No abstract

While studies have noted improvement of psoriasis in most women during pregnancy with subsequent postpartum deterioration, there is little data on the impact of other hormonal events. Moreover, there have been changes in hormonally-based therapies in the last 20 years. We surveyed a large number and diversity of women on the effect that hormonal variations (menarche, menses, exposure to hormonal contraception, infertility therapy, pregnancy, menopause, and hormone replacement therapy) have had on their psoriasis. A 22-question survey was sent through the National Psoriasis Foundation (NPF) e-newsletter and social media, inviting females 13 years and older with psoriasis to complete an anonymous survey. In addition, a validated subset of 105 women who had received care at the University of California, San Diego for psoriasis was contacted. 1652 women responded to the NPF invitation (31% response rate). 102 women contacted from UCSD completed the survey (97%). The average age of participants was 37 years; the two groups had similar responses. 43% had mild disease, 37% moderate, and 20% severe. 711 (43%) had psoriasis at menarche with most having worsening or stable disease with this event. About one-third of women reported worsening the week prior and the week of menstruation. Significant worsening during the post-partum period compared to the 1st, 2nd, and 3rd trimesters of pregnancy was noted (p < 0.05). 78% of 682 women with multiple pregnancies reported the same response with each pregnancy, but 22% had a different response with at least one subsequent pregnancy. Most women reported worsening with menopause, while those who had or were currently on hormone replacement therapy found no change with HRT (p < 0.001). Worsening of psoriasis was more significant with progesteroneonly contraception (injectable shots, implants, and the Mini-Pill) than with combination contraceptive medications (p < 0.05). Psoriasis appears to be influenced by both endogenous and exogenous hormonal changes. Both the level of estrogen and progesterone, and possibly the ratio of these two hormones, may affect psoriasis severity. 241 The relationship between complement levels and disease activity in Japanese cases with hereditary angioedema with C1-inhibitor (C1INH) gene mutation