How Psoriasis Is Different in Women

Psoriasis is a chronic skin condition that causes patches of thickened, inflamed, and red skin that can be covered with silvery scales. Depending on how much of the body is covered, psoriasis can have a major impact on quality of life and overall well-being, both because of the way it looks and the itch it causes.

“In general, women report feeling stress and worry more often than men, regardless of the extent of psoriasis,” says Lauren Taglia, MD, PhD, a dermatologist at Northwestern Medicine in Chicago.

Keep reading to learn about how the symptoms, stress, complications, and mental health challenges can be different for women with psoriasis, and for expert advice on coping strategies.

While the hallmark symptoms of psoriasis are skin plaques or a rash, the type of psoriasis, where it appears, and the severity of symptoms are different in women than men.

Location of Plaques

There are a few differences between women and men in where psoriasis is more likely to appear, says Dr. Taglia. “While nail psoriasis is more common in men, palmoplantar psoriasis, a variant that involves mostly palms and soles, is seen more commonly in women,” she says.

The Itch Factor

“Women tend to report pruritus [itching] more frequently than men, as well as more intensity in overall itch,” says Taglia.

“There are studies showing gender differences in the processing of itch,” says Alison Ehrlich, MD, a board-certified dermatologist at Ehrlich Dermatology in the Washington, DC, area.

Genital Psoriasis

Genital psoriasis can also affect the crease between the thighs and genital area; the vulva; the penis and scrotum; the crease between the buttocks; the pubis, which is the skin above the genitals; and the inner and upper thighs.

Two forms of psoriasis can occur in the genital area: plaque psoriasis and inverse psoriasis. Plaque psoriasis in white 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.

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

In general, female hormones such as estrogen can influence disease severity, says Taglia: “Estrogen has been shown to affect the severity of psoriasis in some patients, as seen in pregnancy.” While estrogen levels are high in pregnancy, many report improvement in psoriasis symptoms and worsening right after the baby is born, when levels return to lower levels, she says.

During perimenopause, the ovaries gradually produce less estrogen, which may translate into more psoriasis flares. Once the menopause transition happens, estrogen levels drop further, and psoriasis symptoms may worsen.

Treatment strategies are similar for men and women, says Taglia. “These include a host of topical agents, including topical steroids, calcipotriene (vitamin D derivative cream), Tazorac (vitamin A based cream), roflumilast, and coal-tar-based treatments,” she says.

For patients with moderate to severe psoriasis, there are oral agents and injectables, as well as UV light treatments, says Taglia.

If you're pregnant or are actively trying to conceive, it's important to discuss plans with your dermatologist so they can recommend the appropriate medications to treat your psoriasis, says Dr. Ehrlich. “Methotrexate, acitretin, and tazarotene should be avoided in patients planning a pregnancy,” she says.

Psoriasis is an independent risk factor for heart disease for both men and women, says Taglia. Severe psoriasis is associated with a higher incidence of heart attack, with a higher risk for women, she says.

Men tend to show a greater area of involvement for psoriatic lesions (meaning they have psoriasis on more parts of their body), whereas women tend to report more significant impact on quality of life and a worse rating on the Dermatology Life Quality Index (DLQI), says Taglia. The DLQI includes questions about psoriasis symptoms as well as how the condition affects everyday activities, level of self-consciousness, relationships, and work.

“Women with psoriasis also report fatigue as well as health-related work disability more often than men,” says Taglia.

She recommends the following to help with mood, anxiety, and fatigue:

• A well-balanced diet consisting of whole grains, fresh fruits and vegetables, and lean protein can help sustain healthy energy levels.
• Limit or skip alcohol altogether. This can be especially impactful for sleep, and getting enough rest can improve mood and energy levels.
• Daily exercise has been shown to improve pain associated with psoriasis, which can lessen fatigue and anxiety.

• While psoriasis affects both sexes equally, women often experience more intense itching, emotional distress, and body image concerns.
• Hormonal changes, such as those that occur during pregnancy or menopause, can affect symptoms.
• Psoriasis in women is associated with a greater risk of heart disease and Crohn's disease, and more severe symptoms in psoriatic arthritis.
• Women with psoriasis are more likely to face depression and anxiety, but a balanced diet, exercise, and good sleep can help manage these challenges.