Psoriasis and the menopause: what you need to know

Find out how changing hormones can impact this common skin condition

Psoriasis can affect anyone but a peak occurs in people aged 50-60
Hormonal changes plus the stress of menopause can trigger the outbreak of dry, flaky skin
Moisturisers and treatments can help manage the condition

Psoriasis is a skin condition that causes flaky patches of skin to form scales. These patches (sometimes called plaques) can appear anywhere on the body but are most commonly found on the elbows, knees, scalp and lower back, and can be itchy or burn or sting.

It’s a chronic disease with no cure but, as Consultant Dermatologist Dr Claudia DeGiovanni explains: ‘Psoriasis can wax and wane. Patients often have periods when their skin is well controlled and times when it is not.’

Psoriasis occurs due to an overactive immune system, which cause skin cells to grow too quickly. Normally, the process of skin cells growing and shedding takes three to four weeks. in people with psoriasis it takes three to seven days and instead of shedding, the cells pile up on the surface of the skin.

The excessive inflammation in the body can affect other organs and tissues as well as skin. For example, one in three people with psoriasis may also develop psoriatic arthritis [1].

In addition, people with psoriasis have a greater risk of cardiovascular disease and stroke, says Consultant Dermatologist Dr Sajjad Rajpar.

‘This is likely due to the chronic inflammation in the body, and controlling psoriasis can help reduce the risk of cardiovascular disorders,’ he says.

RELATED: skin changes during menopause

Who gets psoriasis and why?

Psoriasis is a very common skin condition – according to the NHS, it affects around one in 50 people in the UK [2].

‘There are two peaks in presentation of psoriasis symptoms,’ says Dr Claudia. ‘The first is between the ages of 20 and 30 and the second is between 50 and 60. We don’t fully understand why psoriasis presents more commonly in these age groups, but there are certainly genetic factors as patients with a family history of psoriasis or other autoimmune disease are more likely to develop psoriasis themselves.

‘Stress (emotional or physical) is a commonly recognised trigger for a flare in psoriasis, and drinking alcohol or smoking can also cause it to flare. Certain medications such as B blockers, lithium, ibuprofen, some antimalarial medications and some blood pressure medications called ACE inhibitors may cause a flare in psoriasis.

‘We do see psoriasis presenting or flaring following a type of sore throat caused by a bacteria called streptococcus. This can sometimes be the first presentation of psoriasis and usually manifests as multiple small round red scaly marks on the skin (called guttate psoriasis). Finally, psoriasis can develop in areas of trauma to the skin such as a scar, healing wound or burn. This is called the Koebner phenomenon.’

How does the menopause affect psoriasis?

As mentioned, stress can cause psoriasis to flare up and the perimenopause and menopause can be stressful times, both physically and emotionally, and symptoms such as poor sleep and anxiety can contribute to this.

‘Oestrogen is also responsible for some of the skin’s moisturising mechanism, and without oestrogen the skin is more prone to dryness and itchy, which can exacerbate symptoms of psoriasis,’ adds Dr Sajjad.

On top of this, the hormones oestrogen, testosterone and progesterone are relatively anti-inflammatory. ‘During the menopause, hormonal changes can lead to an increase in systemic inflammation and some studies suggest that psoriasis can flare during the peri/menopause period,’ says Dr Claudia.

‘But we also see changes in the postmenopausal state, when progesterone and oestrogen levels are depleted, and there is an increase in systemic inflammation,’ Dr Claudia continues. ‘Some women experience this as sore or aching joints or fatigue. I believe this systemic inflammation can also contribute to a deterioration in psoriasis, and if systemic inflammation is causing a flare in psoriasis, I’d expect that to continue through the postmenopausal period, when oestradiol and progesterone levels remain low. Unfortunately, the research and evidence base on psoriasis and the menopause is very limited so we do need more research in this area to clarify.’

Can skincare products help?

Because psoriatic skin tends to be dry and inflamed, it is important to keep it well moisturised. ‘This will reduce the appearance and symptoms of the psoriasis but also may reduce the amount of prescribed medication required to treat it,’ advises Dr Claudia.

‘Look for products that have good moisturising ingredients and those without perfumes, preservatives or chemicals that can cause further irritation. Greasy emollients such as liquid paraffin-based products act as a physical barrier, preventing water loss but these can be difficult to use, especially if the psoriasis is widespread.

‘Humectants are low molecular weight molecules that penetrate the outer skin layer (stratum corneum) and attract water, thus increasing the water content of the epidermis (top layer of the skin). Humectants used in moisturisers include urea, hyaluronic acid, glycerin, lactic acid and glycolic acid. However, only small molecular weight hyaluronic acids will be able to penetrate the skin, so the formulation of the cream is really important.

‘It’s also important to know that lactic acid and glycolic acid can irritate the skin so if your skin is more sensitive in the menopause, use these products carefully, building up slowly. Finally, lipids called ceramides help to strengthen and protect the skin barrier and can be very helpful for dry irritated skin.

‘I also recommend using an emollient (moisturiser) instead of soap/shower gel in the shower as the chemicals that cause lathering can dry and irritate skin. Also use a good quality, high factor sunscreen – the number on the bottle relates to the UVB protection and I recommend 50+. The UVA rating is also very important – I recommend looking for products with four or five star UVA rating. These need to be reapplied during the day for full protection. If you have sensitive skin, opt for a mineral/ physical sunscreen that reflects rather than absorbs the sun’s rays.’

Are there any treatments that help psoriasis?

If your psoriasis is persistent, Dr Claudia recommends you see your GP in the first instance for prescribed medications. ‘We would aim to treat skin with creams (usually a combination of steroid and vitamin D derived products) as these are the safest medications to use. If these aren’t successful, we sometimes recommend a course of light treatment, which reduces inflammation in the skin, or tablet or injection treatments according to the symptoms and severity of the condition.’

HRT is the first-line treatment for symptoms of the perimenopause and menopause and optimising your hormones can help to manage symptoms that are known triggers of a psoriasis flare, such as poor sleep, anxiety and inflammation. When menopausal symptoms are managed, this can lead to a reduction in alcohol consumption, smoking and less reliance on pain medication, which can also have a benefit on skin health.

Dr Claudia DeGiovanni is a Consultant Dermatologist with a keen interest in the menopause. Follow her on Instagram @dr.degiovanni_dermatology and read her paper on menopause and skin disorders here.

Dr Sajjad Rajpar is a Consultant Dermatologist and medical director of Midland Skin. Follow him on Instagram @dr.rajpar_dermatologist.

Resources

Psoriasis Association

NHS: psoriasis

References

Mease P.J., Gladman D.D., Papp K.A., Khraishi M.M., Thaçi D., Behrens F., Northington R., Fuiman J., Bananis E., Boggs R., Alvarez D. (2013), ‘Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics’, J Am Acad Dermatol. 69(5), pp 729-735. doi: 10.1016/j.jaad.2013.07.023
NHS: psoriasis