Gender medicine and psoriasis

Table 1 Main gender-specific features among patients with psoriatic disease

Disease onset	Earlier in females
Prevalence	Reported as similar in men and women Some studies however showed an overall higher incidence in males and a peak incidence in women during the sixth decade of life
Genetic aspects	Earlier disease onset in Cw6-positive women than in Cw6-positive men Higher risk of disease manifestation and higher birth weight in offspring of psoriatic fathers
Triggering and risk factors	Association with stressful events more frequent in women Alcohol: increased consumption is both sexes, with statistical difference reached only for men (in one study); increased consumption after diagnosis more evident for women Smoking: association more consistent in women (one study identified smoking as a risk factor only in males); association with adulthood exposure to passive smoking and the ex-smoker status among men
Clinical features	Moderate to severe extent of involvement more frequent in men Palmoplantar pustulosis particularly frequent in females
Psoriatic arthritis	Controversial data on the prevalence in men and women (different results collected in case series from different countries) Most common clinical forms: polyarthritis in females and oligoarthritis in men Females with higher risk of disease progression, greater functional impairment, fatigue and work disability, and worse quality of life; men with higher risk of nail psoriasis lesions, axial involvement and more severe radiographic damage in the peripheral joints
Clinical associations	In a few studies (not always confirmed by others), different prevalence rates of some comorbid conditions among men and women (i.e., increase of diabetes, metabolic syndrome, anogenital lichen sclerosus, and subclinical hypothyroidism in women, and increase of masked hypertension, osteoporosis, migratory glossitis, and hepatitis C virus infection in men) High risk of malignancies particularly in male patients
Quality of life	More severe impact on quality of life, more psychological and sexual distress in females Greater work-related stresses in men Moderate but significant relevance of feeling of stigmatization over time in men Gender differences in coping strategies and effects of social support
Treatment	Men more likely to receive intensive systemic treatments for severe psoriasis Gender differences in psoriasis care utilization Overall higher medication adherence in women (however, survival of anti- tumor necrosis factor therapies longer in male patients) Sporadic reports of gender differences in a few aspects of the efficacy and safety profiles of some treatment modalities