Wake Forest study shows women suffer from 'gender gap' in treatment of severe psoriasis

April 02, 2000

WINSTON-SALEM, N.C. - When it comes to the treatment of severe psoriasis, there is no equality between the sexes.

Men have enjoyed the benefit of powerful drugs that address the disease, but women of childbearing age have gone without, according to dermatologists at the Westwood Squibb Center for Dermatology Research at Wake Forest University School of Medicine.

In an article in the April issue of the Journal of the American Academy of Dermatology, Alan B. Fleischer, Jr., M.D. and Steven E. Feldman, M.D., report that doctors have not prescribed the most effective medicines for treating severe psoriasis for women under 50.

"We believe this reflects the fact that some of the oral medications used for treating severe psoriasis pose risks to pregnant women," said Fleischer, associate professor of dermatology. "They can cause birth defects or induce premature delivery. While we are glad to see that doctors recognize these risks and are not prescribing these medications to women, the result is that women have been left to suffer."

New medications may finally address this inequity, Fleischer said. The newer drugs do not carry risk of birth defects or premature delivery.

Psoriasis is a chronic disease that leaves the skin red and scaly. The affected areas are uncomfortable and easily irritated. Anyone with psoriasis covering more than 10 percent of their body is considered to have a severe case.

In lieu of oral medications that pose a risk, the researchers noted that women received more ultraviolet light therapy than men. But these treatments are more inconvenient than taking pills at home and some ultraviolet treatments carry a significant risk of causing skin cancer.

The report is based on a study of information gathered as part of the National Ambulatory Medical Care Survey for 1990 through 1994. For patients older than 50 (beyond childbearing years) with severe psoriasis, women were more likely than men to receive powerful drugs. For patients younger than 50, men were three times more likely than women to receive powerful drugs.

The study found no differences between the sexes in the treatment for mild cases of psoriasis. The study was financed by a grant from Novartis Pharmaceuticals Corp.

The study does not include information collected in 1995 and 1996, the most recent years that information was available, because of changes in the survey format.

The data does not reflect the development of a new medication that may address this imbalance. In 1998 the Food and Drug Administration approved the use of a new drug using cyclosporin A, sold under the trade name Neoral, for treating severe psoriasis.

Cyclosporin A does not carry the risk of birth defects or premature delivery, Fleischer said, which makes it more suitable for treating women of childbearing age. However, like any powerful drug, its use must be monitored.

"Our research shows that there is clearly a gender gap when it comes to medical options for patients with severe psoriasis," Fleischer said. "But with new treatment options available, women with severe psoriasis should consider seeing their dermatologist."

The Westwood-Squibb Center for Dermatology Research is a research program within the Wake Forest University School of Medicine that investigates economic, ethical and policy issues critical to the practice of dermatology. It was established in August 1998 with the assistance of a five-year, $1 million research grant from Westwood-Squibb Pharmaceuticals.
Contact: Robert Conn, Jim Steele or Mark Wright (336) 716-4587.

Wake Forest Baptist Medical Center

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