Hormones Drive Psoriasis and Eczema Flares Differently in Women

A quarter of women with psoriasis say they have postponed motherhood because they fear passing the condition on to a child, according to Doral Fredericks, PharmD, MBA, global vice president of medical affairs and outcomes research at Organon, who spoke with Dermatology Times about how plaque psoriasis and atopic dermatitis affect women differently than men.

The core mechanism is hormonal. Estrogen and other hormone levels rise and fall across the menstrual cycle, then shift dramatically during pregnancy, the postpartum period and menopause. Plaque psoriasis and atopic dermatitis tend to track those shifts, which can change when a condition first appears, how severe it becomes and how often it flares.

For many women, that means flares cluster at predictable moments: the week before a period, the months after delivery, or somewhere along the road to menopause.

What does this change for dermatologists?

The burden is not distributed evenly by sex, and the data reflect that. "Women with these conditions report a disproportionately greater mental health and quality-of-life impact than men," Fredericks said.

That gap includes higher rates of:

• depression
• fatigue
• loneliness
• stress
• stigma

Add several nights kept awake by itching, and a condition clinicians may file as "just skin" starts spilling into sleep, mood and daily function.

Fredericks' position is that the standard dermatology visit should catch this without waiting for the patient to raise it. She would like to see questions about mood, stress and sleep become a routine part of every appointment, rather than something patients have to work up the nerve to mention.

Where the answers point elsewhere, referrals should follow. Gynecologists, endocrinologists and mental health professionals all have a role when hormonal patterns or psychological burden surface during a skin consult.

The treatment gap during pregnancy

Family planning creates a second, quieter problem in the exam room. Beyond the quarter of women with psoriasis who delay pregnancy over inheritance worries, some women with eczema scale back or stop treatment while pregnant out of fear of harming the baby.

That decision often happens silently. Fredericks notes that inheritance risk depends on many factors, and these are conversations patients should have with their provider early — not judgments women make on their own between visits.

For prescribers, that means surfacing teratogenicity and treatment-continuity questions proactively with women of childbearing age who have psoriasis or atopic dermatitis, before pregnancy forces a rushed decision.

Why integrated care is not just soft medicine

There is hard data behind the mental health piece. Research shows that combining dermatologic treatment with mental health support can calm inflammation, lower stress biomarkers and improve clinical outcomes, Fredericks said.

In other words, the psychodermatology referral is not an add-on. It measurably moves the inflammatory picture.

The practical first step costs nothing: ask patients to track when their flares hit. A pattern tied to the luteal phase, a postpartum window or perimenopause changes the conversation about timing, treatment intensity and which specialist belongs in the loop — emotional symptoms included.

Patients who want structured support can turn to the National Eczema Association, the National Psoriasis Foundation and the Women's Dermatologic Society, all of which offer resources on hormonal patterns, pregnancy planning and quality-of-life management.

As awareness of sex-specific differences in inflammatory skin disease grows, the expectation set by voices like Fredericks is that hormonal history, mental health screening and reproductive planning become standard parts of the psoriasis and eczema visit rather than afterthoughts.