Skin Inflammation as an Overlooked Risk Axis in Female Infertility

Skin inflammation has been proposed as a systemic factor relevant to female reproductive health, but the strength of evidence differs markedly across dermatologic conditions and reproductive endpoints. In a UK population-based cohort, moderate-to-severe psoriasis was associated with a lower fertility rate (rate ratio 0.75, 95% CI 0.69–0.83), while a Danish registry study found a modest overall association with ectopic pregnancy (OR 1.34, 95% CI 1.06–1.68). Two small clinical studies also reported differences in ovarian-reserve markers. These observations do not establish accelerated ovarian aging or a direct causal effect of psoriasis on infertility. Hidradenitis suppurativa provides additional clinical evidence linking a chronic inflammatory dermatosis with infertility and adverse pregnancy outcomes, whereas available data for atopic dermatitis suggest largely comparable pregnancy rates and outcomes to women without the disease. In contrast, no longitudinal study has directly evaluated fertility in women with recurrent erysipelas or cellulitis. For these infections, the proposed reproductive relevance is based mainly on systemic inflammation, shared metabolic risk factors, vascular effects, and microbiome-related mechanisms. Mechanistic evidence involving the IL-23/IL-17 axis, oxidative stress, endothelial dysfunction, and mucosal microbiome dysregulation provides biological plausibility but should not be interpreted as proof of causality. This narrative review distinguishes direct clinical evidence from supportive and hypothesis-generating evidence and considers fertility, ovarian reserve, implantation, pregnancy loss, ectopic pregnancy, and obstetric outcomes as distinct endpoints. Current evidence supports closer attention to reproductive health in women with selected inflammatory dermatoses, while the causal contribution of skin inflammation itself remains unresolved.