Hormonal Influences on Psoriasis: Genetic and Immune Considerations

Psoriasis affects about 0.44 to 2.8% (as per the study published in Indian Express) of the Indian population, most prevalent during the 30s and 40s. Men are more prone to this skin condition than women.

Psoriasis is a chronic skin condition caused by an autoimmune disorder that leads to itchy and/or scaly rashes. This condition flares up in cycles, worsening for a period before subsiding for some time. This skin disease is believed to have genetic, immune, and hormonal origins, although more research is required to establish its pathogenesis with conviction.

This article discusses the genetic, immune, and hormonal causes of psoriasis and the best psoriasis treatments available.

Understanding Psoriasis

Psoriasis is a relatively common, chronic skin condition that manifests differently in different individuals. While there is no cure, you can manage the symptoms with psoriasis treatment and some lifestyle adjustments.

What is Psoriasis?

The appearance of psoriatic flare-ups varies from dandruff-like scales to inflamed eruptions on the skin. It encompasses rashes with purplish or greyish hues on darker skin, whereas pinkish or reddish hues on lighter skin shades. Among children, psoriatic rashes occur as scaly skin in small spots.

Some people may experience bleeding from dry and cracked skin, while others may feel itchiness, soreness, and a burning sensation. The areas of skin affected by this condition are often inflamed and appear red around the whitish-silver or grey scales.

These psoriasis flare-ups can last a few weeks or months before abating until triggered.

The different types of psoriasis are discussed in the upcoming sections.

Plaque Psoriasis

This is the most common form of psoriasis, occurring in about 80 to 90% of the people with this condition. It is characterised by dry and scaly plaques, meaning raised patches of skin. These rashes vary in severity and mostly appear on the scalp, elbows, knees, and lower back. The skin may temporarily darken in the affected areas, a phenomenon called post-inflammatory hyperpigmentation. Plaque psoriasis can be more severe on darker skin tones and difficult to diagnose.

Guttate Psoriasis

This psoriasis is mostly observed in children and young adults as pinkish to violet drop-like scaly spots. The rashes mainly appear on the torso and limbs. Bacterial infections like strep throat commonly trigger guttate psoriasis.

Nail Psoriasis

This type of psoriasis is observed in the fingernails and toenails. It may appear as discolouration, pitted nails, and abnormal nail growth. Onycholysis, the loosening or separation of nails from the nail bed, may also be observed. In severe cases, nails might crumble.

Inverse Psoriasis

Inverse psoriasis is most prominent in the skin folds along the groin area, breasts, armpits, and buttocks. These rashes worsen with friction and are usually triggered by fungal infections. They may appear as smooth, red, and inflamed skin patches.

Pustular Psoriasis

This is a rare variant of psoriasis, occurring as pus-filled blisters on the palms and soles. These rashes may be widespread or confined to small skin patches. The skin in the affected areas becomes inflamed and may appear reddish or purplish depending on the skin tone.

 Erythrodermic Psoriasis

This is the least common but the most severe form of psoriasis. These rashes involve peeling and burning skin that may cover the entire body. Erythrodermic psoriasis can be acute or chronic, with inflamed and shedding scales that appear like severe sunburns. This condition can be life-threatening and thus requires immediate medical attention.

Causes of Psoriasis

Psoriasis is primarily an immune response in which the immune system mistakenly attacks one's own skin. This immune pathway, however, can be triggered by an autoimmune disorder, genetic predisposition, hormonal changes, or environmental factors.

The immune flare-ups speed up the new cell generation process, leading to a buildup of cells that appear on the surface as dry and scaly patches.

These bodily responses can be triggered by the following factors that may act as causes of psoriasis:

• Bacterial or fungal infections
• Skin injuries, including cuts, scrapes, sunburn, and insect bites
• Cold and dry weather
• Smoking or exposure to secondary smoke
• Heavy alcohol consumption
• Medications used to treat high blood pressure, malaria, and other conditions
• Withdrawal from corticosteroids

Genetic Factors in Psoriasis

Research has found evidence of genetic psoriasis due to allelic gene mutations that govern hereditary traits. Advanced techniques have identified around 25 different regions in the human genome, the genetic material, that could be related to the pathogenesis of psoriasis. However, it has been established that the action of such alleles like HLA-Cw6 alone cannot lead to this skin disease.

Is Psoriasis Hereditary?

"Is psoriasis hereditary?" This is a common question among patients and researchers. Although this disease can affect people without a family history of psoriasis, people are more prone to it if someone in their family has it.

Studies have found that people with one or both of the parents with psoriasis have a 10% and 50% chance of developing this disease at some point in their lives, respectively. 

These observations have solidified the relevance of the question, "Is psoriasis inherited?".

Genetic Markers and Psoriasis

Over 80 different genes have been associated with psoriasis. HLA-Cw6, IL12B, IL23R, and LCE3B/3C are the most prominent alleles in this context. A study performed using genetic markers found 15 different regions (Psoriasis Susceptibility 1–15 or PSORS1–15) on the human genome susceptible to and potentially the main contributors to psoriasis heredity. 

Immune System and Psoriasis

A study on people who have psoriasis found that the affected skin contains high amounts of cytokines, compounds associated with inflammation induced by the action of immune cells.

Immune Mechanisms in Psoriasis

The disorderly action of the immune system is among the main causes of psoriasis. When triggered, the body's immune system initiates an inflammatory action against healthy skin cells. This activates the T-lymphocytes or T cells that fight invasion by foreign threats and stimulates the production of inflammatory compounds like cytokines.

The release of cytokine in a certain area widens the blood vessels and aids the accumulation of white blood cells (WBCs). It also leads to the enhanced production of keratinocytes, the skin cells, which causes them to multiply rapidly. In the natural process, skin cells' formation, maturation, and surfacing takes about a month. 

On the contrary, psoriasis speeds up this process to be done within a week. This brisk production of skin cells causes them to pile up in an area and leads to the formation of plaques. Cytokine action also causes the skin to become inflamed and sensitive. 

Psoriasis and Hormonal Influences

The definite relationship between hormones and psoriasis has not been established yet. However, hormones may interlink genetics and psoriasis as changes in their levels have been associated with flare-ups in the symptoms of this condition.

Hormonal levels may fluctuate temporarily due to factors like stress. However, different phases of life, like puberty, pregnancy, and menopause, also have varying hormonal levels.

Additionally, health conditions, including hyperthyroidism, hypothyroidism, menstrual disorders, and polycystic ovary syndrome (PCOS), also disturb hormonal levels.

The common hormones associated with this condition include:

• Estrogen: Fluctuations in the levels of this female sex hormone have been associated with flare-ups in psoriatic symptoms. Estrogen influences immune activity and is thus believed to contribute to psoriasis.
• Progesterone: This is another female sex hormone associated with genetic psoriasis.
• Testosterone: Research has established that around 52% of men suffering from psoriasis have low levels of testosterone, which may be associated with psoriasis genetic disease.

Hormonal Changes and Psoriasis

Estrogen and testosterone are the major hormones contributing to psoriasis in women and men, respectively. Phases involving low levels of estrogen in women and testosterone in men are synchronised with heightened psoriatic systems.

The major phases believed to be associated with hormonal and genetic psoriasis are listed below:

Puberty

Major hormonal shifts have been observed in children between 8 and 14 years of age, which may trigger psoriasis in some individuals. Most cases of childhood psoriasis, however, have been reported right after puberty, when the hormone levels lower and begin to settle.

Menstrual Cycle

Hormonal levels shift throughout the menstrual cycle in women. Around the time of ovulation in the middle of the cycle, estrogen levels are at the highest; therefore, psoriatic symptoms are mild or absent. During menstruation or the bleeding phase, estrogen levels are at their lowest, and psoriatic symptoms are more prominent.

Pregnancy

Pregnant women usually do not experience psoriasis flare-ups as the estrogen levels are high during this time. The symptoms, however, often reappear after childbirth as the hormonal levels lower.

The 40s

During this midlife phase, both men and women experience heightened symptoms of psoriasis genetic disease. In women, this is primarily attributed to perimenopause, characterised by the reduced production of estrogen by the ovaries. Similarly, in men, increasing age involves lowered testosterone levels. Psoriasis is also more prominent in older men.

Menopause

Menopause usually occurs in the early 50s when a woman has not had her periods in at least 12 months. Hormonal levels also drop significantly during this phase, which may contribute to psoriasis.

Hormones and Psoriasis Flare-Ups

The effect of hormones on psoriasis and their association with psoriasis heredity is still widely researched. You can, however, opt for hormonal evaluation and see if there is any association between your hormonal levels and psoriatic flare-ups.

Book a psoriasis evaluation test today to determine your triggers and causes of psoriasis and make managing the condition easier in the future.

Psoriasis Treatment Options

No definite cure for psoriasis has been found yet. However, there are treatment options to manage the symptoms and severity of psoriasis genetic disease. Before offering treatment, your doctor will assess the symptoms and overall health status and evaluate your skin, scalp, and nails. They may also perform a biopsy to rule out other conditions before devising a treatment plan.

The common psoriasis treatments are listed below:

• Topical Medications: To manage psoriasis symptoms, topical ingredients like corticosteroids, retinoids, salicylic acid, anthralin, vitamin D analogues, and JAK inhibitors are prescribed.
• Systemic Medications: These oral and/or injected medications are prescribed in cases of moderate to severe psoriasis. Compounds like methotrexate, cyclosporin, biologics, retinoids, and apremilast are used to treat moderate cases of this disease. Some of these medications are also associated with several side effects and are not suited to women who are pregnant or trying to get pregnant. Thus, they must be taken under a doctor's guidance.
• Light Therapy: Natural light or ultraviolet (UV) light, including UVA and UVB rays, is also used as a treatment for genetic psoriasis. This light kills the white blood cells (WBCs) in the affected areas, which are responsible for inflammation and increased cell growth.

Managing Psoriasis Through Hormonal Regulation

You can opt for a psoriasis evaluation test to determine whether your psoriasis is hereditary or hormonal. If your psoriasis flare-ups are associated with hormonal fluctuations, you might be able to manage them through hormonal regulation.

Hormonal or birth control pills might help you regulate your hormones. Consult with a doctor for effective psoriasis management with minimal to no risk of side effects.

Genetic Testing For Psoriasis

Through genetic testing, you might be able to determine if psoriasis isinherited by you. Some genetic markers have been developed, and genes and genetic regions associated with psoriasis have been identified. A genetic test may help you determine the origin of your psoriasis and make managing it easier.

Conclusion: Understanding the Complexities

The pathogenesis of psoriasis is still a mystery. This makes its management and treatment more complex. Due to this, professional guidance on the immune, hormonal, or genetic origins of this disease and its appropriate management is essential.

The homeopathic branch of medicine addresses the root cause of psoriasis and treats the condition from within. At Dr Batra’s® Clinic, our skin specialists emphasise assessing the physical and psychological symptoms, a physical evaluation of the rashes, and an account of your dietary and lifestyle habits. They form a diagnosis based on their observations and devise a treatment plan to manage the symptoms. Our treatment pattern encompasses natural medications that heal the inner bodily functions and dietary and lifestyle adjustments to complement the benefits of the medicines.

Visit Dr Batra’s® to manage your psoriasis symptoms today effectively!

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