银屑病性别差异的研究进展

doi:10.35541/cjd.20230200

Abstract

Abstract: 【Abstract】 The prevalence, severity, treatment response, and prognosis of diseases may have gender biases. In recent years, studies have shown that there are gender differences in the occurrence, development, treatment, disease burden, prognosis, and comorbidities of psoriasis, which provides new directions for improving the treatment response and prognosis of psoriasis. This review summarizes the gender differences in epidemiology, clinical characteristics, treatment, disease burden, prognosis, and comorbidities of psoriasis.

Key words: Psoriasis, Gender differences, Severity of illness, Long term management, Prognosis

Wei Lu, Wang Chang, Zhang Buxin, Xu Juntao, Wang Li, Wang Qingxing, Lu Lingling, Liu Aimin. Gender differences in psoriasis[J]. Chinese Journal of Dermatology,2024,e20230200. doi:10.35541/cjd.20230200

References ［59］

［1］	Bouman A, Heineman MJ, Faas MM. Sex hormones and the immune response in humans［J］. Hum Reprod Update, 2005,11（4）:411⁃423. doi: 10.1093/humupd/dmi008.
［2］	王澍, 王明悦, 夏杨, 等. 6093例银屑病患者临床资料回顾性分析［J］. 中国医学前沿杂志（电子版）, 2021,13（12）:1⁃8. doi: 10.12037/YXQY.2021.12⁃01.
［3］	Patel S, Yang K, Nambudiri VE. Exploring sex differences in generalized pustular psoriasis hospitalizations［J］. Exp Dermatol, 2023,32（8）:1312⁃1313. doi: 10.1111/exd.14742.
［4］	Grellmann C, Dombrowsky W, Fabricius V, et al. Epidemiology and treatment of patients with rheumatoid arthritis, psoriatic arthritis and psoriasis in Germany: a real⁃world evidence study［J］. Adv Ther, 2021,38（1）:366⁃385. doi: 10.1007/s12325⁃020⁃01522⁃8.
［5］	Pina Vegas L, Sbidian E, Penso L, et al. Epidemiologic study of patients with psoriatic arthritis in a real⁃world analysis: a cohort study of the French health insurance database［J］. Rheumatology （Oxford）, 2021,60（3）:1243⁃1251. doi: 10.1093/rheumatology/keaa448.
［6］	Karmacharya P, Crowson CS, Bekele D, et al. The epidemiology of psoriatic arthritis over five decades: a population⁃based study［J］. Arthritis Rheumatol, 2021,73（10）:1878⁃1885. doi: 10.1002/art.41741.
［7］	Parisi R, Iskandar I, Kontopantelis E, et al. National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modelling study［J］. BMJ, 2020,369:m1590. doi: 10.1136/bmj.m1590.
［8］	Armstrong AW, Mehta MD, Schupp CW, et al. Psoriasis prevalence in adults in the United States［J］. JAMA Dermatol, 2021,157（8）:940⁃946. doi: 10.1001/jamadermatol.2021.2007.
［9］	Asili P, Tootoonchi N, Nasimi M, et al. Demographic aspects, clinical characteristics, and therapeutic approaches in geriatric psoriasis: A study from a tertiary center［J］. Dermatol Ther, 2022,35（8）:e15628. doi: 10.1111/dth.15628.
［10］	Golińska J, Sar⁃Pomian M, Rudnicka L. Dermoscopy of plaque psoriasis differs with plaque location, its duration, and patient's sex［J］. Skin Res Technol, 2021,27（2）:217⁃226. doi: 10.1111/srt.12933.
［11］	Murer C, Sgier D, Mettler SK, et al. Gender differences in psoriasis: a Swiss online psoriasis survey［J］. Arch Dermatol Res, 2021,313（2）:89⁃94. doi: 10.1007/s00403⁃020⁃02066⁃1.
［12］	Chen K, Wang G, Jin H, et al. Clinic characteristics of psoriasis in China: a nationwide survey in over 12000 patients［J］. Oncotarget, 2017,8（28）:46381⁃46389. doi: 10.18632/oncotarget. 18453.
［13］	Eder L, Thavaneswaran A, Chandran V, et al. Gender difference in disease expression, radiographic damage and disability among patients with psoriatic arthritis［J］. Ann Rheum Dis, 2013,72（4）:578⁃582. doi: 10.1136/annrheumdis⁃2012⁃201357.
［14］	Furer V, Wollman J, Levartovsky D, et al. Sex⁃based differences in sonographic and clinical findings among patients with psoriatic arthritis［J］. J Rheumatol, 2023,50（2）:197⁃203. doi: 10.3899/jrheum.220547.
［15］	Na SJ, Jo SJ, Youn JI. Clinical study on psoriasis patients for past 30 years （1982-2012） in Seoul National University Hospital Psoriasis Clinic［J］. J Dermatol, 2013,40（9）:731⁃735. doi: 10.1111/1346⁃8138.12224.
［16］	Odorici G, Paganelli A, Peccerillo F, et al. Moderate to severe psoriasis: a single⁃center analysis of gender prevalence［J］. Ital J Dermatol Venerol, 2021,156（2）:226⁃230. doi: 10.23736/S2784⁃8671.18.06200⁃4.
［17］	Hägg D, Sundström A, Eriksson M, et al. Severity of psoriasis differs between men and women: a study of the clinical outcome measure psoriasis area and severity index （pasi） in 5438 Swedish register patients［J］. Am J Clin Dermatol, 2017,18（4）:583⁃590. doi: 10.1007/s40257⁃017⁃0274⁃0.
［18］	Napolitano M, Mastroeni S, Fania L, et al. Sex⁃ and gender⁃associated clinical and psychosocial characteristics of patients with psoriasis［J］. Clin Exp Dermatol, 2020,45（6）:705⁃711. doi: 10.1111/ced.14218.
［19］	Peng C, Xu X, Chen W, et al. Epidemiological variations in the global burden of psoriasis, an analysis with trends from 1990 to 2017［J］. Front Med （Lausanne）, 2021,8:585634. doi: 10.3389/fmed.2021.585634.
［20］	Colombo D, Bianchi L, Fabbrocini G, et al. The CANOVA study real⁃world evidence of biologic treatments in moderate⁃severe psoriasis in Italy: a gender perspective［J］. Womens Health Rep （New Rochelle）, 2022,3（1）:450⁃457. doi: 10.1089/whr.2021. 0124.
［21］	Maul JT, Augustin M, Sorbe C, et al. Association of sex and systemic therapy treatment outcomes in psoriasis: a two⁃country, multicentre, prospective, noninterventional registry study［J］. Br J Dermatol, 2021,185（6）:1160⁃1168. doi: 10.1111/bjd.20387.
［22］	Cao F, He YS, Wang Y, et al. Global burden and cross⁃country inequalities in autoimmune diseases from 1990 to 2019［J］. Autoimmun Rev, 2023,22（6）:103326. doi: 10.1016/j.autrev. 2023.103326.
［23］	Duruöz MT, Gezer HH, Nas K, et al. Gender⁃related differences in disease activity and clinical features in patients with peripheral psoriatic arthritis: a multi⁃center study［J］. Joint Bone Spine, 2021,88（4）:105177. doi: 10.1016/j.jbspin.2021.105177.
［24］	Lubrano E, Scriffignano S, Fatica M, et al. Psoriatic arthritis in males and females: differences and similarities［J］. Rheumatol Ther, 2023,10（3）:589⁃599. doi: 10.1007/s40744⁃023⁃00535⁃3.
［25］	Passia E, Vis M, Coates LC, et al. Sex⁃specific differences and how to handle them in early psoriatic arthritis［J］. Arthritis Res Ther, 2022,24（1）:22. doi: 10.1186/s13075⁃021⁃02680⁃y.
［26］	Nas K, Kiliç E, Tekeoğlu İ, et al. The effect of gender on disease activity and clinical characteristics in patients with axial psoriatic arthritis［J］. Mod Rheumatol, 2021,31（4）:869⁃874. doi: 10.1080/14397595.2020.1812870.
［27］	Gossec L, Walsh JA, Michaud K, et al. Women with psoriatic arthritis experience higher disease burden than men: findings from a real⁃world survey in the United States and Europe［J］. J Rheumatol, 2023,50（2）:192⁃196. doi: 10.3899/jrheum.220154.
［28］	Alamri A, Alqahtani R, Alshareef I, et al. Psoriasis in Saudi population: gender differences in clinical characteristics and quality of life［J］. Cureus, 2022,14（3）:e22892. doi: 10.7759/cureus.22892.
［29］	Orbai AM, Perin J, Gorlier C, et al. Determinants of patient⁃reported psoriatic arthritis impact of disease: an analysis of the association with sex in 458 patients from fourteen countries［J］. Arthritis Care Res （Hoboken）, 2020,72（12）:1772⁃1779. doi: 10.1002/acr.24090.
［30］	Maul JT, Navarini AA, Sommer R, et al. Gender and age significantly determine patient needs and treatment goals in psoriasis ⁃ a lesson for practice［J］. J Eur Acad Dermatol Venereol, 2019,33（4）:700⁃708. doi: 10.1111/jdv.15324.
［31］	Marques E, Paluch Z, Boháč P, et al. Epidemiology of moderate⁃to⁃severe psoriasis: a comparison between psoriasis patients treated with biological agents, conventional systemic drugs and topical agents［J］. J Dermatolog Treat, 2022,33（3）:1435⁃1448. doi: 10.1080/09546634.2020.1826393.
［32］	Hernández⁃Fernández CP, Carretero G, Rivera R, et al. Effect of sex in systemic psoriasis therapy: differences in prescription, effectiveness and safety in the BIOBADADERM prospective cohort［J］. Acta Derm Venereol, 2021,101（1）:adv00354. doi: 10.2340/00015555⁃3711.
［33］	Mease PJ, Gladman DD, Merola JF, et al. Potential impact of sex and BMI on response to therapy in psoriatic arthritis: post hoc analysis of results from the SEAM⁃PsA trial［J］. J Rheumatol, 2022,49（8）:885⁃893. doi: 10.3899/jrheum.211037.
［34］	Han L, Guo M, Wang B, et al. Sex⁃differential downregulation of methotrexate on plasma viscosity and whole blood viscosity in psoriasis［J］. Clin Hemorheol Microcirc, 2022,81（4）:305⁃314. doi: 10.3233/CH⁃211343.
［35］	Landgren AJ, Jonsson CA, Bilberg A, et al. Sex differences in cytokines and adipokines in obese patients with PsA and controls undergoing a weight loss intervention［J］. RMD Open, 2024,10（1）:e003821. doi: 10.1136/rmdopen⁃2023⁃003821.
［36］	Hägg D, Eriksson M, Sundström A, et al. The higher proportion of men with psoriasis treated with biologics may be explained by more severe disease in men［J］. PLoS One, 2013,8（5）:e63619. doi: 10.1371/journal.pone.0063619.
［37］	Verardi F, Maul LV, Borsky K, et al. Sex differences in adverse events from systemic treatments for psoriasis: A decade of insights from the Swiss Psoriasis Registry （SDNTT）［J］. J Eur Acad Dermatol Venereol, 2024,38（4）:719⁃731. doi: 10.1111/jdv.19730.
［38］	Kojanova M, Fialova J, Cetkovska P, et al. Demographic data, comorbidities, quality of life, and survival probability of biologic therapy associated with sex⁃specific differences in psoriasis in the Czech Republic［J］. Dermatol Ther, 2021,34（2）:e14849. doi: 10.1111/dth.14849.
［39］	Di Cesare A, Bianchi C, Pescitelli L, et al. Risk of acute infections in psoriatic patients during biologic therapies is linked to gender［J］. J Eur Acad Dermatol Venereol, 2019,33（10）:e362⁃e364. doi: 10.1111/jdv.15658.
［40］	van der Schoot LS, van den Reek J, Groenewoud J, et al. Female patients are less satisfied with biological treatment for psoriasis and experience more side⁃effects than male patients: results from the prospective BioCAPTURE registry［J］. J Eur Acad Dermatol Venereol, 2019,33（10）:1913⁃1920. doi: 10.1111/jdv.15733.
［41］	Sondermann W, Djeudeu Deudjui DA, Körber A, et al. Psoriasis, cardiovascular risk factors and metabolic disorders: sex⁃specific findings of a population⁃based study［J］. J Eur Acad Dermatol Venereol, 2020,34（4）:779⁃786. doi: 10.1111/jdv.16029.
［42］	Zheng Q, Kuai L, Jiang W, et al. Clinical feature, lifestyle behavior and non⁃communicable diseases comorbidities among psoriasis patients in Shanghai: gender disparity analysis based on a cross⁃sectional study［J］. Clin Cosmet Investig Dermatol, 2022,15:2751⁃2762. doi: 10.2147/CCID.S393697.
［43］	Duvetorp A, Mrowietz U, Nilsson M, et al. Sex and age influence the associated risk of depression in patients with psoriasis: a retrospective population study based on diagnosis and drug⁃use［J］. Dermatology, 2021,237（4）:595⁃602. doi: 10.1159/00050 9732.
［44］	Mulder M, Wenink MH, Vriezekolk JE. Being overweight is associated with not reaching low disease activity in women but not men with psoriatic arthritis［J］. Rheumatology （Oxford）, 2022,61（2）:770⁃774. doi: 10.1093/rheumatology/keab338.
［45］	Loo WY, Tee YC, Han WH, et al. Predictive factors of psoriatic arthritis in a diverse population with psoriasis［J］. J Int Med Res, 2024,52（1）:30006052 31221014. doi: 10.1177/0300060523122 1014.
［46］	Haddad A, Saliba W, Lavi I, et al. The association of psoriatic arthritis with all⁃cause mortality and leading causes of death in psoriatic arthritis［J］. J Rheumatol, 2022,49（2）:165⁃170. doi: 10.3899/jrheum.210159.
［47］	Murase JE, Chan KK, Garite TJ, et al. Hormonal effect on psoriasis in pregnancy and post partum［J］. Arch Dermatol, 2005,141（5）:601⁃606. doi: 10.1001/archderm.141.5.601.
［48］	Sobolev V, Soboleva A, Denisova E, et al. Differential expression of estrogen⁃responsive genes in women with psoriasis［J］. J Pers Med, 2021,11（9）:925. doi: 10.3390/jpm11090925.
［49］	Gegenhuber B, Wu MV, Bronstein R, et al. Gene regulation by gonadal hormone receptors underlies brain sex differences［J］. Nature, 2022,606（7912）:153⁃159. doi:10.1038/s41586⁃022⁃04686⁃1.
［50］	Adachi A, Honda T, Egawa G, et al. Estradiol suppresses psoriatic inflammation in mice by regulating neutrophil and macrophage functions［J］. J Allergy Clin Immunol, 2022,150（4）:909⁃919.e8. doi: 10.1016/j.jaci.2022.03.028.
［51］	Iwano R, Iwashita N, Takagi Y, et al. Estrogen receptor α activation aggravates imiquimod⁃induced psoriasis⁃like dermatitis in mice by enhancing dendritic cell interleukin⁃23 secretion［J］. J Appl Toxicol, 2020,40（10）:1353⁃1361. doi: 10. 1002/jat.3988.
［52］	Kanda N, Watanabe S. 17beta⁃estradiol stimulates the growth of human keratinocytes by inducing cyclin D2 expression［J］. J Invest Dermatol, 2004,123（2）:319⁃328. doi: 10.1111/j.0022⁃202X.2004.12645.x.
［53］	Wu H, Zeng L, Ou J, et al. Estrogen acts through estrogen receptor⁃β to promote mannan⁃induced psoriasis⁃like skin inflammation［J］. Front Immunol, 2022,13:818173. doi: 10.3389/fimmu.2022.818173.
［54］	杨梅, 唐彩红, 桂雨晴, 等. 咪喹莫特诱导银屑病模型小鼠T细胞免疫功能改变与性别的关系［J］. 中国药理学通报, 2022,38（4）:589⁃597. doi: 10.12360/CPB202108021.
［55］	Kobayashi K, Chikazawa S, Chen Y, et al. Oestrogen inhibits psoriasis⁃like dermatitis induced by imiquimod in mice in relation to increased IL⁃10 producing cells despite elevated expression of IL⁃22, IL⁃23, IL⁃17 mRNA［J］. Exp Dermatol, 2023,32（2）:203⁃209. doi: 10.1111/exd.14688.
［56］	Singh RP, Hahn BH, Bischoff DS. Interferon genes are influenced by 17β⁃estradiol in SLE［J］. Front Immunol, 2021,12:725325. doi: 10.3389/fimmu.2021.725325.
［57］	Gudjónsson JE, Kárason A, Antonsdóttir AA, et al. HLA⁃Cw6⁃positive and HLA⁃Cw6⁃negative patients with psoriasis vulgaris have distinct clinical features［J］. J Invest Dermatol, 2002,118（2）:362⁃365. doi: 10.1046/j.0022⁃202x.2001.01656.x.
［58］	Hong J, Qu Z, Ji X, et al. Genetic associations between IL⁃6 and the development of autoimmune arthritis are gender⁃specific［J］. Front Immunol, 2021,12:707617. doi: 10.3389/fimmu.2021.70 7617.
［59］	He S, Yang F, Lu C, et al. Sex⁃specific differences in patients with psoriatic arthritis:a nationwide study from the Chinese Registry of Psoriatic Arthritis （CREPAR IV）［J］. Clin Rheumatol, 2024,43（3）:1063⁃1071. doi: 10.1007/s10067⁃023⁃06859⁃3.

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[2]	Li Ziyu, Lu Yan. Paying attention to severe skin diseases after COVID-19 [J]. Chinese Journal of Dermatology, 2025, 58(4): 378-383.
[3]	Wan Yongjun, Yang Haijing, Yan Qiao, Chen Mei, Wang Fengyuan, Su Qianya, Dong Zhengbang, Wang Fei. Clinical and prognostic analysis of nine cases of immune checkpoint inhibitor-related Stevens-Johnson syndrome/toxic epidermal necrolysis [J]. Chinese Journal of Dermatology, 2025, 58(4): 347-351.
[4]	Group on Pediatric Dermatology, China Dermatologist Association, Committee on Psoriasis, Chinese Society of Dermatology. Expert consensus on the diagnosis and treatment of pediatric pustular psoriasis in China （2025 version） [J]. Chinese Journal of Dermatology, 2025, 58(4): 297-306.
[5]	He Chunxia, Jin Hongzhong . Principles, current status, challenges and perspectives in the diagnosis and treatment of critical dermatological emergencies [J]. Chinese Journal of Dermatology, 2025, 58(4): 307-314.
[6]	Li Xiuzhen, Xu Xiulian. Effects of interleukin-23 inhibitors on psoriasis comorbidities [J]. Chinese Journal of Dermatology, 2025, 58(3): 268-272.
[7]	Lianghong Chen Yan SUN Jing-Yu WANG. Benvitimod for the treatment of dermatoses [J]. Chinese Journal of Dermatology, 2025, 58(3): 266-268.
[8]	Xu Zhuohong, Hu Yu, Gu Heng. Role of mesenchymal stem cell-derived exosomes in skin diseases [J]. Chinese Journal of Dermatology, 2025, 0(3): 20220881-e20220881.
[9]	Wang Wenqiu, Li Chengxin, Wang Rui. Biologics for the treatment of psoriasis relapse: current status [J]. Chinese Journal of Dermatology, 2025, 0(3): 20230301-e20230301.
[10]	Zhang Xiaoxu, Luo Suju. Efficacy and safety of upadacitinib in the treatment of six cases of palmoplantar pustulosis [J]. Chinese Journal of Dermatology, 2025, 0(2): 20230772-e20230772.
[11]	Jin Lan, Qiu Yun, Wang Weijia, Kang Xiaojing, Ding Yuan. Clinical efficacy and safety of biological agents in the treatment of moderate-to-severe psoriasis in 124 elderly patients: a retrospective analysis [J]. Chinese Journal of Dermatology, 2025, 58(1): 47-52.
[12]	Wang Bo, Zheng Jie. Considerations in the treatment of elderly patients with psoriasis and atopic dermatitis using biologics and small-molecule drugs [J]. Chinese Journal of Dermatology, 2025, 58(1): 72-75.
[13]	Chen Jiaqi, Zhang Jin, Tang Jun. Relationships between coronavirus disease 2019 and psoriasis [J]. Chinese Journal of Dermatology, 2025, 58(1): 84-88.
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