Psoriasis affects people of all skin tones from all over the world. Numerous studies have examined different aspects of psoriasis, but limited data exist on the specific effects of the condition on People of Color.
Psoriasis affects about 2–3% of the world’s total population. Although researchers have learned a great deal about this immune-mediated condition, most data come from studies involving white people.
This has led to a sparsity of data about the differences in how psoriasis affects people with lighter skin tones and People of Color. Potential differences include the prevalence and severity of psoriasis and the treatment options.
Limited images and statistics can affect clinical practices, as well as public perception of the condition and the available treatments. In some cases, this lack of information may lead to People of Color not getting the proper diagnosis and care for psoriasis.
This article examines how psoriasis presents in People of Color and the issues surrounding care, diagnosis, and treatment.
Psoriasis is an immune-mediated condition that affects more than 7.5 million adults in the United States. This means that the immune system is overactive, causing inflammation throughout the body.
Psoriasis is a type of psoriatic disease, with psoriatic arthritis being the other type. About 30% of people with psoriasis will develop psoriatic arthritis at some point in their lifetime.
The inflammation associated with psoriatic disease can also affect other organs throughout the body.
Psoriasis is associated with the development of scaly plaques on the skin. The plaques develop due to the immune system speeding up the growth of new skin cells.
However, the presentation of psoriasis — as well as where it develops, its severity, and a person’s access to treatment —
This can lead to a delayed or missed diagnosis. Dr. Mark A. Innis, who works as a traveling emergency room physician in Kentucky, New York, and Virginia, told Medical News Today: “If a Black person has psoriasis, it may be missed. There are not as many pictures or as much experience.”
Various aspects of psoriasis can differ among different populations of people.
Many studies and prominent organizations, such as the National Psoriasis Foundation, recognize that psoriasis looks different on different skin types. This can lead to misdiagnosis or a missed diagnosis.
Dr. Flor Mayoral, a dermatologist from Coral Gables, Florida, explained: “Unless you have experience treating all skin types, you may not recognize some skin disorders in a Person of Color. Skin diseases tend to look different if you change the color of the skin.”
Dr. Mayoral went on to say, “‘Red’ may look violaceous or gray if someone is really dark.”
However, she did note that “every dermatologist is capable of diagnosing psoriasis, but it may not be first on their differential if they don’t see People of Color often.”
Dr. Innis agrees. He said: “If I am a doctor who works with primarily darker complected people, then I may be better at diagnosing those things. But if I am not, then I am not as adept at making the diagnosis.”
In a 2020 study, researchers broke down some racial differences in psoriasis presentation. They noted the following:
- Black people are more likely to have scalp psoriasis, violaceous lesions, less noticeable inflammation, and postinflammatory hyperpigmentation and hypopigmentation than other people. They are less likely than white people with psoriasis to develop psoriatic arthritis.
- Asian people are more likely than white people to present with scalp, pustular, and erythrodermic psoriasis and more likely to have severe cases.
- Hispanic people are more likely to experience more severe psoriasis, as well as pustular psoriasis.
The researchers also noted that Black and Asian people with psoriasis have a higher likelihood of having a higher severity index score and greater body surface involvement.
According to a 2017 analysis of data from various studies, very few studies have examined the differences in severity between different ethnicities. In their analysis, the researchers noted the following differences in psoriasis severity:
- White people: 63.7% mild to moderate and 36.3% severe to very severe
- Asian people: 45.8% mild to moderate and 54.2% severe to very severe
- Hispanic people: 48.3% mild to moderate and 51.7% severe to very severe
- Black people: 60% mild to moderate and 40% severe to very severe
- Middle Eastern people: 75% mild to moderate and 25% severe to very severe
Their review suggests that white people, Black people, and people of Middle Eastern descent tend to have less severe cases of psoriasis, whereas Asian and Hispanic people tend to report more severe cases.
Access to quality, affordable healthcare is an important concern in the U.S.
Dr. Mayoral sees this in her practice. She noted: “A greater percentage of People of Color have difficulty seeking medical care because of lack of access to healthcare, difficulty taking time off from work, arranging for child care, etc. I also find that many ethnic populations go into ‘denial mode’ and avoid doctors altogether when they have a problem.”
“Their biggest fear is the Big ‘C’ [cancer], and they go when they have no choice or are forced by their family members.”
Dr. Innis reported similar hesitations but also noted that access to care can be an issue. “People have the misconception that they can walk into an emergency room anywhere and be treated for anything, and that’s just not true depending on where you live. There isn’t always access to a specialty.”
He also noted that the wait times to see a specialist can deter people from getting further care. “It can take 3–6 months to see a dermatologist. On discharge instructions, I will give the name of a dermatologist and say go see this person, but it’s hard to make an appointment depending on your location. [Some] specialists are being funneled to larger institutions.”
If a Person of Color can see a dermatologist, Dr. Mayoral is confident that the specialist should be able to diagnose psoriasis. Most dermatologists can make this diagnosis by discussing a person’s symptoms and medical history with them and looking at the affected skin. In some cases, a dermatologist may take a sample of skin to look at under a microscope to confirm psoriasis.
However, if a person does not have access to a specialist or seeks care at the emergency room or urgent care, Dr. Innis said that it may be harder to get a diagnosis.
He explained: “For the most part, I don’t give a direct diagnosis because I want everyone to follow up with their primary care doctor. I am just a pit stop. If I make a mistake, I want them to come back.”
He continued, saying that clinicians hold the key to barriers in diagnostics and treatment among marginalized groups. “We get around the barrier by being caring clinicians. I think we need more caring physicians who will continue to look for answers.”
Differences in treatment between white and Black people exist, according to a
Biologics represent a newer form of medication. Unlike traditional medications that target the entire immune system, biologics provide targeted intervention, which can potentially lead to better disease outcomes for those who take them.
Instead, People of Color
Psoriasis presents differently depending on skin type and tone, which can lead to a misdiagnosis or missed diagnosis. Many doctors are not familiar with the differences in the presentation of psoriasis, but most dermatologists should be able to make an accurate diagnosis.
Other differences regarding access to quality care and treatment options can also affect the outlook of People of Color with psoriasis.