https://doi.org/10.4081/reumatismo.2024.1775
Psoriasis in women with psoriatic arthritis: hormonal effects, fertility, and considerations for management at different stages of life
Published: 11 September 2024
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Objective. This review examines skin manifestations in women with spondyloarthritis, with a particular focus on psoriatic arthritis (PsA) and associated psoriasis.
Methods. A narrative review of the bibliography was conducted using the main databases (PubMed, Scopus, EMBASE).
Results. The review showed that the clinical course of PsA and psoriasis in women is influenced by hormonal fluctuations that occur at different stages of life, such as menstruation, pregnancy, postpartum, and menopause. Gender differences in the epidemiology of PsA and psoriasis are discussed and attributed to biological, hormonal, and environmental differences. The role of estrogen in modulating immune responses and its impact on the severity of PsA and psoriasis are reviewed. Special emphasis is placed on the psychosocial impact of visible skin lesions on women’s quality of life and fertility problems associated with psoriasis. Treatment strategies are also taken into account, favoring personalized approaches that consider the safety of treatments during pregnancy and breastfeeding.
Conclusions. The review highlights the importance of a holistic and gender-sensitive approach to the management of PsA and psoriasis in women, promoting the integration of physical treatment with support for emotional well-being.
Gottlieb AB, Merola JF. Axial psoriatic arthritis: an update for dermatologists. J Am Acad Dermatol 2021; 84: 92-101.
DOI: https://doi.org/10.1016/j.jaad.2020.05.089
Tarannum S, Leung YY, Johnson SR, Widdifield J, Strand V, Rochon P, et al. Sex- and gender-related differences in psoriatic arthritis. Nat Rev Rheumatol 2022; 18: 513-26.
DOI: https://doi.org/10.1038/s41584-022-00810-7
Adachi A, Honda T. Regulatory roles of estrogens in psoriasis. J Clin Med 2022; 11: 4890.
DOI: https://doi.org/10.3390/jcm11164890
Vena GA, Cassano N, Bellia G, Colombo D. Psoriasis in pregnancy: challenges and solutions. Psoriasis (Auckl) 2015; 5: 83-95.
DOI: https://doi.org/10.2147/PTT.S82975
Balakirski G, Gerdes S, Beissert S, Ochsendorf F, von Kiedrowski R, Wilsmann-Theis D. Therapy of psoriasis during pregnancy and breast-feeding. J Dtsch Dermatol Ges 2022; 20: 653-83.
DOI: https://doi.org/10.1111/ddg.14789
Danik JS, Paré G, Chasman DI, Zee RY, Kwiatkowski DJ, Parker A, et al. Novel loci, including those related to Crohn disease, psoriasis, and inflammation, identified in a genome-wide association study of fibrinogen in 17 686 women: the Women’s Genome Health Study. Circ Cardiovasc Genet 2009; 2: 134-41.
DOI: https://doi.org/10.1161/CIRCGENETICS.108.825273
Luna PC, Chu CY, Fatani M, Borlenghi C, Adora A, Llamado LQ, et al. Psychosocial burden of psoriasis: a systematic literature review of depression among patients with psoriasis. Dermatol Ther 2023; 13: 3043-55.
DOI: https://doi.org/10.1007/s13555-023-01060-5
De Simone C, Caldarola G, Moretta G, Piscitelli L, Ricceri F, Prignano F. Moderate-to-severe psoriasis and pregnancy: impact on fertility, pregnancy outcome and treatment perspectives. G Ital Dermatol Venereol 2019; 154: 305-14.
DOI: https://doi.org/10.23736/S0392-0488.18.06255-7
Passia E, Vis M, Coates LC, Soni A, Tchetverikov I, Gerards AH, et al. Sex-specific differences and how to handle them in early psoriatic arthritis. Arthritis Res Ther 2022; 24: 22.
DOI: https://doi.org/10.1186/s13075-021-02680-y
Fallon EA, Boring MA, Foster AL, Stowe EW, Lites TD, Odom EL, et al. Prevalence of diagnosed arthritis - United States, 2019-2021. MMWR Morb Mortal Wkly Rep 2023; 72: 1101-7.
DOI: https://doi.org/10.15585/mmwr.mm7241a1
Bu J, Ding R, Zhou L, Chen X, Shen E. Epidemiology of psoriasis and comorbid diseases: a narrative review. Front Immunol 2022; 13: 880201.
DOI: https://doi.org/10.3389/fimmu.2022.880201
Chimenti MS, Perricone C, D’Antonio A, Ferraioli M, Conigliaro P, Triggianese P, et al. Genetics, epigenetics, and gender impact in axial-spondyloarthritis susceptibility: an update on genetic polymorphisms and their sex related associations. Front Genet 2021; 12: 671976.
DOI: https://doi.org/10.3389/fgene.2021.671976
Bucur Ș, Savu AP, Stănescu AMA, Șerban ED, Nicolescu AC, Constantin T, et al. Oversight and management of women with psoriasis in childbearing age. Medicina (Kaunas) 2022; 58: 780.
DOI: https://doi.org/10.3390/medicina58060780
Jung S, Lee SM, Suh D, Shin HT, Suh DC. The association of socioeconomic and clinical characteristics with health-related quality of life in patients with psoriasis: a cross-sectional study. Health Qual Life Outcomes 2018; 16: 180.
DOI: https://doi.org/10.1186/s12955-018-1007-7
Lin X, Huang T. Impact of pregnancy and oestrogen on psoriasis and potential therapeutic use of selective oestrogen receptor modulators for psoriasis. J Eur Acad Dermatol Venereol 2016; 30: 1085-91.
DOI: https://doi.org/10.1111/jdv.13661
Sobolev V, Soboleva A, Denisova E, Denieva M, Dvoryankova E, Suleymanov E, et al. Differential expression of estrogen-responsive genes in women with psoriasis. J Pers Med 2021; 11: 925.
DOI: https://doi.org/10.3390/jpm11090925
Merrheim J, Villegas J, Van Wassenhove J, Khansa R, Berrih-Aknin S, le Panse R, et al. Estrogen, estrogen-like molecules and autoimmune diseases. Autoimmun Rev 2020; 19: 102468.
DOI: https://doi.org/10.1016/j.autrev.2020.102468
Mohammad I, Starskaia I, Nagy T, Guo J, Yatkin E, Väänänen K, et al. Estrogen receptor α contributes to T cell-mediated autoimmune inflammation by promoting T cell activation and proliferation. Sci Signal 2018; 11: eaap9415.
DOI: https://doi.org/10.1126/scisignal.aap9415
Chakraborty B, Byemerwa J, Krebs T, Lim F, Chang CY, McDonnell DP. Estrogen receptor signaling in the immune system. Endocr Rev 2023; 44: 117-41.
DOI: https://doi.org/10.1210/endrev/bnac017
Hoffmann JP, Liu JA, Seddu K, Klein SL. Sex hormone signaling and regulation of immune function. Immunity 2023; 56: 2472-91.
DOI: https://doi.org/10.1016/j.immuni.2023.10.008
Bello GD, Maurelli M, Schena D, Gisondi P, Girolomoni G. Variations of symptoms of atopic dermatitis and psoriasis in relation to menstrual cycle. J Am Acad Dermatol 2022; 87: 892-5.
DOI: https://doi.org/10.1016/j.jaad.2021.12.014
Wu H, Zeng L, Ou J, Wang T, Chen Y, Nandakumar KS. Estrogen acts through estrogen receptor-β to promote mannan-induced psoriasis-like skin inflammation. Front Immunol 2022; 13: 818173.
DOI: https://doi.org/10.3389/fimmu.2022.818173
Hoffman MB, Farhangian M, Feldman SR. Psoriasis during pregnancy: characteristics and important management recommendations. Expert Rev Clin Immunol 2015; 11: 709-20.
DOI: https://doi.org/10.1586/1744666X.2015.1037742
Lambe M, Bergstrom AV, Johansson ALV, Weibull CE. Reproductive patterns and maternal and pregnancy outcomes in women with psoriasis - a population-based study. J Am Acad Dermatol 2020; 82: 1109-16.
DOI: https://doi.org/10.1016/j.jaad.2019.05.099
Richard MA. Impact de la grossesse sur le psoriasis. Eur J Dermatol 2020; 30: 3-7.
Belinchón I, Armesto S, de la Cueva P, Ferrándiz L, Rivera Díaz R, Carrascosa JM. Implementation of recommendations for the management of psoriasis during preconception, pregnancy, postpartum, breastfeeding, and perinatal care. Actas Dermosifiliogr 2022; 113: 666-73.
DOI: https://doi.org/10.1016/j.ad.2022.06.003
Ceovic R, Mance M, Bukvic Mokos Z, Svetec M, Kostovic K, Stulhofer Buzina D. Psoriasis: female skin changes in various hormonal stages throughout life-puberty, pregnancy, and menopause. Biomed Res Int 2013; 2013: 571912.
DOI: https://doi.org/10.1155/2013/571912
Zouboulis CC, Blume-Peytavi U, Kosmadaki M, Roó E, Vexiau-Robert D, Kerob D, et al. Skin, hair and beyond: the impact of menopause. Climacteric 2022; 25: 434-42.
DOI: https://doi.org/10.1080/13697137.2022.2050206
Go GM, Oh HJ, Han K, Kim YH, Lee HJ, Lee JH. Hormone replacement therapy and psoriasis risk: a nationwide population-based cohort study. J Korean Med Sci 2023; 38: e377.
DOI: https://doi.org/10.3346/jkms.2023.38.e377
Li W, Chan AA, Han J, Chlebowski RT, Lee DJ. Alcohol and smoking cessation as potential modulators for smoking-associated psoriasis risk in postmenopausal women: the women’s health initiative. Am J Clin Dermatol 2023; 24: 325-32.
DOI: https://doi.org/10.1007/s40257-022-00750-8
Martínez-Ortega JM, Nogueras P, Muñoz-Negro JE, Gutiérrez-Rojas L, González-Domenech P, Gurpegui M. Quality of life, anxiety and depressive symptoms in patients with psoriasis: A case-control study. J Psychosom Res 2019; 124: 109780.
DOI: https://doi.org/10.1016/j.jpsychores.2019.109780
Hawro M, Maurer M, Weller K, Maleszka R, Zalewska-Janowska A, Kaszuba A, et al. Lesions on the back of hands and female gender predispose to stigmatization in patients with psoriasis. J Am Acad Dermatol 2017; 76: 648-54.e2.
DOI: https://doi.org/10.1016/j.jaad.2016.10.040
Richard MA, Saint Aroman M, Baissac C, Merhand S, Aubert R, Audouze A, et al. Burden of visible [face and hands] skin diseases: results from a large international survey. Ann Dermatol Venereol 2023; 150: 95-100.
DOI: https://doi.org/10.1016/j.annder.2022.11.008
Golpour M, Hosseini SH, Khademloo M, Ghasemi M, Ebadi A, Koohkan F, et al. Depression and anxiety disorders among patients with psoriasis: a hospital-based case-control study. Dermatol Res Pract 2012; 2012: 381905.
DOI: https://doi.org/10.1155/2012/381905
Maul JT, Navarini AA, Sommer R, Anzengruber F, Sorbe C, Mrowietz U, et al. Gender and age significantly determine patient needs and treatment goals in psoriasis - a lesson for practice. J Eur Acad Dermatol Venereol 2019; 33: 700-8.
DOI: https://doi.org/10.1111/jdv.15324
Rosińska M, Rzepa T, Szramka-Pawlak B, Żaba R. Body image and depressive symptoms in person suffering from psoriasis. Psychiatr Pol 2017; 51: 1145-52.
DOI: https://doi.org/10.12740/PP/68948
Ghorbanibirgani A, Fallahi-Khoshknab M, Zarea K, Abedi H. The lived experience of psoriasis patients from social stigma and rejection: a qualitative study. Iran Red Crescent Med J 2016; 18: e27893.
DOI: https://doi.org/10.5812/ircmj.27893
Bulat V, Šitum M, Delaš Aždajić M, Lovrić I, Dediol I. Study on the impact of psoriasis on quality of life: psychological, social and financial implications. Psychiatr Danub 2020; 32: 553-61.
Chen TC, Iskandar IYK, Parisi R, Pierce M, Tower C, Kleyn CE, et al. Global psoriasis atlas. fertility trends and adverse pregnancy outcomes in female patients with psoriasis in the UK. JAMA Dermatol 2023; 159: 736-44.
DOI: https://doi.org/10.1001/jamadermatol.2023.1400
Gisondi P, Fargnoli MC, Amerio P, Argenziano G, Bardazzi F, Bianchi L, et al. Italian adaptation of EuroGuiDerm guideline on the systemic treatment of chronic plaque psoriasis. Ital J Dermatol Venerol 2022; 157: 1-78.
DOI: https://doi.org/10.23736/S2784-8671.21.07132-2
Ferreira C, Azevedo A, Nogueira M, Torres T. Management of psoriasis in pregnancy - a review of the evidence to date. Drugs Context 2020; 9: 2019-11-6.
DOI: https://doi.org/10.7573/dic.2019-11-6
Chi CC, Wang SH, Wojnarowska F, Kirtschig G, Davies E, Bennett C. Safety of topical corticosteroids in pregnancy.Cochrane Database Syst Rev 2015; 2015: CD007346.
DOI: https://doi.org/10.1002/14651858.CD007346.pub3
Park KK, Murase JE. Narrowband UV-B phototherapy during pregnancy and folic acid depletion. Arch Dermatol 2012; 148: 132-3.
DOI: https://doi.org/10.1001/archdermatol.2011.1614
Adalimumab. In: Drugs and lactation database (LactMed®). Bethesda (MD): National Institute of Child Health and Human Development; 2023.
Xiao Y, Yi Y, Jing D, Yang S, Guo Y, Xiao H, et al. Age at natural menopause, reproductive lifespan, and the risk of late-onset psoriasis and psoriatic arthritis in women: a prospective cohort study. J Invest Dermatol 2024; 144: 1273-81.e5.
DOI: https://doi.org/10.1016/j.jid.2023.11.010
How to Cite
Cassalia, F., & Belloni Fortina, A. (2024). Psoriasis in women with psoriatic arthritis: hormonal effects, fertility, and considerations for management at different stages of life. Reumatismo, 76(3). https://doi.org/10.4081/reumatismo.2024.1775
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