The groin isa common site for psoriasis; however,the combined friction and moisture inthis location does not allow the typicalwhite adherent scale of the psoriaticlesions to accumulate.Treatment options include lowpotencycorticosteroid creams andlotions, calcipotriene cream, and thetopical immune modulators tacrolimusointment and pimecrolimuscream. In addition, topical and oralantifungals are often used to eradicatesuperimposed Candida and Pityrosporumcolonization.Both calcipotriene and the immunemodulators are very effectiveand may be applied long term. Often,low-potency topical corticosteroidsare only partially effective and canlead to cutaneous atrophy; telangiectasias;and steroid rosacea, which featuresrebound erythema, papulopustules,and burning, especially whenthe corticosteroid is discontinued.CASE 2:APPROACH AND OUTCOMEThe patient responded well totwice-daily application of calcipotrienecream.