How Hormones Affect Psoriasis

Many women with psoriasis experience skin changes — sometimes good, sometimes bad — during pregnancy and menopause.

However, research isn’t very clear about how psoriasis and hormones are connected or what women with the skin condition can expect at different stages of their lives. Here’s what doctors do know.

Psoriasis and Pregnancy

Researchers know a little more about how hormones affect psoriasis during pregnancy than they do about the ways hormones affect psoriasis during menopause, explains Kristina Callis Duffin, MD, associate professor of dermatology at the University of Utah in Salt Lake City.

Among the 47 pregnant women with psoriasis, 55 percent experienced an improvement in their skin during pregnancy and 23 percent saw their psoriasis get worse. The rest experienced no change. The study also found a correlation between better skin and higher estrogen levels.

Also, skin changes can occur after childbirth. Often women whose skin improves during pregnancy experience flares postpartum, while women whose skin gets worse during pregnancy may watch their skin improve after giving birth.

Another finding is that women tend to have the same experience across pregnancies, Duffin notes. Among the patients she studied, those whose symptoms improved during the first pregnancy had similar experiences in later pregnancies. Those whose symptoms worsened when they were pregnant for the first time suffered flares again in subsequent pregnancies.

Which group you fall into may have to do with your genetic makeup. Researchers have found that women whose psoriasis improved during pregnancy often carry the major gene for psoriasis, Duffin explains.

Some psoriasis medications are not recommended during pregnancy because of risks they carry to the developing fetus. If you are pregnant or planning on becoming pregnant, it is important to let your dermatologist know so that a safe treatment plan can be designed. Also, let your doctor know if you are planning to breastfeed.

Psoriasis and Menopause

If higher estrogen levels during pregnancy are associated with an improvement in psoriasis, you might think that dropping estrogen levels during menopause would lead to psoriasis flares.

In her own research, however, Duffin didn’t find that menopause or oral contraceptives affected psoriasis symptoms. The same goes for hormone replacement therapy taken after menopause. “There’s no data to support the idea of taking HRT for psoriasis,” Duffin says.

However, anecdotally, women may report that the intensity of their psoriasis changes at menopause or while they are taking hormones, she adds.

Part of the reason this is unclear is that so many other factors could explain changes in psoriasis. One big factor is stress, which often plays a role during pregnancy, childbirth, and menopause. Sometimes women develop psoriasis at the birth of their child, which is attributed to the stress of childbirth, notes Duffin.

Treatment at Different Stages

Psoriasis treatment should always be tailored to how your skin is doing, regardless of whether you’re pre- or postmenopausal.

Both oral and topical psoriasis medications can pose risks to mom and baby during pregnancy. Although some treatments are likely safe, such as ultraviolet B light therapy, options need to be weighed by the patient, her dermatologist, and her obstetrician, Duffin advises.

For women going through menopause, Duffin uses many of the same psoriasis treatment options she would for anyone experiencing psoriasis flares, including topical treatments, phototherapy, systemic medications, and biologic drugs.

With psoriasis, there’s no predicting how your skin will react to different life stages, but being informed and talking with your doctor about your options will help you to better deal with both the condition and your hormones.

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