Sex Differences in Psoriasis Impact Perceptions of Disease, Treatment, & Quality of Life

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Data from the Swiss Psoriasis Registry and the EuroGuiDerm guidelines highlight sex differences in psoriasis and the impact on health-related quality of life.

At Maui Derm 2025, multiple sessions focused on the management of psoriasis. In a panel discussion with Joel Gelfand, MD, and April W. Armstrong, MD, MPH, the clinicians discussed the development of “patient-centered treatment plans to maximize outcomes and improve quality of life (QoL),” according to Dr. Gelfand.

In his introduction, Dr. Gelfand noted the existence of healthcare disparities in psoriasis. While Drs. Gelfand and Armstrong specifically addressed racial and ethnic disparities in psoriasis during their presentation, the chronic inflammatory skin condition also results in unique management challenges due to sex-related disparities.

In a separate study that was not presented at the meeting, Julia-Tatjana Maul, MD, and colleagues examined real-world data from the Swiss Psoriasis Registry (SDNTT). The findings highlight how men and women experience psoriasis differently, impacting their health-related quality of life (HRQoL).

Clinical Guidelines & Barriers to Treatment

Sex-based disparities in psoriasis go beyond biological differences. Women report a higher psychological burden, social stigmatization, and reduced QoL compared with men, despite often presenting with lower objective disease severity scores. Dr. Maul and colleagues found that women had significantly higher baseline Dermatology Life Quality Index (DLQI) scores than men, indicating greater perceived disease impact. This disparity persisted over 2 years, particularly among women treated with IL-12/23 inhibitors.

These findings, which were published in Acta Dermato-Venereologica, align with previous research suggesting that women experience greater mental health challenges and lower satisfaction with psoriasis treatments. The psychological toll of psoriasis, particularly in women, can affect adherence to therapy and overall treatment success, further complicating disease management.

Current guidelines for systemic psoriasis treatment, such as the EuroGuiDerm guidelines, emphasize disease severity and response to therapy but lack specific recommendations addressing sex-based differences.

The findings from Dr. Maul and colleagues support the need for a more personalized approach that accounts for HRQoL, treatment expectations, and patient-reported outcomes.

The EuroGuiDerm guideline on systemic psoriasis treatment notes that a significant barrier to equitable psoriasis management is the historical under-representation of women in clinical trials. Additionally, dermatologists may underestimate the psychological impact of psoriasis in women. Addressing these barriers requires increased use of patient-reported outcome measures (PROMs) in clinical decision-making, enhanced clinician awareness of sex differences in psoriasis burden, and more inclusive clinical trials that stratify treatment responses by sex. Clinicians should also be mindful of unconscious biases that may influence treatment decisions and work toward fostering a more patient-centered approach in psoriasis care, the authors of the guidelines noted.

Treatment, Communication & Management Strategies

Personalized treatment strategies should consider both clinical severity and HRQoL measures, the guideline authors continue. Women may benefit from early intervention with biologic therapies that effectively address both physical and psychological disease burden. Regular HRQoL assessments should be integrated into treatment planning to ensure therapies align with patient needs. IL-12/23 inhibitors may require closer monitoring in female patients, given their association with persistently lower QoL scores in the study cohort. Physicians should address psychosocial factors, such as depression and self-esteem issues, which disproportionately affect women with psoriasis. Expanding access to mental health support services and encouraging a multidisciplinary approach to psoriasis care can improve patient outcomes and long-term well-being.

Together, these research findings emphasize the impact of sex disparities in perceptions of disease, treatment satisfaction, and long-term QoL. Further, the Swiss Psoriasis Registry study reinforces the need for a gender-sensitive approach to psoriasis management.

By incorporating HRQoL assessments, tailoring treatment choices, and improving patient education, physicians can help bridge the gap in psoriasis care and ensure better outcomes for all patients. As research continues to explore the intersection of gender and disease burden, healthcare professionals must remain adaptable in their approach, striving for equitable care that addresses both the physical and emotional aspects of psoriasis.