Exploring the Impact of Gender and Age of Onset on Psoriasis Treatment Management

Background: Psoriasis is a chronic inflammatory skin disease characterized by a bimodal onset distribution, with cases categorized as early-onset or late-onset. While the prevalence of psoriasis is nearly equal between genders, men typically experience more severe forms of the disease, leading to differences in treatment approaches and clinical outcomes. The aim of this study was to investigate gender-based differences in treatment patterns among psoriasis patients, with a focus on how these differences vary by disease onset (early vs. late). Methods: A retrospective cohort study including individuals diagnosed with psoriasis between 1998 and 2022 through Clalit Health Services (CHS) in Israel. Gender-based differences in treatment patterns by psoriasis onset were analyzed using Chi-square and Fisher exact tests and survival analyses. Results: The disease onset showed a bimodal distribution among 3999 individuals, with women experiencing earlier onset compared to men (median age 37.2 vs. 40.1 years; p < 0.001). In early-onset psoriasis, men were significantly more likely than women to receive systemic (17.9% vs. 6.5%; p < 0.001) and biological therapies (3.8% vs. 1.6%; p = 0.005) and initiated these treatments earlier (p < 0.001). In contrast, no significant gender-based treatment differences were observed in late-onset cases. Regardless of gender, early-onset patients began phototherapy earlier than late-onset patients (p < 0.001). Conclusions: Our results suggest that disease onset timing may influence treatment decisions and highlight the need for a more personalized approach to psoriasis management that considers both gender and age of onset.