CASE 2: Localized Inverse Psoriasis

A 46-year-old man complains that his "jock itch" failed to respond to antifungal creams. The patient has had psoriasis on his elbows and knees for many years. The history and the striking salmon pink color of the eruption suggest inverse psoriasis of the groin. (Case and photograph courtesy of Joe Monroe, PA-C.)

What treatment would you prescribe?

A REVIEW OF THE OPTIONS Inverse psoriasis is characterized by smooth, glistening, and sometimes moist and macerated plaques that affect intertriginous skin. The groin is a common site for psoriasis; however, the combined friction and moisture in this location does not allow the typical white adherent scale of the psoriatic lesions to accumulate. Treatment options include lowpotency corticosteroid creams and lotions, calcipotriene cream, and the topical immune modulators tacrolimus( ointment and pimecrolimus( cream. In addition, topical and oral antifungals are often used to eradicate superimposed Candida and Pityrosporum colonization. Both calcipotriene and the immune modulators are very effective and may be applied long term. Often, low-potency topical corticosteroids are only partially effective and can lead to cutaneous atrophy; telangiectasias; and steroid rosacea, which features rebound erythema, papulopustules, and burning, especially when the corticosteroid is discontinued. CASE 2: APPROACH AND OUTCOME The patient responded well to twice-daily application of calcipotriene cream.