While the prevalence of psoriasis is similar between men and women, the burden of disease can differ.
For women, diagnosis and treatment initiation may occur during peak reproductive years, which adds an additional layer of complexity to management. Additionally, it is known that psoriasis activity can fluctuate with hormonal changes, including those which occur during pregnancy.
“We know that the primary risk factor for psoriasis is a patient’s genetic make-up. However, female hormones can influence disease severity,” says Jenny Murase, M.D., the Associate Clinical Professor of Dermatology at the University of California, San Francisco and Director of Medical Consultative Dermatology, at the Palo Alto Medical Foundation in Mountain View, California.
Estrogen and Psoriasis
Estrogen, in particular, has shown to affect the severity of psoriasis in some female patients. Research has shown that during pregnancy, many female patients report an improvement in psoriasis symptoms. “When levels of estrogen increase [during] pregnancy, psoriasis tends to improve, and when it decreases right after baby is born, it worsens,” Dr. Murase explains. A study of women with psoriasis showed that 55 percent of pregnant women who also have psoriasis reported an improvement in their disease, which correlated with a high level of estrogen. However, only 9 percent of patients reported an improvement during the postpartum time. Furthermore, data from that study also showed that psoriatic body surface area significantly decreased between 10 to 20 weeks gestation and increased significantly by 6 weeks post-partum. 
Furthermore, there is evidence that estrogen receptors are a member of the superfamily of nuclear receptors for steroid hormones. “The estrogen receptor is a nuclear receptor. Estrogen binds to these receptors as vitamin D, corticosteroids and other thyroid hormones do, and these medications have been used as psoriasis treatments,” says Dr. Murase.