The vague etiologies that trigger psoriasis led scientists to explore every possible factor that could be causing, improving, worsening, or preventing this condition.

Like other skin conditions, hormonal fluctuations and psoriasis go hand in hand. Understanding how hormones influence psoriasis symptoms can be very helpful for patients and their doctors to control this disease.

For instance, if the sudden drop of estrogen and progesterone is the cause that’s worsening your symptoms (the case of menopause), your doctor may recommend hormone replacement therapy (HRT) to solve this issue. 

Another scenario where treating the underlying condition can help psoriasis is Hashimoto’s thyroiditis. This autoimmune disease causes a dramatic increase in the levels of thyroid hormones, which precipitate psoriasis flareups. If you treat this condition with antithyroid medications, symptoms usually improve within a few days/weeks.

In this article, we will cover the details of hormonal influence on psoriasis and how it can lead to flareups when left untreated.

Psoriasis and the menstrual cycle

During the menstrual cycle, hormone levels vary greatly. Before menstruation, estrogen levels will be very low. After your period, hormone levels start increasing gradually.

According to research, fluctuation in estrogen could be responsible for making psoriasis symptoms worse.

Therefore, if you experience psoriasis flareups during specific times in your cycle, make sure to mention that to your dermatologist for tailored medical care.

Remember that the occurrence of psoriasis flareups may not always be connected to your menstrual cycle. To provide your doctor with accurate data, create a journal where you write down relevant information about your clinical evolution.

Pregnancy and psoriasis

Just like during the menstrual cycle, pregnancy drives female hormones to go haywire. This generally has an impact on psoriasis symptoms.

For instance, at mid-pregnancy, your symptoms could either improve or worsen. Research shows that more than 50% of pregnant women experience symptom improvement at this point. On the other hand, 20% will experience severe flareups.

To explain this phenomenon, researchers theorized that the switch of immunity from specific types of cells to others is key here.

Once a patient hits menopause, the severity of psoriasis seems to increase, which is due to the drastic drop in estrogen and other female hormones. 

Unfortunately, severe forms of psoriasis during pregnancy can increase the risk of complications. These include abortions, eclampsia, macrosomia, and premature rupture of membranes. However, scientists believe that this might be the result of other comorbidities associated with psoriasis.

We should note that psoriasis is by no means a contraindication of pregnancy.

Prolactin and psoriasis

Prolactin is a hormone released by the pituitary gland to stimulate breast milk production and other reproductive functions. Interestingly, the skin cells have receptors for this hormone. When these receptors get activated, they give signals to the cells to start proliferating.

Prolactin also interferes with the action of some hormones, which may trigger psoriasis. Via a complex set of reactions, this hormone stimulates the overactivation of lymphocytes, leading to skin inflammation.

In fact, many reports found high levels of prolactin in a variety of autoimmune diseases, including:

• Lupus erythematosus
• Rheumatoid arthritis
• Sjogren’s syndrome
• Hashimoto’s thyroiditis
• Multiple sclerosis

Today, experts are certain that prolactin plays an important role in the pathogenesis of psoriasis. A key element that confirmed this theory is the fact that prolactinoma* worsens the symptoms of psoriasis.

Adding to the argument, systemic treatment of psoriasis significantly reduces the levels of prolactin. Scientists even suggested that bromocriptine, a drug used in the treatment of prolactinoma, may be helpful in the management of psoriasis.

*Prolactinoma is a benign tumor that leads to the overproduction of prolactin.

Thyroid hormones and psoriasis

Similar to prolactin, skin cells have receptors for thyroid hormones. When the connection occurs, the levels of epidermal growth factor increases, leading to cellular proliferation.

There is a common belief that thyroid hormone may worsen the symptoms of psoriasis. Over the years, researchers collected the following arguments to support this theory:

• Observations of psoriasis flareups after excessive production of thyroid hormones
• Patients with psoriasis have higher levels of free thyroxine (a thyroid hormone)
• Severe cases of psoriasis are characterized by increased levels of thyroid-stimulating hormone (TSH)
• Patients with Hashimoto’s thyroiditis have longer disease periods

Furthermore, prescribing antithyroid drugs to treat hormonal issues led to clinical improvement of psoriasis. For instance, propylthiouracil benefited psoriasis patients in some studies.

The final argument to support this connection is the number of reported cases that completely healed after removing the thyroid gland surgically.

Of course, the indication for the surgery was not psoriasis. Patients had to undergo thyroidectomy to treat suspicious thyroid nodes. In any case, psoriasis improved after removing the gland.

Leptin, ghrelin, insulin, and obesity – How do they affect psoriasis?

The metabolic syndrome that encompasses obesity, diabetes, and blood hypertension is associated with psoriasis.

Let us see what science says about this connection:

Adipose tissues (i.e., fat cells) release a hormone known as leptin, which suppresses your appetite after you eat. This is often referred to as the hunger hormone. Conversely, ghrelin increases appetite when you don’t eat anything for a while.

Ghrelin antagonizes the action of insulin, which may explain the negative correlation between this hormone and psoriasis severity.

Researchers found a relationship between leptin and psoriasis. However, the reports confirming this connection are contradictory. Generally speaking, psoriasis patients will have lower levels of leptin relative to healthy individuals.

Before taking any treatment or following “internet advice” on how to address these issues, make sure to speak with your primary care physician or dermatologist. Trying out things without consulting your doctor can lead to dire consequences!

Takeaway message

Hormonal imbalance has a great impact on many dermatological conditions, including psoriasis. Addressing these issues can be the missing piece that will make your symptoms fade away.

We hope that this article helped you grasp the impact of hormonal balance on psoriasis and how the two are connected.

If you want to read more about psoriasis and pregnancy read this.

Written by Dr. Zac Hyde