Background: Inverse psoriasis often requires a targeted treatment strategy due to the inherent sensitivity, thinness, and occlusion of flexural areas. However, most treatment recommendations are based on anecdotal evidence.Methods: A systematic literature search was conducted in October 2018 in Pubmed, Scopus, Embase, and Cochrane Library with keywords 'inverse psoriasis,' 'genital psoriasis,' and 'treatment.' All prospective studies assessing efficacy of treatments for inverse psoriasis that had a sample size of at least 10 patients were included in our analysis.Results: The initial search yielded 340 results, and 14 studies were included in the final analysis. These studies comprised over 1000 patients with mild to severe psoriasis involving axillary, inframammary, facial, and/or anogenital regions. The included studies demonstrated efficacy of topical immunomodulators (N = 7), vitamin D analogs (N = 4), topical corticosteroids (N = 3), antiseptics (N = 2), and biologics (N = 1) in improving genital and flexural psoriasis symptoms.Conclusions: There is a paucity of high-quality studies on which to base treatment recommendations, especially with regard to the role of systemic and biologic therapies. Few studies, many of which are of low evidence quality, suggest that topical immunomodulators, vitamin D analogs, and mid-to-high-potency topical corticosteroids may be effective treatments, but more randomized controlled trials are needed.
Keywords: Axillary psoriasis; calcipotriol; calcitriol; corticosteroids; flexural psoriasis; genital psoriasis; immunomodulators; inframammary psoriasis; intertriginous psoriasis; inverse psoriasis; pimecrolimus; tacrolimus; topical treatments; vitamin D analogs.