It is known that psoriasis affects about as many women as men. However, it has been shown, both in Sweden and internationally, that men receive more frequent and more expensive care for their disease, compared to women.
"We find these differences unsettling, which is why we performed this study," says the senior author of the study, Marcus Schmitt-Egenolf, chief physician at the Dermatology & STI clinic of Norrland's University Hospital and associate professor at Umeň University. "While the study cannot rule out that women receiving psoriasis care are discriminated against, it does indicate that gender variations in care consumption are mainly caused by a greater severity of illness in men. It is important to incorporate the issue of the differences in the degree of severity into the debate about gender inequality in medical care."
In the study, which has been published in the open access journal PLOS One
, data from 2,294 Swedish patients with moderate to severe psoriasis was analysed. The study focused on the degree of severity of the illness in women and men, and at what stage of the symptoms biologics were administered. Biologics are a relatively new treatment and, being more costly than traditional treatment methods, are therefore often used when other treatments prove ineffective.
Data on patients' disease were obtained from the National Psoriasis registry PsoReg, which include, among other things, records of treatment with biologics.
The study shows that men had more severe symptoms than women, according to the Psoriasis Area and Severity Index, PASI, which is an established tool to evaluate the treatment effect on the skin.
The men had a significantly higher PASI score at the first contact with a dermatologist. When treatment with biologics was initiated, the average PASI score was 12.3 in men compared with 9.8 in women. Age, disease severity and joint involvement were factors that played a significant role in the decision to use biologics, while sex itself did not appear to have any significance.
"According to the results of the study", says Marcus Schmitt-Egenolf, "men with psoriasis have more severe symptoms than women, which in turn could explain why they receive more rigorous treatment at an earlier stage of the disease."
Marcus Schmitt-Egenolf, who is also responsible for the quality registry PsoReg, is convinced that the Swedish quality registries are an important instrument for achieving equality in care.
"One of the reasons why we set up PsoReg was to ensure that women and men get the same access to modern medicines," says Marcus Schmitt-Egenolf.