<p>Plaque psoriasis is a complex disease that can negatively impact personal and social aspects of life, and it has some potentially unique implications for women. For example, it often overlaps with a woman’s reproductive years, which can influence disease presentation and treatment decisions. Plaque psoriasis can also influence sexual health and well-being disproportionately in women, especially due to stigma around the condition.</p>

There are many unique considerations when treating plaque psoriasis in women, such as physical and psychosocial impacts of special site involvement, as well as family planning. This, in turn, translates into tailored therapeutic discussions that can impact treatment selection. Pregnancy is the “perfect storm,” requiring nuanced approaches. Due to the massive shift in hormone production during and after pregnancy, some patients find that their plaque psoriasis improves during gestation only to flare a few months after giving birth. On the other hand, some patients’ plaque psoriasis gets worse during pregnancy, or—even more concerning—some may develop impetigo herpetiformis, or “pustular psoriasis of pregnancy,” which can potentially be life-threatening for both the mother and the fetus. There is no way to predict which scenario a patient will experience, and, therefore, clear education, expectation setting, follow-up, and shared decision making with treatment selection are requisites for success.

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Taking a step back, let us consider when psoriasis typically manifests. The emergence of plaque psoriasis is somewhat bimodal; it usually peaks in a patient’s 20s and then again in their 50s. This first peak occurs during a time when people may be graduating from college, starting relationships, and planning families. Plaque psoriasis can, no doubt, get in the way of that. Even if family planning is not in sight, we should always ask about and consider the possibility of future pregnancy and what it will mean for their treatment choice today.

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Patients can be especially reluctant to use a systemic therapy during pregnancy, but it is important to make it clear that stopping treatment altogether can be dangerous. There are data showing that there can be poor fetal outcomes associated with undertreated plaque psoriasis during pregnancy, and we have options that can be considered for use during gestation.

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Aside from pregnancy, while psoriasis can morphologically present similarly in men and women, the physical and social impacts may be different, especially when it presents on visible areas, such as with sebopsoriasis. Sebopsoriasis can also directly cause hair loss, and topical therapy can make it very difficult for a patient to style their hair. Moreover, because psoriasis can be instigated by friction or trauma (such as with the Koebner phenomenon), women with inverse psoriasis may experience more disease activity and recurrence under the breast area, or resulting from tight-fitting clothing. Psoriasis can also have an impact on sexual well-being in women, with genital psoriasis being a key consideration. It is, unfortunately, human nature to assume that any cutaneous finding located in the genital area is sexually transmitted, which obviously psoriasis is not. Both active disease and the disfigurement of discoloration or scarring can have a tremendous impact on quality of life and can affect a patient’s relationships.