Psoriasis in Women: Special Concerns – Everyday Health

Is psoriasis more common in women or men? Researchers dont necessarily agree on the answer, but according to one study in the journal JAMA Dermatology, 3.2 percent of women in the United States have a formal psoriasis diagnosis versus 2.8 percent of men.

These women may face challenges that the men dont. Women with psoriasis have unique considerations. I feel like [these issues] are under-addressed, says Jennifer Soung, MD, director of clinical research at Southern California Dermatology in Santa Ana, California, and a clinical professor at Harbor-UCLA Medical Center.

What can women with psoriasis do to make sure their medical, emotional, and mental health needs are met? Here are a few important things to keep in mind if you are a woman with psoriasis.

According to the National Psoriasis Foundation (NPF), women are more likely than men to feel the stigma of having a visible skin condition, particularly untreated or undertreated individuals who experience frequent flare-ups.

This can cause stress, which can lead to more flare-ups. The mind and the body are inextricably connected with the skin. If someone has a history of psoriasis, if they are stressed, the psoriasis can flare up. When the stress is better controlled, the psoriasis will improve. It works in both directions, says Amy Wechsler, MD, a New York Citybased psychiatrist and dermatologist.

Research suggests that women with psoriasis are more likely than men to experience depression, even though psoriasis tends to be more severe in men than in women, and that psoriasis can have a greater impact on womens quality of life.

Does the start of your menstrual cycle, when estrogen and progesterone levels are at their lowest monthly levels, automatically lead to a psoriasis flare-up? Not necessarily. The effect of hormonal changes on psoriasis will differ from person to person.

That said, a womans estrogen level on any given day can raise or lower the risk of a flare-up. Research backs this up, showing a correlation between skin inflammation and hormone levels.

The dramatic hormonal changes that come with pregnancy appear to have a particular impact on psoriasis,research indicates. Many (though not all) women experience a significant improvement in psoriasis symptoms during pregnancy, when estrogen and progesterone levels rise, and a worsening of psoriasis symptoms after giving birth, when these hormone levels plummet.

According to theNPF, as many as two-thirds of men and women with psoriasis may experiencegenital psoriasis at some point in their lives. It definitely happens, says Dr. Soung.

Some women may feel extremely self-conscious if they are experiencing a psoriasis flare-up on or around the vagina, anus, or genital fold area.

Its important to properly identify if the skin condition is psoriasis or something else, says Soung. The No. 1 question my patients ask is, Are you sure its not a STD? Another question her patients ask is, Can I still have sex? (TheAmerican Academy of Dermatology Association offers useful tips on sex with genital psoriasis.)

There are two forms of psoriasis that can occur in the genital area: plaque psoriasis and inverse psoriasis. Plaque psoriasis often appears on the scalp, knees, elbows, and torso, as well as the genital area. According to the NPF, plaque psoriasis in Caucasian skin can look red, with a scaly, silvery-white buildup of dead skin cells. Among people of color, the plaques may be darker and can range in color from purple to gray to dark brown.

Inverse psoriasis usually occurs in body folds such as the underarms, under breasts, and in the genital area. Symptoms include skin that looks smooth, glossy, and tight.

Both forms of psoriasis can hurt, itch, or crack.

Dermatologists may treat genital psoriasis with topical steroids, generally low-potency formulations for mild to moderate cases. Since the skin of the genital area is thin and extremely sensitive, its important for patients on topical drugs to talk to their doctor immediately about any issues involving pain, bleeding, or stinging, including during urination or defecation.

If topical steroids arent working or are causing side effects, or if the genital psoriasis is severe, doctors might consider oral medication or injectable biologics instead.

Call your dermatologist if you think you are pregnant or actively trying to conceive in order to potentially adjust any medications you are taking, including but not limited to oral medication used for psoriasis, says Soung.

The concern is that certain psoriasis drugs could potentially harm a fetus.

For instance, while doctors dont commonly prescribe the psoriasis medicationacitretin (Soriatane) anymore, women whove taken the drug should wait three years after their last dose before trying to conceive in order to reduce the risk of serious birth defects.

Soung says that pregnant patients should apply high-potency topical steroids sparingly or not at all during pregnancy. She notes that before a breast-feeding session, a patient should use a damp cloth to gently wipe off any steroid creams or ointments on the skin.

In extremely rare cases, people may experiencepustular psoriasis of pregnancy, also known as PPP, a potentially life-threatening condition that requires immediate treatment.

PPP can impact both the pregnant person and the fetus and typically occurs during the third trimester of pregnancy. Skin lesions that look like open, infected sores may start on the stomach or abdomen, then spread.

The NPF estimates that of the nearly 8 million Americans with psoriasis, a third will develop psoriatic arthritis. While the prevalence of psoriatic arthritis is the same in women and men, someresearch has shown that the so-calledburden of disease is greater for women than men: Women tend to have more disease activity, higher levels of joint pain, and lower functional capacity.

Soung says that physicians should keep gender-specific considerations in mind (concerning cardiovascular and bone health, for instance) when prescribing psoriatic arthritis treatment.

Allan Avendao is a Hollywood makeup artist who has psoriasis. He thinks that while people with psoriasis may want the option of camouflaging any plaques on their face with makeup, its important to focus on how cosmetics can showcase your best features.

Here he lays out the basics of apsoriasis-friendly makeup routine:

One last piece of advice: When choosing makeup, listen to your skin. If a certain brand is making you flare up, you may need to switch, a process that may require some trial and error. During a bad flare you might also need to take a short break from cosmetics.

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Psoriasis in Women: Special Concerns - Everyday Health