Ask the Expert: How Does Psoriasis Affect People with Skin of Color?

While people of all ethnicities are affected by psoriasis, those with skin of color can face unique challenges when it comes to psoriasis. These challenges can include barriers to accessing healthcare, obstacles to diagnosis, and difficulty with receiving treatments.

Barriers to accessing care can include:

• lack of disease awareness
• lack of insurance coverage or being underinsured
• costs
• location
• physician availability

Obstacles to diagnosis may include differences in how psoriasis presents on the body and limitations in accessing culturally competent care. This includes healthcare that respects your language needs and cultural values.

Difficulties with accessing treatment can be caused by:

• differences in treatment preferences
• lack of awareness of treatment options
• underrepresentation in clinical trials

Because of barriers to accessing care, delays in diagnosis, and treatment limitations, people with skin of color may be less likely to receive certain therapies and may be more likely to be hospitalized for severe psoriasis.

Additionally, while all people may experience the psychosocial impacts of psoriasis, people with skin of color may experience a greater impact on their quality of life.

The clinical presentation of psoriasis can vary across ethnic groups and skin types. People with skin of color can have psoriasis plaques that have different colorations. In darker skin types, psoriasis plaques may appear more blueish-purple, brown, or gray colored.

To an untrained eye, the inflammation associated with psoriasis may be less noticeable, and people with skin of color may experience more temporary changes in skin color after a flare. These are called post-inflammatory pigmentation changes.

Because some dermatologists may lack culturally competent training in the diagnosis of skin diseases in skin of color, these differences in the clinical presentation of psoriasis can lead to misdiagnosis or delays in diagnosis.

You should always seek a second opinion if you feel that your needs are being unmet or that your disease isn’t being adequately addressed.

People with skin of color may require special treatment considerations. Psoriasis plaques may be thicker or more scaly in some people and may involve different body surface areas.

It’s also important to take into account cultural preferences that those with skin of color may have. For example, scalp psoriasis may be more common in some people with skin of color, and it may also be more severe in black women.

It’s important that healthcare teams develop culturally competent treatment plans that account for:

• differences in hair type
• cultural grooming preferences
• hairstyle

This helps people to stick with their treatments and improves outcomes.

People with skin of color may also be left with hyperpigmentation (dark patches) after psoriasis lesions heal. Your care team should address this as part of your treatment plan if you develop it.

There may also be special considerations when using light therapy, also called phototherapy. Phototherapy may require higher dosing for those with skin of color, can cause darkening and tanning of the skin, and may cause dark spots to become more obvious. This should also be discussed in conversations about treatment.

While psoriasis plaques often look pink or red on white skin, psoriasis lesions may look quite different in people with skin of color.

In skin of color, skin inflammation may be less noticeable to the untrained eye.

In Hispanic people, psoriasis lesions may look salmon-colored, with a silvery-white scale.

In Black people, psoriasis plaques can look dark brown or violet, and the plaques may have a grayish scale.

People with skin of color may also have lighter or darker patches left behind on their skin where the psoriasis lesions once were. This is called post-inflammatory pigment change.

People with skin of color have historically been underrepresented in clinical trials, and psoriasis studies have traditionally been among the least diverse in clinical trials for dermatologic conditions.

Additionally, publications of clinical trials for psoriasis haven’t consistently reported comprehensive racial and ethnic data.

Going forward, it’s important to enroll more people with skin of color in future psoriasis clinical trials. It’s also important to find clinical investigators who have patients of color in their practices so they can enroll them in future psoriasis studies.

Further, future research should focus on how genetics may influence psoriasis treatment response, and data for different ethnic groups and their clinical response should be specifically reported.

People with skin of color can advocate for themselves by educating others about psoriasis and actively sharing their experiences and challenges with psoriasis.

They can also advocate by sharing their experiences with policymakers, helping to influence government policy that allows for greater access to care for people with skin of color who have psoriasis.

They can also join organizations, such as the National Psoriasis Foundation, to help build awareness about psoriatic disease and how it impacts their lives and the lives of others with skin of color, especially as relates to:

• challenges navigating the healthcare system
• accessing care
• receiving affordable and effective medications

Dr. Raechele Cochran Gathers is an ABMS board certified dermatologist and a fellow of the American Academy of Dermatology. She is passionate about wellness and health literacy. She is the founder of MDhairmixtress.com, a health and wellness website, and brand co-founder of Bloomballa Beauty, which creates adaptogenic tea-infusion beauty and wellness supplements.

How we reviewed this article:

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• Yadav G, et al. (2022). Unmet need in people with psoriasis and skin of color in Canada and the United States.
  link.springer.com/article/10.1007/s13555-022-00811-0

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