I am on Methotrexate for psoriasis. Should I try hormone therapy?

Question

Hello doctor,

I am 42, and my psoriasis exploded after my hysterectomy six months ago. The patches cover about 60 % of my body now, including scalp, elbows, knees, and even the genital area, which makes intimacy impossible.

My dermatologist tried Methotrexate, but it made me feel nauseous, and my liver enzymes went up to ALT 89 and AST 76.

The hormone replacement therapy I am taking might be making it worse, but without it, I get terrible hot flashes and bone density problems. The psoriatic plaques are so thick and itchy that I scratch until I bleed, especially at night.

I have even tried phototherapy, but the sessions interfere with my work schedule. My joints are starting to hurt too, particularly fingers and lower back. The skin flakes get all over my clothes and furniture, which is embarrassing. So, my concerns are:

What psoriasis treatments work best after surgical menopause?
Can HRT be adjusted to reduce flares?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Thank you for sharing all of this so clearly. Based on your description, you are dealing with a severe flare of psoriasis that may have been triggered or worsened by hormonal changes after your hysterectomy, and the added challenge of joint pain raises concern for psoriatic arthritis.

Surgical menopause can have an impact on the immune system and cause inflammation of the skin, and even though hormone replacement therapy (HRT) helps alleviate menopausal symptoms, there are specific types of HRT that are more effective for alleviating menopausal symptoms but will definitely affect the progression of psoriasis in some people.

It would be good to consult your dermatologist and gynecologist to see whether changes can be made to your HRT treatment plan that would reduce flare-ups without aggravating menopausal symptoms.

Since Methotrexate caused liver enzyme elevation and side effects, and phototherapy is not practical for your schedule, newer biologic therapies may be a good next step.

These targeted treatments, such as IL (interleukin)-17 or IL-23 inhibitors, are often very effective for both skin and joint symptoms, with a better side effect profile than older systemic drugs. They can provide substantial relief and improve quality of life, even in cases as extensive as yours.

I hope you find this information helpful.

For more queries, feel free to reach out to me anytime.

Thank you.