Sex Differences in Quality of Life Related to Nail Psoriasis Among Patients With Psoriatic Disease

BACKGROUND: Nail psoriasis (NPso) affects around 70% of patients with psoriatic disease (PD), affecting the aesthetic, psychological, and functional aspects of their lives. Despite its burden, sex differences in quality of life related to nail psoriasis (QoL-NPso) remain underexplored. OBJECTIVES: The study aimed to compare QoL-NPso between female and male patients with PD and to examine the interaction between sex and QoL-NPso in relevant patient-reported outcomes (PROs). METHODS: We conducted a cross-sectional analysis nested within IMPACTO, a prospective PD cohort at a tertiary academic center. NPso was assessed using the Nail Psoriasis Severity Index (NAPSI), and QoL-NPso was measured with the Nail Psoriasis Quality of Life questionnaire. PROs included the WHOQoL-BREF, HAQ-DI, and HADS. Interaction analyses evaluated the combined effect of sex and QoL-NPso on PROs, adjusting for relevant sociodemographic and clinical covariates. The institutional ethics committee approved the study. RESULTS: The study included 77 PD patients; NPso was present in 66%. Women exhibited longer disease duration ( p =0.03), higher disease activity ( p =0.02), more years of formal education ( p =0.02), and lower rates of paid employment ( p =0.003). QoL-NPso was associated with lower physical, psychological, and social QoL scores, as well as higher disability, depression, and anxiety scores. These associations were significant in women but not in men. Interaction analysis revealed that women in the highest QoL-NPso tertile experienced significantly worse scores across the PROs than men. CONCLUSIONS: Sex modified the impact of NPso on PROs, with women experiencing greater psychosocial distress and QoL impairment than men, supporting the need for sex-gender-sensitive interventions.