Psoriasis: gender perspective on disease characteristics and treatment

Psoriasis is a chronic multifactorial skin disease, characterized by inflammation and a strong genetic predisposition. The prevalence of psoriasis ranges between 0.4 and 5% worldwide. Psoriasis is often associated with a poor quality of life and high physical and psychosocial burden. Several therapies are now available for the treatment of psoriasis. Patients are treated with different drugs, depending on the severity of disease, as indicated by the PASI (Psoriasis Area Severity Index) score. Mild-to-moderate subjects are usually treated with topical treatments, while moderate-tosevere psoriatic patients often require systemic treatments. Among the systemic drugs, biological therapies have been revolutionizing the treatment of psoriatic patients. These are target-specific drugs, mainly monoclonal antibodies and receptor fusion proteins. Biologics are able to improve therapeutic outcomes, and have a favorable tolerability. Biological therapies used in psoriasis include antagonists of cytokines or their receptors, such as anti-TNF agents, anti-IL12/23, anti-IL17, anti-IL17-receptor, and anti-IL23 antibodies. Biologic agents lead to a significant improvement in symptoms; however, psoriasis remains a condition with no permanent resolution. Thus, innovative mechanisms of action are currently being investigated, in order to identify new possible therapeutic targets. The prevalence of psoriasis among men and women is known to be balanced. However, the severity of the disease can vary between genders: several studies show that, in fact, female patients are less severely affected by psoriasis than males. The median PASI score is often lower in women, regardless of age, thus female patients receive systemic treatments less frequently. However, in many cases women suffer from a greater psychological distress. For all these reasons, physicians should consider gender perspective in the management of psoriatic patients and their comorbidities. No clear differences have been observed in the response to treatment of psoriatic patients, regardless of their lifestyle, race/ethnicity, geographic location or gender. In spite of their higher cost, biologics are currently the treatment of choice of moderate-to-severe psoriatic patients, due to their favorable safety and efficacy profiles.