Cutaneous Autoimmune Connective Tissue Disorders

  • Wohl Yonit


Gender has a significant influence on the development of autoimmune diseases whereby in general, women are more susceptible than men. The established striking predominance in females in most of cutaneous collagen disorders such as Systemic Lupus Erythematosus, Systemic Sclerosis or Siogren Syndrome is related mainly to the complex interactions of sex hormones and the immune system.

Despite the increased awareness and significant progress in research detailed in this review, there is still a gap of reference to gender in some skin specific autoimmune disorders investigated, providing challenging future goals.


Female predominance Gender dimorphism Immunologic hormonal interface Multifactorial pathogenesis Environmental and lifestyle induced autoimmunity 


  1. 1.
    Brenner S, Wohl Y. Gender as a roadmap to dermatological diseases. Womens Health. 2007;3(2):127–9.Google Scholar
  2. 2.
    Eaton WW, Rose WR, et al. Epidemiology of autoimmune diseases in Denmark. J Autoimmun. 2007;29:1–9.CrossRefGoogle Scholar
  3. 3.
    Ngo ST, Steyn FJ, McCombe PA. Gender differences in autoimmune disease. Front Neuroendocrinol. 2014;35:347–69.CrossRefGoogle Scholar
  4. 4.
    Ansar Ahmed S, Hissong BD, Verthelyi D, Donner K, Becker K, Karpuzoglu-Sahin E. Gender and risk of autoimmune diseases: possible role of estrogenic compounds. Environ Health Perspect. 1999;107:681–6.CrossRefGoogle Scholar
  5. 5.
    Si ML, Al-Sharafi B, Lai CC, Khandori R, Chang C, Su CY. Gender differences in cytoprotection induced by estrogen on female and male bovine aorthic endothelial cells. Endocrine. 2001;15:255–62.CrossRefGoogle Scholar
  6. 6.
    Otensen M, Forgert F, Nelson JL, Schuhmacher A, Hebisch G, Villiger PM. Pregnancy in patients with rheumatic disease: anti-inflammatory cytokine increase in pregnancy and decrease post partum. Ann Rheum Dis. 2005;64:839–44.CrossRefGoogle Scholar
  7. 7.
    Saito S, Nakashima A, Ito M, Shima T. Clinical implications of recent advances in our understanding of IL-17 and reproductive immunology. Expert Rev Clin Immunol. 2011;7:649–57.CrossRefGoogle Scholar
  8. 8.
    Straub RH. The complex role of estrogens in inflammation. Endocr Rev. 2007;28:521–74.CrossRefGoogle Scholar
  9. 9.
    Sharma S, Eghbali M. Influence of sex differences on micro RNA gene regulation in disease. Biol Sex Differ. 2014;5:3.CrossRefGoogle Scholar
  10. 10.
    Chandran V, Raychaudhuri SP. Geo-epidemiology and environmental factors of psoriasis and psoriatic arthritis. J Autoimmun. 2010;34:314–21.CrossRefGoogle Scholar
  11. 11.
    Mok CC, Lau CS. Profile of sex hormones in male patients with systemic lupus erythematosus. Lupus. 2000;9:252–7.CrossRefGoogle Scholar
  12. 12.
    Chang DM, Chang CC, Kuo SY, et al. Hormonal profiles and immunological studies of male lupus in Taiwan. Clin Rheumatol. 1999;18:158–62.CrossRefGoogle Scholar
  13. 13.
    Murphy G, Isenberg D. Effect of gender on clinical presentation in systemic lupus erythematosus. Rheumatology. 2013;52(12):2108–15.CrossRefGoogle Scholar
  14. 14.
    Mok C, Lau C, Chan TS, et al. Clinical characteristics and outcome of southern Chinese males with systemic lupus erythematosus. Lupus. 1999;8:188–96.CrossRefGoogle Scholar
  15. 15.
    Renau AI, Isenberg DA. A comparison of ethnicity, clinical features, serology and outcome over 30 year period. Lupus. 2012;21:1041–8.CrossRefGoogle Scholar
  16. 16.
    Andrade R, Alacon G, Fernandez M, et al. Accelerated damage accrual among men with systemic lupus erythematosus. Results from a multi centric US cohort. Arthritis Rheum. 2007;56:622–30.CrossRefGoogle Scholar
  17. 17.
    Tan TC, Fang H, Magder L, et al. Differences between male and female systemic lupus erythematosus in a multi centric population. J Rheumatol. 2012;39:759–69.CrossRefGoogle Scholar
  18. 18.
    Tamir E, Brenner S. Gender differences in collagen diseases. Skinmed. 2003;2(2):113.CrossRefGoogle Scholar
  19. 19.
    Durosaro O, Davis MDP, Reed KB, et al. Incidence of cutaneous lupus erythematosus, 1965-2005. A population-based study. Arch Dermatol. 2009;145(3):249–53.CrossRefGoogle Scholar
  20. 20.
    Jarukitsopa S, Hoganson D, Crowson C, Sokumbi O, Davis MD, et al. Epidemiology of systemic lupus erythematosus and cutaneous lupus in a predominantly white population in the United States. Arthritis Care Res. 2015;26(6):817–28.CrossRefGoogle Scholar
  21. 21.
    Grönhagen CM, Fored CM, Granath F, Nyberg F. Cutaneous lupus erythematosus and the association with systemic lupus erythematosus. A population-based cohort of 1088 patients in Sweden. Br J Dermatol. 2011;164(6):1335–41.CrossRefGoogle Scholar
  22. 22.
    Vera-Recabarren M, Garcia-Carasaco M, Ramos-Casals M, Herrero C. Cutaneous lupus erythematosus: clinical and immunological study of 308 patients stratified by gender. Clin Exp Dermatol. 2009;35:729–35.CrossRefGoogle Scholar
  23. 23.
    Ramsey-Goldman R, Mattai SA, Schilling E, et al. Increased risk of malignancy in patients with systemic lupus erythematosus. J Investig Med. 1998;46:217–22.Google Scholar
  24. 24.
    Weyland CM, Scmidt D, Wagner U, et al. The influence of sex on the phenotype of rheumatoid arthritis. Arthritis Rheum. 1998;41:817–22.CrossRefGoogle Scholar
  25. 25.
    Schuna AA. Autoimmune rheumatic diseases in women. J Am Pharm Assoc. 2002;42:612–24.Google Scholar
  26. 26.
    Roberts-Thomson PJ, Jones M, Hakendorf P, et al. Scleroderma in South Australia: epidemiological observations of possible pathogenic significance. Intern Med J. 2001;31:220–9.CrossRefGoogle Scholar
  27. 27.
    Nashid M, Khanna PP, Furst DE, Clements PJ, et al. Gender and ethnicity differences in patients with diffuse systemic sclerosis - analysis from three large randomized clinical trials. Rheumatology. 2011;50(2):335–42.CrossRefGoogle Scholar
  28. 28.
    Tjarlund A, Rider TA, Mille L, Werth FW, Pilkington P, de Visser CA, Elin MF. Ethnic but not gender differences in disease manifestations in dermatomyositis patients. Arthritis Rheum. 2011;63:235.Google Scholar
  29. 29.
    Wohl Y, Heyman R, Shemesh P, Brenner S. Dermatomyositis illustrating the gender gap: a retrospective analysis of a series. Cutis. 2008;82(2):137–9.Google Scholar
  30. 30.
    Brandt JE, Priori R, Valesini G, Fairweather D. Sex differences in Sjögren’s syndrome: a comprehensive review of immune mechanisms. Biol Sex Differ. 2015;6:19.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Maccabi Health ServicesTel AvivIsrael
  2. 2.Ben Gurion University of the NegevBeer ShevaIsrael

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