Psoriasis is a chronic inflammatory condition that affects the skin. Psoriasis is less common among African Americans, but patients are more likely to experience more severe disease. Because skin tones vary from person to person, identifying, diagnosing, treating, and managing psoriasis effectively can be challenging.

Psoriasis typically appears in the form of red plaques covered in white or silver colored scales. This may appear differently on individuals with darker skin. Data from a national study revealed that African Americans are more likely to have undiagnosed psoriasis. Awareness of symptoms and what to look for can help lessen the likelihood of a missed or delayed diagnosis and equip you to better manage the condition.

Variations in Presentation

On fair or light skin, psoriasis looks red covered with silver scales. In African Americans, psoriasis often presents as more of a purple or violet color. On darker skin tones, it may present as a darker brown color which can be difficult to recognize.  Plaques may also be thicker and have more scales, impact larger areas of the body, and may be misdiagnosed as dark patches rather than active flares.

Key Considerations

Key considerations when evaluating psoriasis in skin of color include:

• Lesions may appear more pigmented rather than red in color
• Possibility of increased area of involvement when compared to lighter skin
• Temporary discoloration may occur at the site once psoriasis clears
• Dyspigmentation is a common occurrence and concern
• Physical symptoms of other conditions may be similar to psoriasis

Challenges in Diagnosis

There are challenges that exist when diagnosing psoriasis in skin of color. A recent study revealed that when compared to white patients, patients with darker skin tones may wait up to 3 times longer to receive a psoriasis diagnosis and can be 4 times as likely to require a biopsy to confirm diagnosis.

Receiving an appropriate diagnosis is the first step to moving forward with access to treatment options. It may be beneficial to follow up with a dermatologist who is a person of color or  specializes in treating skin of color. It is important that you advocate for yourself and ensure you are comfortable expressing your concerns to your provider.

Treatment considerations

Psoriasis treatment is the same regardless of skin color. Because patients of color with psoriasis may experience more severe disease and thicker plaques, more aggressive treatment may be necessary.

Patients with darker skin should also use caution when utilizing phototherapy as a treatment option due to the increased risk of changes in skin color of the affected areas. If you are living with scalp psoriasis, your provider may recommend treatment that includes daily use of medicated shampoo. If daily hair washing is not part of your usual routine, communicate your concerns with your provider. Communication is key to ensure your treatment plan works best for you.

Resources and Support

Regardless of skin tone, patients of all races living with psoriasis face various challenges. You are not alone in your journey.

If you or someone you know has been diagnosed with plaque psoriasis learn more about the LATITUDE study.

References

• The Journal of Clinical and Aesthetic Dermatology. Psoriasis in Skin of Color: Epidemiology, Genetics, Clinical Presentation, and Treatment Nuances
• Journal of the American Academy of Dermatology. The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: Results from NHANES 2003–2004
• American Academy of Dermatology Association. Can You Get Psoriasis if You Have Skin of Color?
• National Psoriasis Foundation. Skin of Color Resource Center
• Racial Disparities in the Diagnosis of Psoriasis