We are used to psoriasis being a red scaly disease but when
it involves the flexures the scale is much less apparent. The moist occluded
surfaces mitigate against any scale formation but tend to encourage some
secondary candida on the damaged moist surfaces. Sometimes these candida
lesions present as satellite pustules with isolated pustules seen a few
centimeters away from the main rash on a background of normal skin. Combination
creams with 1% hydrocortisone and an antifungal preparation such as clotrimazole
are ideal for treating both the psoriasis and the secondary candida. Stronger
fluorinated topical steroid creams should not be used in these flexural
occluded areas as absorption is enhanced and skin atrophy with striae formation
can occur surprisingly quickly within weeks. Weight loss and having cotton
between the breast surfaces to absorb sweat can help the condition resolve more
quickly. Sometimes a tinea fungal infection can mimic this rash so taking skin
scrapings of the edge for microscopy and fungal culture is always a good idea.
