4 Tips to Manage Psoriasis Under the Breasts
If you have inverse psoriasis, you know it affects sensitive areas of the body that are usually covered by clothing, and that it can be uncomfortable and keep reoccurring.
“Inverse psoriasis usually happens in areas of skin folds like the underarm, groin, and under the breasts,” says Julie Russak, M.D., a board-certified dermatologist practicing in New York City. “In these areas, you have a lot skin-on-skin contact, so the skin becomes macerated, or sweaty, and moisture typically occurs.” That moisture and chronic rubbing can cause psoriasis to flare, which can cause discomfort just about anywhere, but can really be an issue beneath the bra line.
Interestingly, according to Michele Koo, M.D., a board-certified plastic surgeon in St. Louis, Missouri who founded the skincare line Private Practice by Dr. Koo, this type of psoriasis is strictly caused by the “mechanical abrasion of skin against skin,” and if you follow the proper steps, you can prevent flares and feel more comfortable.
Keep It Dry
Since moisture is essentially the enemy here, it’s imperative to keep the area under your breasts dry. That doesn’t mean skipping lotion or skin cream, but rather keeping it from being wet for long periods of time. “After you shower, make sure you dry that area really well,” says Russak. “Using a towel alone is not enough. I recommend patients also put a blow dryer on warm and dry the area for a few minutes, then follow up with a good barrier cream.” Options include petroleum jelly (like Vaseline) or dimethicone (like in Vanicream Moisturizing Ointment). You can also use creams containing ceramides (like CeraVe Moisturizing Cream). Ceramides are waxy lipid molecules that function as the glue that holds our skin together to maintain our skin barrier and keep it healthy.
The skin cream will not only provide a barrier for that skin-on-skin friction, but it can also provide a barrier between your skin and the band of your bra, if you wear one, preventing further irritation.
Since clothing and undergarments often come in contact with the skin under the breasts, certain ingredients in detergents like dyes and fragrances may also exacerbate the problem.
“I recommend patients always use a fragrance-free detergent designed for sensitive skin such as Arm & Hammer Sensitive Skin, Free and Clear,” says Russak. “It’s important to be mindful of any and all ingredients coming into contact with the skin.” Some other suggestions include detergents such as All Free Clear and liquid softeners like Downy Free & Gentle.
Choose the Right Bra
If you have psoriasis under your breasts, daily bra wearing can be the equivalent of a nagging toothache in need of a root canal. Russak and Koo advise wearing a bra to support your bust and prevent skin-on-skin friction, but one without a stiff underwire, if possible. Instead, look for soft, breathable nonabrasive fabrics that are also moisture-wicking, like those typically used in sports bras. This way, you can prevent some of the sweating that can lead to a flare.
“Dabbing a drying powder, such as cornstarch, or placing light day pads underneath your bra band can also help minimize sweat,” Koo suggests.
Also, be sure your bra fits well, as a too-tight band or straps can cause chafing, and skin injury can cause a new flare, in what’s known as the Koebner phenomenon.
Russak emphasizes that psoriasis should always be diagnosed and treated by a board-certified dermatologist, if possible. “They’ll likely prescribe a medication to decrease inflammation,” she says. That can go a long way in reducing flares and helping you feel more comfortable. If you do experience a flare-up, it’s safe to initially try a very low-potency hydrocortisone 1% cream found over the counter, once or twice daily, a couple of times a week, says Russak. If symptoms don’t improve, you may need a prescription cream, such as a higher-strength hydrocortisone 2.5% cream, pimecrolimus cream, or tacrolimus ointment.
Also, a doctor can check to see if you have a coexisting skin infection such as intertrigo. Intertrigo is very common underneath the breasts. This area is also prone to yeast infections due to the inherently moist environment. Intertrigo may look similar to inverse psoriasis and is diagnosed through an in-office test. If you do have an infection, treatment of it will help improve your inverse psoriasis faster.
Also note, if you’re pregnant or breastfeeding, talk to your doctor to make sure any medications you’re taking, including topicals, are safe to use. Generally, it’s best to not apply a cream directly to the breast in areas where it may come into contact with your baby.
Jené Luciani is author of The Bra Book.
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