Study Highlights Gender Disparities in Treatment Outcomes for Skin Diseases

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A new study highlighted gender and sex disparities in treatment outcomes for psoriasis and other skin diseases, a notable conclusion of which was the fact that the female sex was a negative predictor of response to psoriasis treatment.¹

This new analysis was led by Sarah Preis, from the Technical University of Munich School of Medicine and Health’s department of dermatology and allergy in Germany. The investigators sought to evaluate the long-disregarded gender and sex disparities related to skin disease which, they noted, had not been systematically reviewed.

In fact, Preis et al. commented that for decades, there had been a prevailing view that female and male cells had the same characteristics. They added that evidence-based medicine had also been largely delineated by clinical studies looking at male patients.²

“Therefore, this systematic review aims to examine the current knowledge of sex and gender in treatment outcomes of skin diseases to identify gender-specific considerations that could lead to improved and more tailored treatment approaches for both male and female patients and path the way for individualized medicine,” Preis and colleagues wrote.¹

Trial Design

In January 2001, the World Health Organization (WHO) recommended that those in healthcare develop and implement local strategies for gender-sensitive care. Consequently, the investigators conducted their research and utilized the PubMed Medline, Embase, and Web of Science databases.

Their search was done in May 2022, with an update in December 2022. The research team used free-text terms, medical subject headings, study-type filters, and filters for humans and adult patients where applicable.

Endnote was implemented by 2 reviewers in their independent screening of all identified records by title and abstract, with those deemed potentially relevant being obtained for full-text screening. Full-text papers were screened for eligibility using a protocol developed using the PICO (population, intervention, comparison, and outcome) framework.

Both English and German randomized controlled trials were included in the team’s research, as well as prospective and retrospective cohort studies and case–control studies. This resulted in a total of 83 included reports.

Study Findings

The majority of the publications identified by the research team were aimed at gender differences in psoriasis and psoriatic arthritis (49 in total), followed by 8 studies related to melanoma, and several on infectious, inflammatory, and autoimmune skin disorders.

In all aspects, the investigators identified gender differences in psoriasis, though specific publications with regard to gender differences in other skin diseases were lacking. Among the notable findings highlighted, the team noted that males with psoriasis and hand eczema had been typically given systemic therapies at a younger age versus females.

Females were also noted as having received more topical therapies and fewer systemic options versus males. The investigators also found that males were more likely to be given whole-body UV treatment and that women received slightly more non-biologic therapies versus men (71.6% versus 69.4%, respectively). Women also used methotrexate for shorter periods, leading to lower cumulative doses (P < .00).

Additionally, the research team found that male patients with psoriasis began systemic treatment typically at a younger age than females, the latter of which also experienced delays in beginning b-DMARDS. Males were found to have higher Psoriasis Area Severity Index (PASI) scores by the point of biologic initiation, though the team noted no differences between the sexes in the time to initiation of biologic therapies.

Male gender was also linked with better TNFi effectiveness. Following a year of medication, females were also noted as having worse physical function and increased risk of mortality in psoriasis. In summary, most studies identified in this review showed that female gender/sex was a negative predictor of response to psoriasis treatment.

“In the future, every clinical study should therefore evaluate its results with regard to sex and gender to address these factors,” they wrote. “To answer the initial question posed in the title: It is not generally time for new guidelines, but it is time to consider sex and gender in every aspect of the patient journey. To achieve this, gender-specific studies are needed initially, and yes, eventually it may be time for new guidelines as well.”

References

1. ^{Preis S, Ziehfreund S, Biedermann T, Horster S, Zink A. A systematic review of sex and gender differences in treatment outcome of inflammatory skin diseases: Is it time for new guidelines? J Eur Acad Dermatol Venereol. 2024 Jul 30. doi: 10.1111/jdv.20256. Epub ahead of print. PMID: 39078087.}
2. ^{Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, Brinton RD, Carrero JJ, DeMeo DL, et al. Sex and gender: modifiers of health, disease, and medicine. Lancet. 2020; 396(10250): 565–582.}