Psoriasis is a chronic inflammatory skin condition that affects people of all races and ethnicities but presents unique challenges for patients of color, complicating diagnosis and treatment. On lighter skin tones, psoriasis typically appears as erythema or red scaly plaques, but on skin of color, it often manifests differently, with lesions appearing more violet, grayish, or dark brown, and with thicker scales.
These clinical variations often lead to misdiagnosis or delayed diagnosis, resulting in more severe disease at initial presentation.
In deeply pigmented skin, psoriasis can be misdiagnosed as lichen planus, cutaneous lupus erythematosus, or sarcoidosis. One study reported that African American patients tend to have more extensive disease involvement and higher body surface area (BSA) involvement compared to non skin-of-color patients, with severe scalp involvement reported as common in both Black and Asian patients.
The impact of psoriasis on patients of color is profound, extending beyond physical symptoms to include significant psychological and social burdens. Studies have shown that patients with skin of color diagnosed with psoriasis experience greater impairment in health-related quality of life compared to White patients, even when controlling for percent BSA affected, physician’s global assessment (PGA), and other confounding factors.
Treatment for psoriasis includes topical treatments, phototherapy, and systemic medications. In severe cases, biologics may be necessary. However, people with psoriasis and skin of color may be less likely to receive treatment with biologic therapies than White patients. A study of medication use in patients with psoriasis found that biologic utilization was lower among Black patients than among White patients and lower among other racial minority groups as well. Another study found that Black and Hispanic patients were less likely to receive various biologic and non-biologic therapies than White patients.
Differences in how people with skin of color experience dermatological conditions are intertwined with the barriers to healthcare they encounter.
Barriers to care for patients of color are multifaceted. Access to dermatologists who are knowledgeable about psoriasis in diverse skin tones may be limited, contributing to disparities in care. Socioeconomic factors, including lack of insurance or underinsurance, can prevent these patients from seeking timely medical attention or affording necessary treatments. Cultural and language barriers may also play a role, as patients may face difficulties in communicating their symptoms and concerns effectively or may encounter healthcare providers who lack cultural competence.
Addressing these barriers is crucial for improving health outcomes and achieving health equity in psoriasis care. Enhancing medical education to include comprehensive training on dermatological conditions in diverse skin types is a fundamental step. By doing so, we can enhance health outcomes and move towards greater health equity in psoriasis care.
Sources:
- Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014;7(11):16-24.
- Chatrath S, Bradley L, Kentosh J. Dermatologic conditions in skin of color compared to white patients: similarities, differences, and special considerations. Arch Dermatol Res. 2023;315(5):1089-1097. doi:10.1007/s00403-022-02493-2
- Kaufman BP, Alexis AF. Psoriasis in Skin of Color: Insights into the Epidemiology, Clinical Presentation, Genetics, Quality-of-Life Impact, and Treatment of Psoriasis in Non-White Racial/Ethnic Groups [published correction appears in Am J Clin Dermatol. 2018 Jun;19(3):425. doi: 10.1007/s40257-018-0347-8]. Am J Clin Dermatol. 2018;19(3):405-423. doi:10.1007/s40257-017-0332-7
- Khanna R, Khanna R, Desai SR. Diagnosing Psoriasis in Skin of Color Patients. Dermatol Clin. 2023;41(3):431-434. doi:10.1016/j.det.2023.02.002
- Yadav G, Yeung J, Miller-Monthrope Y, et al. Unmet Need in People with Psoriasis and Skin of Color in Canada and the United States. Dermatol Ther (Heidelb). 2022;12(11):2401-2413. doi:10.1007/s13555-022-00811-0
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