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Managing Your Psoriasis

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How Psoriasis Is Different for People of Color

Medically Reviewed By William C. Lloyd III, MD, FACS

It doesn’t seem entirely surprising that a skin disease could present differently in people of various ethnicities and skin colors. However, in the case of psoriasis, these differences sometimes make it challenging for People of Color to receive a proper diagnosis.

Let’s examine some of the clinical characteristics and overall experience of psoriasis in patients with skin of color.

1. People of Color are less likely to have psoriasis, but when they do, it has a greater impact on their quality of life

Studies have shown white people have a higher incidence of psoriasis as compared to other groups, though the number of People of Color with psoriasis has increased in recent years. A survey performed in 2013 estimated 3.6% of white people over the age of 20 are affected by psoriasis, whereas 1.9% of African American people and 1.6% of Hispanic people suffer from the disease.

However, African American people and Hispanic people appear to be more negatively impacted by psoriasis. Based on a quality-of-life questionnaire, one study found these two groups reported worse physical and psychological symptoms resulting from psoriasis than white participants. Additionally, the National Psoriasis Foundation reported 72% of people in historically marginalized communities stated that psoriasis affected their lives, as opposed to 54% of white people surveyed.

2. Skin areas affected by psoriasis are not typically red

The way psoriasis appears in people with dark skin is often different than what is seen in their lighter-skinned counterparts. While most white people will present with reddened patches of skin, People of Color may have psoriasis that is dark brown or violet in color. The scales of psoriasis are often thicker as well.

Once the psoriasis plaques clear up, People of Color are also more likely to find the affected skin is noticeably darker or lighter than it was previously. This change in appearance can last for up to a year, and for some people, can be quite distressing.

3. Psoriasis covers more body surface area for People of Color

African Americans often have psoriasis that is more widespread. In one study, African Americans reported that up to 10% of their body surface area was affected by psoriasis, while white people reported only 1 to 2%.

Psoriasis is also more commonly found on the scalp in People of Color than it is in white people.

4. People of Color with psoriasis are more likely to be misdiagnosed

In darker-skinned individuals, other skin conditions can look quite similar to psoriasis, including lichen planus, sarcoidosis, and cutaneous lupus. Often a biopsy is needed to determine the true disease. However, when this is not performed, people are more likely to receive an improper diagnosis. Unfortunately, the longer the delay in receiving proper treatment, the more the disease can progress.

5. People of Color with psoriasis may follow different treatment paths than their white counterparts

It may difficult to pin down the most effective psoriasis treatment regimen for People of Color. For example, phototherapy is commonly used to treat severe cases of psoriasis. Darker-skinned people may require more intense light exposure to adequately treat the disease. At the same time, they are also more likely to experience changes in skin pigmentation following phototherapy, so doctors need to discuss this prior to beginning treatment.

Cultural preferences and practices must also be taken into account when making treatment decisions. In the case of scalp psoriasis, doctors should consider someone's hair care routine and help develop a plan that works in conjunction with it. In addition, some people may already use herbal treatments or therapies that are native to their cultures, and it is important that doctors take the time to assess for this in order to avoid potential adverse reactions to the treatment prescribed.

Thankfully, we’re continuing to learn more and more about the nuances of psoriasis in People of Color. Doctors are speaking on behalf of their Patients of Color to increase awareness and advocate for proper management of psoriasis. Research is increasing in this area, as well.

In the meantime, as always, if you have any concerns about your psoriasis and its treatment, check in with your doctor. Communication is key to develop a plan that works best for you.

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  1. Alexis A, Blackcloud P. Psoriasis in Skin of Color: Epidemiology, Genetics, Clinical Presentation, and Treatment Nuances. Journal of Clinical and Aesthetic Dermatology. 2014 Nov; 7(11): 16–24
  2. Docs tell Congress to improve care for psoriasis in people of color. National Psoriasis Foundation.
  3. How to diagnose, treat psoriasis in skin of color. National Psoriasis Foundation.
  4. People of all races overcome psoriatic disease. National Psoriasis Foundation.
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2022 Dec 4
View All Managing Your Psoriasis Articles
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