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Sex-specific differences in the treatment of severe psoriasis
R S Hotard1, S R Feldman, A B Fleischer
1Westwood Squibb Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Background:
Psoriasis treatment requires consideration of patient-specific concerns in addition to the severity of skin involvement. There may be sex-specific differences in the treatment of severe psoriasis.
Objective:
The purpose of this study was to determine whether there are sex-specific differences in the treatment of severe psoriasis.
Methods:
We analyzed the medications prescribed to patients with a primary and only diagnosis of psoriasis recorded in the 1990-1994 National Ambulatory Medical Care Survey.
Results:
There were 8.5 million visits to physicians for the treatment of psoriasis in the years 1990-1994. These visits were made by approximately 4.3 million women and 4.1 million men. Only 39% of patients receiving systemic treatments were women. Women received less methotrexate (23% women) and etretinate (35% women) than men, but more psoralen photochemotherapy (PUVA) (63% women) and isotretinoin (100% women) than men. In contrast, there was no notable difference by sex in the potency of topical corticosteroid agents prescribed.
Conclusion:
For mild disease treated with topical agents alone, there is no notable difference in the treatment of men and women. Men are more likely than women to receive intensive treatments for severe psoriasis, at least in part because of the teratogenic potential of these treatments. There is a need for development of new treatments for severe psoriasis that are safe for women of childbearing potential.