If you were to peruse the “psoriasis” hashtag on Instagram, you would find not hundreds or thousands but millions of candid photos from folks living with the common skin condition. You would also find that most of those psoriasis posts come from women—not men. Despite the silence from dudes on social media though, psoriasis affects both sexes equally. And, get this: Men are more likely than women to have severe psoriasis. Still, the chances of guys going to the doctor to get their skin checked out are significantly lower. Keep reading to find out why this is—plus some expert-approved, guy-specific psoriasis care and treatment options.
Men and Psoriasis: The Unique Risks
In a Swedish study that looked at 5,438 patients with psoriasis, researchers found that women have a significantly lower incidence of severe psoriasis compared to men. What they couldn't decipher? The reason why. “What this study highlights is how important it is for men to seek the appropriate help and care for severe psoriasis, especially given the associated comorbidities,” says Adam Friedman, M.D., a board-certified dermatologist at George Washington Medical Faculty Associates in Washington, D.C.
Case in point: Men with psoriasis are more at risk for getting both cardiovascular and metabolic diseases. In fact, according to research in the American Journal of Cardiology, those with severe forms of psoriasis are more likely to develop a heart disease under age 60.
Unfortunately, Dr. Friedman says men with psoriasis are more likely to wait over two years longer than women to see a physician about their psoriasis. He believes this is due to a variety of factors, including shame surrounding skin conditions and the pressure that some men feel to simply “walk things off” or fix a problem themselves. Also, the mere fact that men tend to be less concerned with their physical appearance than women can come into play, too.
“It likely stems from societal expectations and the gender stereotypes that are put on men at a young age, as well as how they’re raised,” he explains. “It’s definitely a problem because we have great targeted systemic medications that can very effectively control the skin and joint disease, with emerging data showing reversal of some of the systemic comorbidities, which is why it’s so important that men seek treatment as soon as possible. They need to take the first step if they want to feel better.”
One form of condition does, however, seem to get guys to doctor faster, and that's scalp psoriasis. “The flaky red patches on the head are more noticeable, especially when the hair is short, which is probably why they seek treatment quicker than they would if it were located somewhere else on the body,” says Joyce Park, M.D., a board-certified dermatologist at Kaiser Permanente San Jose Medical Center in California.
Where Else Does Psoriasis Show Up on Guys?
Same as their female counterparts, the most common type of psoriasis that men encounter is plaque psoriasis, which is characterized by scaly, thickened patches of skin with a silvery appearance and defined edges. In both sexes, this type is most prevalent on the scalp, elbows, knees, and lower back. It can also appear in the genital area.
For the most part, men experience psoriasis in mostly the same places as women, but according to the National Psoriasis Foundation, men are more likely to experience genital psoriasis, which can be especially uncomfortable because it appears in ultra-sensitive areas, including the scrotum, the shaft and the tip of the penis, as well as the groin area. It can also greatly impact one’s sex life due to the stigma of having plaque psoriasis in these parts of the body. This form of psoriasis is even more difficult for men to talk about, as many males associate their genitals with their manhood. Dr. Park hypothesizes that this is one of the main reasons that men avoid or delay going to the doctor for their psoriasis.
What Are the Best Treatments for Men?
Because men tend to be more severely affected by psoriasis, there is a higher proportion of men treated with systemic or ultraviolet treatment compared to women, explains Shalini Vemula, M.D., a clinical instructor of dermatology at Harvard Medical School. But, there’s a host of effective treatment options available for men with mild, moderate, and severe psoriasis.
Topical Steroids: Also known as corticosteroids, these topical agents work to reduce inflammation and slow down skin-cell growth, thereby dramatically decreasing the amount of psoriasis plaques you get. They come in a variety of different forms, too, including creams, gels, ointments, oils, sprays, and foams, though Dr. Park says men tend to prefer the latter over creams and ointments as they’re less greasy and easier to apply.
A doctor will choose the best formulation and concentration based on your specific case. Topical steroids are separated into seven different classes based on their potency, with class I having the highest potency and class VII, which includes 1% hydrocortisone cream, being the least aggressive. In class I, you have medications like Diprolene, Psorcon, and Ultravate; in class II, you have Halog, Kenalog, and Lidex; in class III there’s Elocon, Betanate, and Cyclocort.
Vitamin D: Topical forms of vitamin D help can help slow down the growth of new skin cells and reduce psoriasis plaques. Dovonex cream, or calcipotriene, is a man-made form of vitamin D that’s commonly used to treat plaque psoriasis, though you should not use it if you have high levels of calcium in your blood, or if you already have a high level of vitamin D in your body, which can happen if you overdose on supplements.
Topical Calcineurin Inhibitors: Used as an alternative to topical steroids, calcinieurin inhibitors are approved by the FDA for the treatment of atopic dermatitis, though two of the drugs, Protopic and Elidel, have been used off-label to treat psoriasis in recent years with proven benefit. They work by taming local inflammation in the body, which helps slow down the hyper-production of skin cells, resulting in fewer plaques. Both drugs come with a laundry list of side effects, though, so they should be used with caution and only when prescribed by your doctor.
Phototherapy: Also called light therapy, this treatment involves using ultraviolet light on affected areas of the skin, which can help reduce the size, itchiness, and overall appearance of psoriasis plaques. It can be extremely effective, with an estimated 75% of people developing clear skin when they undergo treatments two to three times a week for up to a month. Even more: The clear skin can last for at least six months. That begin said, it does come with an increased risk of skin cancer, so doctors advise patients to limit their lifetime usage of phototherapy to 150 sessions. The most common form of phototherapy is narrow-band UVB, as it limits the light wavelengths used in the treatment in order to keep the possible side effects to a minimum.
Biologics: Biologics are protein-based injection drugs that are often recommended for patients who haven’t benefited from other available treatment options, and work by targeting or blocking only the part of the immune system that’s overreactive due to psoriasis. Because it only targets one area, there’s less risk of causing issues with the liver, kidneys, and other organs than with other psoriasis medicines. Some of the most common biologics include Humira, Enbrel, Remicade, Cosentyx, and Stelara, each of which work a bit differently and come with their own respective side effects.
What Are Some Surprising Psoriasis Triggers?
There’s a wide range of triggers for psoriasis, running the gamut from certain foods to run-of-the-mill stress and so much more. Here are a few to try to steer clear from, especially if you’re a guy.
- Red meat and dairy: Both red meat and dairy contain a polyunsaturated fat called arachidonic acid, which can easily convert into inflammatory compounds and may exacerbate psoriasis symptoms.
- Smoking: Need another reason to kick the habit? Turns out, lighting up can kickstart psoriasis inflammation. And, you should also be wary of the company you keep. One study published in the American Journal of Epidemiology found that people who were exposed to secondhand smoke had an increased risk of developing psoriasis.
- Cuts and scrapes: Accidents happen, but you should know about an interesting aspect of psoriasis called the Koebner phenomenon, in which traumatizing the skin can cause you to develop psoriasis in that area. Just FYI.
- Stress: Researchers believe that psoriasis and stress go hand in hand. This is because mental and emotionally anxiety causes the body to release chemicals that create an inflammatory response, thus resulting in a psoriasis flare-up. Of course, psoriasis in is already stressful, which is why it’s so important to find tactics to help self-soothe and minimize stress as much as possible in other areas.
Can Therapy Help Your Skin?
It’s no secret that men in general are less likely to talk about their feelings than women. But when you’re living with a chronic skin condition like psoriasis, it can be extremely beneficial to open up and talk about your emotions rather than keep them bottled up inside. Whether it’s a close friend, family member, or counselor, finding someone you can be vulnerable with and express your emotions with is key.
While emotional stress doesn’t necessary cause a new psoriasis diagnosis, if you already have it you may notice more frequent flares and more advanced lesions. It’s like a downward spiral said John Koo, director of the Psoriasis, Phototherapy and Skin Treatment Clinic at the University of California, San Francisco, in Nature. “The more visible you have it, the more upset people get,” he noted. “The more upset you get, the more inflammatory your skin disease gets.”
Regular talk therapy, as well as group therapy, are both great options to consider, as it allows you to get emotions off your chest—and have your feelings validated. Studies have shown that those with chronic skin conditions like psoriasis are at a higher risk for anxiety and depression, so it’s no joke, guys.
There are even psychologists who specialize in dermatological conditions and the emotional toll they take on people — they’re known as pyschodermatologists. So, if your psoriasis is having a huge effect on your happiness and ability to cope with everyday tasks and activities, definitely don’t ignore it, because there is help out there.