Gender perspective in the management of psoriasis

Gender medicine has been achieving increasing importance. Gender differences in disease depend on hormonal status and may involve functions of the skin, immune responses and metabolic pathways, and have to do also with indications and response to treatments. Psoriasis is a common chronic inflammatory immune-mediated disease. The prevalence of psoriasis in the population is balanced between males and females, but early onset psoriasis is slightly more prevalent in males, with the latter suffering from a more severe disease. In general, male and female patients receive identical drugs at equivalent dosages. However, females receive systemic treatments less frequently compared to males. Males are more satisfied with their psoriasis treatment and respond better to biologics. Females have a significant higher rate of adverse events and drug-related discontinuation rate compared to males. About conventional systemic treatments for psoriasis during pregnancy, only cyclosporine is suggested when the benefits exceed the potential side effects, whereas methotrexate is contraindicated during pregnancy and lactation and in the three months before fatherhood and motherhood. Among the biologics, only certolizumab pegol is considered safe in pregnant patients, as it does not cross the maternal-placental barrier. Therefore, it is important to consider a gender perspective in the treatment of psoriasis, including her willingness to procreate. This is a narrative review highlighting the challenges that the healthcare dermatologists may face regarding management of psoriasis in female patients.