Autoimmune skin diseases: Role of sex hormones, vitamin d, and menopause

Autoimmune diseases that affect the skin occur predominantly in women and are classified as rheumatic diseases. They include systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, Sjögren’s syndrome, and scleroderma. Data support the idea that estrogen elevates autoantibodies and T helper 2 responses and promotes fibrosis by stimulating profibrotic interleukin-4 and transforming growth factor-β and fibroblast growth factor, all of which contribute to increased skin inflammation in rheumatic diseases in women. Epidemiological data indicate that more than 60 % of postmenopausal women have vitamin D insufficiency and 16 % are vitamin D deficient. Vitamin D deficiency is far more common among women with rheumatic diseases than controls and is associated with worse disease severity and cutaneous manifestations. This chapter describes our current understanding of the role of sex hormones, vitamin D, and the effect of menopause on the development of autoimmune skin diseases.