Sex and gender exist on spectrums. This article will generally use the terms “men” and “women” to refer to a person’s sex assigned at birth.
Psoriasis is a common inflammatory skin condition that, though estimates vary, affects roughly 0.5% to 5% of the world population. While every individual is unique, generally speaking, psoriasis can affect men and women differently.
According to a 2006 research review, most studies have suggested that psoriasis may be slightly more common in men, though the onset of disease may be earlier in women. For women, the average age of onset of psoriasis is in the late 20s, which can coincide with reproductive years (more on this below).
Data suggests that men may have more severe disease, but according to a 2019 review, several studies have shown that women experience a significantly higher burden from their psoriasis in terms of quality of life and perceived stigmatization.
Women with psoriasis are more likely to experience decreased happiness and increased stress and loneliness than men with the condition.
There have also been increasing reports on the associations between psoriasis and many other conditions, including:
- heart disease
- autoimmune disease
- psoriatic arthritis
Finally, while biologic therapies have revolutionized the management of psoriasis, women may be more likely to experience treatment limiting side effects, per a
Skin conditions are not hidden — everyone can see them. People who have psoriasis may feel embarrassed by the appearance of the rash or note having to change clothing due to the constant flaking. Having psoriasis in highly visible locations, like the backs of the hands, can be particularly challenging.
Many people feel that others worry that their skin condition may be contagious. In administered questionnaires, people with psoriasis noted concerns about rejection, feelings of being flawed, and sensitivity to the opinions of others.
Those with psoriasis, particularly women, often feel self-conscious about their skin and fear rejection.
Psoriasis can involve many different areas of the skin, including genital skin and the gluteal cleft. A substantial portion of people who have psoriasis will experience genital involvement at some point.
This can impact sexual function. Women are more likely than men to note a decrease in sexual activity after being diagnosed with psoriasis, according to the National Psoriasis Foundation (NPF).
Patients should discuss psoriasis with their partner whenever they feel comfortable. They can feel empowered knowing that it’s common, not contagious, and treatable.
In general, psoriasis is not thought to impact fertility. However, women with psoriasis, particularly severe psoriasis, do have slightly lower rates of pregnancy for reasons that are unclear and likely multifactorial.
The majority of women note either an improvement or no change in their skin during pregnancy. A small subset of women do experience worsening symptoms, though.
Importantly, pregnancy and lactation have implications in terms of treatment options. Many treatments are very safe throughout pregnancy and nursing, but some could result in harm to the unborn or newborn baby.
Women with psoriasis should always discuss plans for pregnancy and nursing with their doctor.
Many people with psoriasis feel that stress impacts their skin, though proving this can be challenging and studies have had mixed results.
This represents a unique challenge for women who, as detailed above, experience more stress from their psoriasis. This can potentially lead to a cycle of stress worsening psoriasis and psoriasis worsening stress.
Mental health and self-care are important for everyone, including those with psoriasis.
I advocate for a healthy, balanced lifestyle for anyone who has psoriasis, for reasons that extend beyond their skin condition.
Alcohol use may be both a risk factor for development and a consequence of having psoriasis. It’s also been shown to be a risk factor for worsening disease, treatment failure, and overall mortality.
Both obesity and smoking may be associated with the development of psoriasis, and this has been shown more for woman than for men.
Importantly, there is no diet that will cure or prevent psoriasis. However, since those with psoriasis have increased risk of cardiovascular disease, diabetes, and fatty liver disease, I do recommend diets that minimize high-glycemic index and processed foods.
Dermatologists have so many treatment options for psoriasis. Options range from topical therapies and light therapy to pills and injectable medications.
For many, psoriasis is a chronic condition that waxes and wanes over time. Appropriate treatment can both resolve current flares and prevent future ones. Success rates in clearing the skin, particularly with newer agents, are impressively high.
Studies have shown that effective treatment can improve or stabilize the effects of psoriasis on quality of life. I strongly encourage anyone dealing with psoriasis to talk with a dermatologist regarding treatment recommendations.
Many people who have psoriasis find that lighter colored clothing is less likely to show flaking than darker colored clothing.
Medicated shampoos, like Neutrogena T-sal shampoo, can help to reduce flaking in the scalp.
Regular use of moisturizers can also help with the appearance of redness and flaking, and they can decrease the itching that some people with psoriasis experience.
Nail psoriasis can be particularly challenging and often requires systemic treatment (pills or injections). Minimizing trauma to the nails is important to prevent worsening.
The NPF has excellent resources and support groups for people managing with this condition.
Dr. Sara Perkins is an ABMS board certified dermatologist at Yale Medicine in Connecticut who practices general medical dermatology and has special interests in skin cancer prevention, screening, and treatment. She especially enjoys helping patients diagnosed with an aggressive form of skin cancer, melanoma, and addressing other skin-related dermatologic concerns that can result from too much sun exposure. Perkins is also an instructor of dermatology at Yale School of Medicine.