My 15-Year Path to an Inverse Psoriasis Diagnosis

It all started with my nails. For some time, I noticed that they seemed… wrong. The whites of my fingernails extended too far into the nail beds. There was a strange reddish jagged line and ridges running through some of them.

My toenails were thick and some of them crumbled when I cut them. I showed my doctor during a regular checkup and he said, “Nail fungus. You should try a lacquer first. It doesn’t work in most cases like this, but it’s worth a try, because the internal fungal medication is hard on the liver.”

So I took his advice and diligently applied a prescription antifungal nail polish called Penlac to my nails and the skin around them for 6 months. It accomplished nothing.

We moved on to the oral medication Lamisil, which required me to first go for blood tests to determine whether my liver was healthy enough for it. My toenails did improve, but my fingernails didn’t.

“That’s strange. Usually it’s easier to clear the fingernails,” my doctor said. We were out of options, though, so he told me I could just keep trying the Penlac, which could take up to a year to work.

It wasn’t a severe enough problem to affect my life much; I just didn’t use nail polish because I read that could make nail fungus worse. I kept my nails short, and I moved on with life.

Join the free Psoriasis community!

Connect with thousands of members and find support through daily live chats, curated resources, and one-to-one messaging.

Sign up

The misdiagnosis continues

Years later, I woke up one morning with terrible itching and redness under and between my breasts. I figured it would go away on its own, but after more than a week, it stayed just as bad and was a strong annoyance.

“I fell asleep in a sports bra,” I told a different primary doctor (my original one had retired). “I think I was just sweaty and got this… irritation? I don’t know what to call it, but it won’t go away now. Is it a skin fungus?”

“Looks like it,” she agreed, and prescribed an antifungal cream. It took some time, but eventually, the redness and itching subsided. I figured the cream had done its job, and I stopped using it. But the irritation came back a few weeks later.

It became cyclical. It would clear up and come back over and over, particularly when I wore tight-fitting clothing or got overheated. I learned to just wear loose tops and tried under-dressing for bed.

My doctor called in multiple refills. I couldn’t tell if it was actually doing anything or if the red patches were just going away on their own with time. But I was too afraid to stop the cream and find out if it would get worse.

The itching got maddening sometimes. I tried ice packs. I tried exposure to sunlight. I threw athlete’s foot powder into my bra. I was desperate for relief.

When I went for a routine mammogram, the technician refused to see me until my doctor wrote a note saying that I had a fungal skin infection and that it was safe for me to have imaging done.

Oral symptoms begin

Then came the weird tongue.

One day while brushing my teeth, I looked in the mirror and was horrified — my tongue was mottled with red patches, looking like someone had removed pieces of its surface. I sent a picture to my doctor.

“Geographic tongue,” she said. “It’s harmless. There’s no treatment for it, but don’t worry. No one really knows what causes it, but it doesn’t cause any health problems.”

Yeah, but… I really hated it! I was embarrassed to open my mouth in case anyone saw it. I went for a second opinion and was told the same thing. Nothing anyone could do. It came and went as it pleased, creating new and disturbing patterns.

New skin symptoms arise

Then came the underarms.

I began getting red, inflamed areas on my armpits. I chalked it up to a too-harsh new deodorant, or shaving too hard with a new razor, or just sensitive skin.

It never occurred to me to ask anyone about this. I just tried to shave more delicately and use deodorant made for sensitive skin.

Finally a diagnosis

Fifteen years after the first incident with my nails — which waxed and waned a bit but never fully went away — I went for a routine dermatology screening. My dermatologist asked me if I had any skin concerns.

“Well, I have a couple of birthmarks to check out… oh, and I have a fungal infection under my breasts that keeps flaring up. It seems to go away, but it always comes back.”

“Let me see,” he said, with eyebrows furrowed. Then he shook his head. “You have inverse psoriasis.”

“I… what?”

“You have dandruff, too,” he said — which just seemed mean at that point. Thanks for noticing, doc!

“Do you have redness anywhere else, like your armpits or by your tailbone?”

“Yes!”

“Inverse psoriasis,” he repeated. “How long have you been treating it with antifungal cream?”

“Years.”

“And you never saw a dermatologist?”

“I didn’t think I needed to. My primary doctor never suggested it.”

After some questioning, he connected all the dots for me.

My weird nailbeds were from psoriasis, which also makes them more susceptible to nail fungus (my toenails really did have nail fungus, but my fingernails didn’t — which is why they didn’t clear up with Lamisil).

My geographic tongue was commonly associated with psoriasis.

The dandruff was mild psoriasis on my scalp. The redness, the itching… all of it came from psoriasis, and no one had put it together for me before.

What is inverse psoriasis?

Inverse psoriasis affects only 3 to 7 percentof people with psoriasis, a chronic inflammatory skin condition caused by an overactive immune system.

As opposed to plaque psoriasis, which produces patches of skin that are usually red and raised and covered in silvery “scales,” inverse psoriasis is typically smooth and shiny.

It can be painful or itchy. It occurs mainly in skin folds. It can show up in conjunction with other types of psoriasis, or by itself.

Managing inverse psoriasis

I left the dermatologist with new instructions: Put cornstarch on the irritated areas during the day and Vaseline at night. When the itching was moderate, I would use zinc ointment. When it was bad, I would use hydrocortisone cream.

“Don’t overdo it, though, because steroids can make your skin thinner,” he explained. “Just use it when you really need it.”

My condition was not strong enough to require biologics (injected or IV-administered drugs to block proteins that cause inflammation), which are recommended for more severe cases. But biologics can be used to treat inverse psoriasis as well, along with UVB light therapy.

I wear only loose-fitting cotton pajamas and keep bedding lightweight. I shower every day (moisture from perspiration aggravates psoriasis). I never wear the same bra for more than a day.

Stress is another trigger, so I practice stress-relief techniques like breathing exercises, yoga, meditation, guided relaxation, or other methods that help let off steam.

The takeaway

It’s common for people with psoriasis to be misdiagnosed with eczema or other skin conditions. Be sure to see a dermatologist and not just a primary doctor if you suspect you have it.

While I still get flares, getting answers about what was happening to my body and understanding how psoriasis works has helped to give me peace of mind and a plan to keep it well-controlled.

Article originally appeared on November 12, 2021 on Bezzy’s sister site, Healthline. Last medically reviewed on Novemeber 12, 2021.