Understanding Psoriasis: Causes, Hormonal Influence, and Effective Treatments

By SWA

Psoriasis is a chronic autoimmune skin disorder that affects millions of people worldwide. 

It's characterized by red, scaly patches of skin due to rapid skin cell turnover and persistent inflammation. While it’s not contagious, psoriasis can significantly affect a person's quality of life—both physically and emotionally. Understanding the foundation, hormonal influences, and treatment options is crucial for managing the condition effectively.

The Foundation of Psoriasis

Psoriasis develops due to a combination of genetic, immune, and environmental factors:

1. Genetics

  • Psoriasis often runs in families.

  • Certain genes, especially HLA-Cw6, are linked to an increased risk.

  • However, not everyone with a genetic predisposition develops the disease.

2. Immune System Dysfunction

  • Psoriasis is driven by an overactive immune response, particularly involving T-cells.

  • These immune cells mistakenly attack healthy skin cells, triggering an inflammatory cascade.

  • This leads to excessive production of skin cells, which accumulate and form plaques.

3. Skin Cell Overproduction

  • In healthy individuals, new skin cells rise to the surface in a few weeks.

  • In people with psoriasis, this process takes just a few days, causing the buildup of thick, scaly patches.

4. Environmental Triggers

Several factors can initiate or worsen psoriasis, including:

  • Stress

  • Skin injuries (Koebner phenomenon)

  • Infections (especially streptococcal infections)

  • Certain medications (e.g., beta-blockers, lithium)

  • Cold, dry weather

  • Smoking and heavy alcohol use

Hormonal Influence on Psoriasis

Hormones play a significant modulatory role in the onset and progression of psoriasis. Fluctuations in hormone levels can affect immune function and inflammation.

1. Cortisol (Stress Hormone)

  • Cortisol helps regulate inflammation.

  • In people with psoriasis, chronic stress may lead to low cortisol response, resulting in heightened inflammation and disease flares.

2. Estrogen and Progesterone

  • Estrogen has anti-inflammatory properties and is often protective.

  • Many women experience psoriasis improvement during pregnancy (high estrogen) and worsening postpartum or during menopause (low estrogen).

  • Progesterone has mixed effects and may contribute to flares in some women.

3. Testosterone

  • Some studies suggest that low testosterone may be associated with more severe psoriasis in men, though evidence is still emerging.

4. Melatonin

  • Often reduced in people with psoriasis.

  • Melatonin is a natural antioxidant that may help regulate immune function and reduce inflammation.

  • Poor sleep, which lowers melatonin levels, may trigger or worsen flares.

5. Pro-inflammatory Cytokines

  • Although not traditional hormones, cytokines like TNF-α, IL-17, and IL-23 act similarly in promoting inflammation.

  • These are the key targets of modern biologic therapies.

Medications for Psoriasis

Treatment is tailored to disease severity, type, and individual response. It falls into three main categories: topical, systemic, and biologic therapies.

Topical Treatments (For Mild to Moderate Psoriasis)

These are applied directly to the skin:

  • Corticosteroids: Reduce inflammation and itching (e.g., hydrocortisone, clobetasol)

  • Vitamin D analogs: Slow skin cell production (e.g., calcipotriol)

  • Coal tar & salicylic acid: Help reduce scale buildup

  • Calcineurin inhibitors: For sensitive areas like the face or groin (e.g., tacrolimus)

Systemic Treatments (For Moderate to Severe Psoriasis)

Taken orally or by injection:

  • Methotrexate: Suppresses overactive immune cells

  • Cyclosporine: Fast-acting immune suppressant for short-term use

  • Acitretin: An oral retinoid that helps normalize skin growth

  • Apremilast (Otezla): A non-biologic that reduces inflammation via PDE4 inhibition

Biologic Therapies (For Moderate to Severe or Resistant Psoriasis)

Biologics target specific immune pathways, particularly cytokines:

  • TNF-alpha blockers: Adalimumab (Humira), Etanercept (Enbrel)

  • IL-17 inhibitors: Secukinumab (Cosentyx), Ixekizumab (Taltz)

  • IL-23 inhibitors: Guselkumab (Tremfya), Risankizumab (Skyrizi)

  • IL-12/23 blocker: Ustekinumab (Stelara)

These medications are often injected and can be highly effective for both skin and joint symptoms (psoriatic arthritis).

Additional Supportive Measures

While medications are central to managing psoriasis, lifestyle changes and supportive care also play a key role:

  • Moisturizers: Help reduce dryness and itching.

  • Omega-3 fatty acids: May reduce inflammation.

  • Phototherapy: Controlled UV exposure to slow cell growth.

  • Stress management: Yoga, meditation, and therapy can reduce flare frequency.

  • Healthy diet and weight control: Inflammation and severity often improve with a balanced lifestyle.

Conclusion

Psoriasis is more than a skin condition—it's a systemic immune disorder influenced by genetics, immune dysfunction, hormonal changes, and environmental triggers. While it cannot be cured, it can be effectively managed with a combination of treatments. From topical creams to cutting-edge biologics, patients now have more options than ever to live comfortably and confidently.

If you or someone you know is struggling with psoriasis, working with a dermatologist to find a personalized treatment plan is the best way forward.

 

© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9

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