How Hormonal Balance Changes Lives in Women with Psoriasis

1. The Role of Hormones in Psoriasis (Table 1)

Psoriasis is a chronic, immune-mediated disorder characterized by dysregulation of immune responses, leading to persistent inflammation and hyperproliferation of keratinocytes.[1,2] Hormonal factors, particularly estrogen and progesterone, exert considerable influence on immune modulation and can significantly affect the course of psoriasis in women.[5,6] This review explores the mechanisms through which these hormones impact immune function and psoriasis severity.

Table 1. Role of hormones in immune modulation.

Estrogen	- Suppress production of pro-inflammatory cytokines: tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interferon-gamma (IFN-γ). - Promotes the production of anti-inflammatory cytokines: interleukin-10 (IL-10) and transforming growth factor-beta (TGF-β). - Switches the balance from a pro-inflammatory Th1 and Th17 response to a more anti-inflammatory Th2 response. - Enhances Treg function.	[5,6,11,12] [6,13,14,15] [16] [17]
Progesterone	- Inhibits proliferation of T cells - Reduces production of pro-inflammatory cytokines	[9] [9]
Prolactin	- Promotes keratinocyte proliferation. - Promotes production of pro-inflammatory cytokines.	[23] [22,23,24]
Cortisol	- Acute cortisol release has immunosuppressive effects. - Chronic stress can lead to dysregulation of cortisol production and promotes a pro-inflammatory state with an increase in production of pro-inflammatory cytokines, worsening psoriasis symptoms.	[25,26] [25,26,27,28]

Table 1. Role of hormones in immune modulation.

Estrogen	- Suppress production of pro-inflammatory cytokines: tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interferon-gamma (IFN-γ). - Promotes the production of anti-inflammatory cytokines: interleukin-10 (IL-10) and transforming growth factor-beta (TGF-β). - Switches the balance from a pro-inflammatory Th1 and Th17 response to a more anti-inflammatory Th2 response. - Enhances Treg function.	[5,6,11,12] [6,13,14,15] [16] [17]
Progesterone	- Inhibits proliferation of T cells - Reduces production of pro-inflammatory cytokines	[9] [9]
Prolactin	- Promotes keratinocyte proliferation. - Promotes production of pro-inflammatory cytokines.	[23] [22,23,24]
Cortisol	- Acute cortisol release has immunosuppressive effects. - Chronic stress can lead to dysregulation of cortisol production and promotes a pro-inflammatory state with an increase in production of pro-inflammatory cytokines, worsening psoriasis symptoms.	[25,26] [25,26,27,28]

Estrogen and Immune Modulation

Estrogen, the primary female sex hormone, regulates not only the reproductive system and secondary sexual characteristics but also plays a critical role in modulating both innate and adaptive immunity.[10] The immunomodulatory properties of estrogen are multifaceted, involving various immune cells and signaling pathways that influence inflammation levels in psoriasis.[6,10]

Anti-inflammatory Effects of Estrogen

Elevated estrogen levels are generally associated with anti-inflammatory effects.[6] Estrogen interacts with estrogen receptors (ERα and ERβ) on multiple immune cells, including T cells, B cells, dendritic cells, and macrophages.[11] Through these receptors, estrogen can downregulate the production of pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interferon-gamma (IFN-γ), all of which are central to the pathogenesis of psoriasis. By inhibiting these cytokines, estrogen reduces inflammatory responses and may ameliorate psoriasis symptoms.[5,6,11,12]

Additionally, estrogen promotes the secretion of anti-inflammatory cytokines, including interleukin-10 (IL-10) and transforming growth factor-beta (TGF-β). These cytokines modulate immune responses by restricting the activity of pro-inflammatory cells and promoting immune tolerance, which is essential in mitigating autoimmune responses associated with psoriasis.[6,13,14,15]

Influence on Immune Cell Function

Estrogen also plays a role in altering the balance of T helper (Th) cell subsets. It can shift the immune response from a Th1 and Th17 profile, which is pro-inflammatory and prevalent in psoriasis, to a more anti-inflammatory Th2 profile.[16] This shift reduces the production of inflammatory mediators, subsequently decreasing skin lesions.[6,16] Furthermore, estrogen enhances the activity of regulatory T cells (Tregs), which are pivotal in maintaining immune tolerance and preventing autoimmunity. By enhancing Treg function, estrogen contributes to the suppression of autoimmune processes involved in psoriasis pathogenesis.[15,16,17]

Progesterone’s role in Psoriasis

Progesterone, another critical female hormone, plays a vital role in immune regulation by fostering an anti-inflammatory environment, particularly within the context of autoimmune diseases like psoriasis. It achieves this by inhibiting the proliferation of T cells—immune cells that are heavily involved in the inflammatory cascade of psoriasis.[9] T cells, especially T helper (Th1 and Th17) cells, are known for driving pro-inflammatory responses in psoriasis by releasing cytokines such as IL-17, IL-22, and TNF-α, which stimulate keratinocyte hyperproliferation and sustain the characteristic plaques and scaling of psoriatic skin.[18] Progesterone dampens this activity by reducing the production of these pro-inflammatory cytokines, thereby directly countering immune responses that exacerbate psoriasis.[9]

In addition to its impact on T cell function, progesterone modulates immune responses through its influence on other cytokines and immune cells. For instance, it enhances the production of anti-inflammatory cytokines like IL-10, which helps to limit the activity of pro-inflammatory cells, promoting a more regulated immune environment.[15,19] By reducing the expression of inflammatory mediators, progesterone helps restore balance in the immune system, creating conditions that are less favorable for psoriatic inflammation.[9,15,19]

The immunosuppressive effects of progesterone may also explain the symptomatic changes often observed in women with psoriasis during different stages of the menstrual cycle and pregnancy.[19] During the luteal phase of the menstrual cycle, progesterone levels rise, which may contribute to a reduction in psoriatic inflammation and an improvement in symptoms for some women.[19,20,21] In pregnancy, progesterone levels increase significantly, especially in the second and third trimesters, creating an anti-inflammatory state that can lead to symptomatic relief for many women with psoriasis.[7] However, in the postpartum period, when progesterone levels drop sharply, a rebound increase in inflammation may occur, often leading to psoriasis flare-ups.[19,20,21]

Understanding these cyclical changes in progesterone and their effects on immune regulation is crucial in managing psoriasis in women, particularly those with hormone-sensitive disease patterns. This insight suggests that hormonal fluctuations are a significant factor in disease severity and may offer a basis for exploring hormone-based therapeutic approaches to modulate immune responses and improve patient outcomes in women with psoriasis.

Prolactin's Role in Psoriasis

Prolactin, a polypeptide hormone primarily associated with lactation, is increasingly recognized for its role in immune regulation. Prolactin is produced not only by the pituitary gland but also by various immune cells, including T and B lymphocytes, under certain conditions.[22] This hormone has pro-inflammatory properties that may exacerbate autoimmune conditions like psoriasis.[22,23]

In psoriasis, elevated prolactin levels have been linked to an increase in keratinocyte proliferation—a hallmark feature of the disease.[23] Prolactin promotes the expression of pro-inflammatory cytokines, such as TNF-α, IL-6, and IL-17, in keratinocytes and immune cells. These cytokines drive inflammatory processes in the skin, leading to the formation and maintenance of psoriatic plaques. Prolactin can also stimulate lymphocyte activity, enhancing the immune response and potentially worsening psoriasis symptoms.[22,23,24] Understanding prolactin’s role in psoriasis underscores the need for therapies that modulate this hormone in patients who show elevated levels, especially during times of physiological stress or lactation.

Cortisol and Stress Response

Cortisol is a glucocorticoid hormone synthesized by the adrenal glands in response to stress through the hypothalamic-pituitary-adrenal (HPA) axis. It plays a complex role in immune regulation and inflammation. Acute increases in cortisol typically exert immunosuppressive effects by inhibiting the release of pro-inflammatory cytokines and reducing lymphocyte proliferation, which is beneficial for transient inflammatory responses. However, chronic stress leads to dysregulation of cortisol production, often resulting in a "flattened" diurnal rhythm where cortisol levels are abnormally low in the morning and elevated at night.[25,26]

This cortisol dysregulation can shift the immune system into a chronic pro-inflammatory state, exacerbating autoimmune conditions like psoriasis. When cortisol is persistently low or irregular, the body’s natural anti-inflammatory response weakens, allowing inflammatory pathways, particularly those involving IL-17 and TNF-α, to persist unchecked.[27,28] This heightened inflammatory response in the skin leads to increased keratinocyte activity and further contributes to plaque formation and scaling in psoriasis.[27,28] The relationship between cortisol levels, stress, and psoriasis suggests that stress management strategies—such as mindfulness-based interventions, cognitive-behavioral therapy, and, in some cases, pharmacological support—could play a supportive role in managing psoriasis.[29]

Hormonal Imbalance and Psoriasis Severity

The delicate balance between hormones such as estrogen, progesterone, prolactin, and cortisol is crucial for immune homeostasis, and disruptions in this balance are known to influence psoriasis severity.[5,6,18,22,23,28] Estrogen generally promotes anti-inflammatory effects, while progesterone supports immune tolerance; together, they create a protective hormonal environment against autoimmune inflammation.[6,9] However, when estrogen levels are low (e.g., during the luteal phase of the menstrual cycle or post-menopause), or when there is an imbalance between estrogen and progesterone, the risk of immune dysregulation increases.[6,10] This imbalance can shift the immune response towards a pro-inflammatory state, marked by an increase in Th1 and Th17 activity, both of which are associated with psoriasis pathogenesis.[16] In clinical practice, understanding these hormonal interdependencies underscores the importance of a personalized approach to psoriasis treatment in women. Comprehensive management strategies that address hormonal balance, stress reduction, and lifestyle modifications hold promise for improving quality of life and reducing disease severity in women affected by psoriasis.[30]

4. Impact on Quality of Life

Psoriasis significantly affects women’s quality of life by influencing physical health, emotional well-being, social interactions, and professional activities. Hormonal fluctuations often intensify these challenges, particularly during life stages such as menstruation, pregnancy, postpartum, and menopause, which can exacerbate symptoms.[30,36]

Physical Effects

Psoriasis is associated with several physical symptoms that can impair day-to-day functioning:

• Discomfort and Pain
  Women with psoriasis frequently experience persistent itching, pain, and skin tightness, which can worsen during hormonal fluctuations. Lesions in sensitive areas such as the scalp, nails, genitals, and skin folds can interfere with routine activities like dressing, grooming, and hygiene. Discomfort can disrupt sleep, leading to fatigue, which further diminishes quality of life. Sleep deprivation can exacerbate both physical symptoms and psychological distress, creating a cycle that compounds disease burden.[37]
• Functional Impairment
  Psoriasis can affect fine motor skills, particularly if lesions are present on the hands or if psoriatic arthritis is involved. Nail psoriasis, for instance, may impair tasks such as typing, writing, or buttoning clothes. Joint pain and stiffness, characteristic of psoriatic arthritis, can limit mobility and make simple movements painful. This functional impairment impacts independence and productivity in both personal and professional contexts.[38,39]

Psychological and Emotional Well-being

Psoriasis has profound effects on mental health and self-perception:

• Self-esteem and Body Image
  The visibility of psoriatic lesions can cause psychological distress and impact body image. Women with psoriasis may feel embarrassed, self-conscious, and stigmatized, affecting their confidence in social, professional, and intimate settings. This can result in social withdrawal and reluctance to engage in activities that reveal affected skin, such as swimming or exercising in public spaces.[40]
• Mental Health Disorders
  Women with psoriasis are at an increased risk of mental health conditions, particularly depression and anxiety. The chronic nature of psoriasis, combined with hormonal imbalances and the unpredictability of symptom flare-ups, can exacerbate these mental health challenges. Depression and anxiety are not only consequences of physical symptoms but also contribute to a cycle that can worsen psoriasis severity due to stress and emotional strain.[41]
• Coping Mechanisms
  Some women may develop maladaptive coping mechanisms in response to psoriasis, such as social withdrawal, substance use, or disordered eating. These behaviors can provide temporary relief from emotional pain but ultimately worsen physical health and mental well-being. Access to mental health support and counseling is crucial for promoting adaptive coping strategies and breaking this cycle.[42]

Social and Interpersonal Relationships

The social implications of psoriasis extend beyond self-perception, affecting relationships and interactions with others:

• Social Isolation
  Due to the visibility of lesions and the fear of judgment or misunderstanding, many women with psoriasis withdraw from social activities. Misconceptions about psoriasis being contagious can amplify feelings of isolation, as friends, colleagues, or even strangers may avoid physical contact. This isolation can deepen psychological distress and reinforce negative self-image.[43]
• Intimate Relationships
  Psoriasis can affect intimate relationships on both physical and emotional levels. Concerns about appearance, physical discomfort during sexual activity, and decreased libido (influenced by hormonal changes and psychological distress) can impact intimacy. Open communication with partners is essential for managing expectations and providing reassurance. Educating partners about psoriasis’s non-contagious nature can also foster understanding and empathy, strengthening relationships.[43,44,45]
• Communication and Education
  Educating close contacts about psoriasis and its impact can dispel misconceptions and improve social support. Friends and family who understand the chronic, non-contagious nature of psoriasis are better equipped to provide meaningful support, reducing the emotional burden and promoting acceptance.[46]

Professional and Educational Impact

Psoriasis also affects women’s professional lives and educational pursuits, presenting barriers to productivity, acceptance, and advancement:

• Work Productivity
  Physical symptoms such as pain and fatigue, combined with psychological distress, can reduce productivity, increase absenteeism, and limit career opportunities. Psoriatic arthritis may further hinder workplace performance by restricting mobility and causing joint pain, especially in physically demanding jobs. Visible lesions can be particularly challenging in professions that emphasize appearance or require public interaction, as stigma and discomfort can affect performance and self-confidence.[43,47,48]
• Discrimination and Stigma
  Women with psoriasis may encounter discrimination or harassment in the workplace or educational settings due to misconceptions about their condition. Psoriasis is often misunderstood, with some perceiving it as contagious or reflective of poor hygiene, leading to prejudice. Legal protections may be necessary to address workplace discrimination, ensure fair treatment, and promote an inclusive environment.[49,50]
• Academic Challenges
  Managing psoriasis symptoms and treatment regimens can interfere with academic responsibilities, impacting performance and opportunities for advancement. For students with psoriasis, navigating treatment schedules alongside coursework and social obligations may be challenging. Educators and academic institutions that are informed about psoriasis can help provide support and accommodations, such as flexibility with assignments or exams, allowing students to manage their health without compromising their education.[51,52]

6. Management Strategies

Effective psoriasis management in women requires a personalized treatment approach that considers unique factors, such as hormonal fluctuations, disease severity, comorbidities, and life stages. Here’s a breakdown of scientifically-supported approaches in managing psoriasis:

2. Personalized Treatment Approaches

Topical Therapies

• Corticosteroids: Topical corticosteroids are often the first-line treatment for mild to moderate psoriasis. They help reduce inflammation and slow cell turnover. However, long-term use should be monitored to prevent skin thinning, especially in sensitive areas.[8,63]
• Calcineurin Inhibitors (e.g., Tacrolimus): Effective for delicate skin areas like the face and genitals, these agents modulate immune response without the same side effects as steroids, although they are usually used as second-line treatments.[57]
• Emollients and Moisturizers: Regular use of emollients helps keep the skin hydrated, reducing scaling and discomfort. Studies show that well-hydrated skin can improve the efficacy of other topical treatments.[64]

Systemic Treatments

• Methotrexate and Cyclosporine: These immunosuppressants are often used for moderate to severe cases of psoriasis but can have significant side effects, including liver and kidney toxicity. For women planning pregnancy, methotrexate is contraindicated due to its teratogenic effects.[57]
• Acitretin: A retinoid used in psoriasis treatment, acitretin is effective but also teratogenic, with pregnancy avoidance recommended for 3 years post-treatment.[57]
• Biologic Agents: Biologics, including TNF-α inhibitors (e.g., infliximab), IL-17 inhibitors (e.g., secukinumab), and IL-23 inhibitors (e.g., guselkumab), target specific immune pathways involved in psoriasis and offer targeted, effective control with fewer systemic effects. Biologics are generally considered safe but must be evaluated on an individual basis, especially for pregnant or breastfeeding women.[57]

Phototherapy

• Narrowband UVB and PUVA Therapy: Phototherapy is effective for moderate to severe psoriasis and is considered safe during pregnancy, making it a valuable option for women needing more than topical treatments. Narrowband UVB therapy has been shown to reduce flare-ups without systemic side effects, making it suitable for long-term management.[65]

Hormone-Based Therapies

• Hormone Replacement Therapy (HRT): Postmenopausal women may see some improvement in psoriasis symptoms with HRT, as estrogen can have anti-inflammatory effects. However, HRT carries risks (e.g., cardiovascular disease, breast cancer), and its impact on psoriasis varies; thorough risk assessment is essential before initiation.[34]

2. Lifestyle Modifications

Stress Management

• Mindfulness, Relaxation and Meditation: These techniques help manage psychological stress, which can trigger or exacerbate psoriasis flares. Stress management has been shown to positively impact immune function and hormonal balance, potentially reducing symptom severity.[66,67]
• Cognitive-Behavioral Therapy (CBT): CBT helps women develop effective coping mechanisms and reduces psoriasis-related anxiety and depression. Studies have found CBT beneficial in reducing stress-related flare-ups.[66,67]

Healthy Diet

• Anti-Inflammatory Diet: Diets rich in antioxidants, omega-3 fatty acids, and anti-inflammatory foods, such as fruits, vegetables and whole grains, have been associated with reduced psoriasis symptoms. Omega-3 fatty acids, found in fish and flaxseeds, have been shown to reduce systemic inflammation.[68,69]
• Avoiding Processed Foods and Alcohol: Alcohol, processed foods, and high sugar intake are linked to increased inflammation and can exacerbate psoriasis. A healthy diet supports overall immune function and may reduce the frequency of flares.[59,60,70]

Regular Exercise

• Physical Activity: Regular exercise improves cardiovascular health, reduces obesity risk, lowers stress levels, and improves psoriasis severity. Exercise also reduces pro-inflammatory markers, aiding in better disease management.[71]

Avoiding Triggers

• Personal Triggers: Common triggers include smoking, alcohol, allergens, and certain foods. Keeping a symptom diary to identify triggers can help in managing flare-ups more effectively. Smoking, for instance, is associated with higher psoriasis risk and severity, making cessation highly beneficial.[59,60,70,72]

2. Multidisciplinary Care

Collaborative Approach

• Team-Based Care: A multidisciplinary approach involving dermatologists, rheumatologists, gynecologists, mental health professionals, and primary care providers offers comprehensive care. This collaborative care model is critical for women with psoriasis, addressing physical symptoms, emotional challenges, hormonal influences, and reproductive health needs.[62,73,74,75]

Patient Education

• ● Self-Management Education: Educating women about how hormonal changes impact psoriasis empowers them to manage their condition proactively. Support groups, counseling, and access to educational resources can improve self-management and treatment adherence, particularly during life stages associated with hormonal changes, such as pregnancy or menopause.[46,62]

Psychological Support

• Mental Health Access: Psychological support is crucial for managing psoriasis, as the visible nature of the disease can lead to anxiety, depression, and social withdrawal. Access to mental health resources like counseling and support groups can help women manage the emotional aspects of living with a chronic skin condition.[75]

Family Planning Services

• Safe Contraception and Preconception Counseling: For women of reproductive age, coordinated care is essential to address contraception choices, preconception counseling, and pregnancy management. Many psoriasis medications are contraindicated during pregnancy, so advance planning with a healthcare provider can optimize reproductive outcomes and minimize disease activity during pregnancy.[57,62]

7. Future Directions and Research

Recent research highlights the complexity of psoriasis, a chronic inflammatory disease that appears to be influenced by various factors, including immune function, hormonal balance, genetics, and psychological aspects.[1,5,6,75] Below are key areas for further investigation:

Estrogen Receptor Studies

• Role of Estrogen Receptors in Psoriasis Pathogenesis: Estrogen has been shown to influence immune function, but the exact mechanisms remain unclear.[6,10] Estrogen receptors (ERs), specifically Erα and Erβ, are expressed on immune cells and play roles in immune regulation. Research suggests that Erα activation might have pro-inflammatory effects, while Erβ activation could be anti-inflammatory, potentially impacting psoriasis severity.[11,76]
• Targeting Estrogen Receptor Pathways: By investigating how different estrogen receptors influence immune cells, scientists may uncover specific pathways that could be modulated for therapeutic purposes. For example, selective estrogen receptor modulators (SERMs) might offer ways to manage inflammation in psoriasis without the side effects associated with broad hormone replacement therapies.[77]

Genetic and Epigenetic Factors

• Genetic Variations and Psoriasis Susceptibility: Studies have identified several genetic loci associated with psoriasis, particularly in genes related to immune responses, such as IL-23 and TNF-α pathways.[78] Research into how these genetic variations interact with hormonal changes could explain why psoriasis severity fluctuates with life stages (e.g., puberty, pregnancy, menopause).[7,9,19,78]
• Epigenetic Modifications and Hormone Sensitivity: Epigenetic changes, such as DNA methylation and histone modifications, influence gene expression without altering DNA sequences.[79] Hormones like estrogen can impact these epigenetic mechanisms, potentially affecting psoriasis severity and treatment responses.[16,80,81] Investigating how epigenetic factors modify hormonal sensitivity in individuals with psoriasis may provide insights into why some patients experience more severe symptoms and aid in the development of personalized therapies.
• Personalized Medicine: Identifying genetic and epigenetic markers linked to psoriasis severity and treatment response could facilitate personalized medicine.[81] By tailoring treatment approaches based on genetic profiles, healthcare providers may be able to optimize therapies and reduce side effects.

Longitudinal Studies

• Natural History of Psoriasis Through Life Stages: Longitudinal studies that follow women through hormonal transitions (e.g., puberty, pregnancy, menopause) are essential for understanding how hormonal fluctuations impact psoriasis.[7] Such studies can clarify if specific life stages exacerbate or alleviate symptoms, informing the timing and types of intervention strategies.
• Tracking Disease Progression and Triggers: By monitoring psoriasis progression and flare-up patterns in relation to hormonal changes, researchers can gather insights into which interventions are most effective at different life stages. For instance, such studies could identify whether hormone fluctuations are linked to periods of remission or exacerbation, guiding both timing and choice of treatments.
• Evidence-Based Treatment Timelines: Long-term data can help identify optimal treatment windows and strategies for managing psoriasis, potentially leading to interventions that are timed to life-stage transitions, such as beginning hormone-based treatments at menopause if appropriate.

Hormone-Based Treatments

• Selective Estrogen Receptor Modulators (SERMs): SERMs, which are already used in conditions like osteoporosis and breast cancer, may represent a promising area for psoriasis treatment.[77,82] These drugs selectively stimulate or block estrogen receptors, which could allow for modulation of immune responses related to psoriasis without widespread hormonal effects.[77] Trials are needed to determine the efficacy and safety of SERMs for psoriasis.
• Progesterone Analog Research: Progesterone, another key hormone, may have immunomodulatory effects that could impact psoriasis.[9] Progesterone analogs could be explored for their potential in modulating immune function, particularly during life stages where progesterone naturally fluctuates (e.g., pregnancy). Current research is limited, but understanding how progesterone and its receptors impact psoriasis could open new therapeutic options.
• Clinical Trials for Hormone-Based Therapies: Clinical trials investigating hormone-based therapies, including estrogen and progesterone treatments, are essential for understanding their effects on psoriasis.[6,9] Such trials can assess the safety, efficacy, and optimal dosing regimens of hormone therapies for patients with psoriasis, especially for women undergoing hormonal changes.

Psychoneuroimmunology Research

• Mind-Body Interactions in Psoriasis: The emerging field of psychoneuroimmunology (PNI) examines how psychological factors, neurological processes, and immune responses interact in disease contexts.[83] Stress, for example, can exacerbate psoriasis by stimulating the hypothalamic-pituitary-adrenal (HPA) axis, which releases cortisol and other stress hormones. Chronic stress also impacts immune function, leading to increased inflammatory cytokine production that can worsen psoriasis.[84]
• Role of Stress Hormones and Neurotransmitters: Research suggests that stress hormones like cortisol, as well as neurotransmitters such as serotonin and dopamine, may influence immune responses in psoriasis.[26,27] This connection indicates that stress reduction and psychological interventions may play important roles in managing psoriasis, especially given the skin-brain connection.[85] Investigating these pathways could lead to novel, holistic approaches that combine pharmacological and psychological therapies.
• Interdisciplinary Treatment Approaches: Given the complex interactions between the mind and immune function, interdisciplinary approaches that include mental health support alongside dermatologic treatment may improve outcomes. This approach might involve cognitive-behavioral therapy (CBT), mindfulness-based stress reduction, and other interventions aimed at reducing stress and improving mental well-being.[66,67,75]

8. Conclusion

Hormonal balance is a fundamental factor in the clinical course and management of psoriasis in women, significantly affecting disease severity, symptom fluctuation, and overall quality of life. Hormones such as estrogen, progesterone, prolactin, and cortisol interact with immune pathways critical to psoriasis pathogenesis, modulating cytokine profiles, T-cell activation, and keratinocyte activity. These hormonal influences highlight the need for individualized, adaptive management strategies that accommodate the unique physiological and immunological needs of each woman. Women face distinctive challenges as hormonal fluctuations during menstruation, pregnancy, postpartum, and menopause can exacerbate or mitigate psoriasis symptoms. Each life stage involves unique hormonal shifts that necessitate personalized treatment protocols, psychological support, and education. A comprehensive, multidisciplinary approach that includes dermatologists, endocrinologists, gynecologists, and mental health professionals offers a holistic framework to address not only the physical manifestations but also the psychosocial and emotional impacts of living with psoriasis. This integrated approach can significantly improve patient outcomes by targeting the diverse factors that influence disease progression. Healthcare providers must recognize and address the intricate interplay between hormonal dynamics and psoriasis to support women more effectively. Combining pharmacologic treatments with lifestyle interventions, stress management, and patient education empowers women to navigate the complexities of this chronic autoimmune disease. Continued interdisciplinary research and collaboration will deepen our understanding of hormonal impacts on psoriasis, facilitating innovative, patient-centered care and improved quality of life for women with this condition.