Psoriasis on skin of color typically appears as dark patches with gray scales. These patches may be brown, purple, or darker than the surrounding skin.
Psoriasis lesions tend to be thick and crusty and often form on the scalp, elbows, knees, and back.
In this article, learn about psoriasis on skin of color, including its appearance and symptoms, and how to treat it.
Psoriasis is a common condition affecting more than 8 million people in the United States and 125 million worldwide.
According to the National Psoriasis Foundation, it affects approximately 1.5% of African American individuals compared with 3.6% of white people.
A person may develop psoriasis at any age, but there are two common peaks of onset, ages 20–30 and 50–60. It is a long-term condition. While there is no cure, many treatment options are available to help manage the symptoms.
Below are pictures of different psoriasis presentations.
Psoriasis presents as thickened areas of skin, sometimes with an overlying scaly crust that may look shiny or silver. These lesions are usually itchy. If a person scratches them, they will bleed and scab over.
In People of Color, psoriasis can look violet or purple. The individual may also notice areas of darker, thicker skin. In both cases, the lesions can appear scaly. Lesions can develop anywhere on the body, including the scalp.
As psoriasis heals, it can leave areas of discoloration, which can take 3–12 months to disappear, according to the American Academy of Dermatology (AAD).
Psoriasis tends to follow a relapsing-remitting pattern, meaning that people will experience a period of few or no symptoms and a flare-up of more severe symptoms.
There are several different types of psoriasis, which can vary in their appearance. These are:
Chronic plaque psoriasis
Chronic plaque psoriasis is the most common form of the condition. It causes clearly defined lesions on the elbows, knees, and scalp.
Guttate psoriasis is more common in children or young people recovering from an infection, such as strep throat.
It causes small bumps less than 1 cm across that can cover the entire body.
Some people with psoriasis only have symptoms on their nails. Nail psoriasis looks like tiny pinpricks on the fingernails or toenails. Symptoms of nail psoriasis also include:
- nail pits, or small dents
- thickening or crumbling of the nail
- nails separating from the skin beneath
- blood under the nail
Inverse psoriasis appears on folds where the skin touches another part of the skin. It commonly occurs in the armpits, the buttocks, the groin, and the folds underneath the breasts. The lesions may be purple or darker than the surrounding skin.
A dermatologist will perform a physical examination and ask questions about the lesions to diagnose psoriasis. They will probably also ask about any family history of psoriasis or related conditions, such as arthritis.
Psoriasis on darker skin tones can be challenging to diagnose because it may resemble other skin disorders that are more common in People of Color.
In some cases, the doctor may also take a skin biopsy so that they can rule out other conditions.
The treatment options for psoriasis are essentially the same regardless of skin tone, although some carry special considerations for people with darker skin.
Standard psoriasis treatments include:
Creams and ointments
Creams and ointments are the first treatment option for most people with psoriasis.
Prescription creams and ointments for psoriasis include:
- topical corticosteroids
- synthetic vitamin D3 creams
- vitamin A creams
- topical calcineurin inhibitors
Topical corticosteroids are the primary treatment for psoriasis. However, using corticosteroids long term, or not as directly prescribed carries a risk of adverse side effects such as scarring or skin discoloration. Topical treatments such as synthetic vitamin D creams carry less risk of side effects, so they can be more suitable for long-term treatment.
Some over-the-counter creams and ointments may help reduce psoriasis symptoms such as swelling or itching. These include products containing aloe vera, jojoba, zinc pyrithione, salicylic acid, and coal tar.
Oral and injectable medications
If creams and ointments do not work, a doctor may prescribe oral or injectable medications. These drugs are called systemic medications, and they may be pills, liquids, or injections.
Systemic medications include:
A doctor may prescribe biologic drugs for moderate to severe psoriasis. People usually receive these drugs, which target specific parts of the immune system, as an injection or infusion.
Examples of biologic drugs include:
- TNF-alpha inhibitors, such as Enbrel (etanercept) and Humira (adalimumab)
- interleukin-12/interleukin-23 inhibitors, such as Stelara (ustekinumab)
- interleukin-17A inhibitor Cosentyx (secukinumab)
- interleukin-23 inhibitors
- T-cell inhibitors, such as Orencia (abatacept)
Phototherapy is also called light therapy. This treatment involves regularly exposing the skin to ultraviolet light under medical supervision.
Standing in a lightbox two or three times a week can cause the skin to tan or darken. The AAD warns that this may make dark spots on darker skin tones more noticeable.
Learn more about phototherapy for psoriasis in this article.
There is currently no cure for psoriasis. Anything that irritates the skin can cause the condition to flare up. The AAD offers the following advice to help avoid flare-ups wherever possible:
- avoid skin injuries, such as nicks, cuts, and bug bites
- protect the skin from sunburn
- use a cold compress and moisturize regularly to alleviate the itching associated with psoriasis
- avoid scratching itchy skin
Learning how to recognize the triggers that lead to flare-ups can also be helpful. Triggers differ among individuals but can include:
- bug bites
- summer heat
- cold winter weather
Some people with psoriasis develop lesions on their scalp, so doctors may also recommend frequent shampooing with a medicated shampoo.
Psoriasis is a common skin condition that affects fewer African American individuals than white people in the United States.
In People of Color, psoriasis may look darker than the surrounding skin or appear purple. In both cases, it tends to have a scaly overlay. Psoriasis lesions can appear anywhere on the body, including the scalp.
Anyone with symptoms of psoriasis should speak with a doctor about diagnosis and appropriate treatment options.