Historically, racial and ethnic minorities in the United States have lived with long-term disparities in both access to health care and the quality of care that they receive. These differences are improving thanks to laws like the Affordable Care Act. Still, some minority groups have higher rates of illness and death from many health conditions than white people. And they’re still more likely to face prejudice and other barriers to health care.
These differences in care also include treatment for plaque psoriasis, a skin disease that causes an itchy, scaly rash. Research shows racial minorities see a doctor less often for the condition than white people. Here’s a look at some reasons for these disparities and how the medical community can help.
What Are the Barriers to Psoriasis Care for People of Color?
The issue of insurance
Walking into the doctor’s office is the first step in getting care for your psoriasis. But you may not be able to make this step without health insurance coverage. This is a problem that impacts racial and ethnic minorities more often in the U.S. For Americans under age 65, Asian Americans are just slightly more likely to be uninsured than white people, while Hispanics, American Indians, and Alaska Natives are more than 2.5 times more likely to have no coverage. The uninsured rate for Black Americans is almost 2 times that of whites.
Without coverage, access to health care remains out of reach for many people of color.
Getting the right diagnosis
Once you’re able to see a doctor, the next step in treating psoriasis is getting a proper diagnosis. That’s not always easy for anyone – psoriasis is often mistaken for conditions like eczema or dry skin.
But it’s doubly hard for people of color. During medical training, many doctors don’t learn how to spot psoriasis on nonwhite skin. While the condition tends to look bright red on lighter skin, it often appears purplish, brown, or reddish-brown on darker skin tones. Some people of color may also have thicker psoriasis plaques and more scaling across more areas of their bodies.
A biopsy (a study of a small skin sample under a microscope) helps doctors figure out if you have psoriasis. Dermatologists suggest the procedure when it’s hard to tell plaque psoriasis from other conditions. They say it can be especially useful for people of color.
Access to treatment
Once you have a psoriasis diagnosis, you and your doctor will work together to figure out the best treatment options. But for some, access to a doctor and treatment is another hurdle in getting care.
One issue is a lack of dermatologists in underserved communities. This can be an issue with a treatment like light therapy, which calls for visits to the dermatologist two or three times a week.
Meanwhile, if you’re a person of color in the U.S., finding a dermatologist of the same race or ethnicity can also be a challenge.
While dermatologists of all backgrounds are qualified to treat skin of color, you may prefer care from a doctor who looks like you. In one study, Black people who visited skin-of-color clinics said dermatologists there had better training to address their concerns. They also felt the doctors showed them more respect and dignity and were more trustworthy.
Reena Ruparelia is a Toronto-based psoriasis advocate who has lived with the condition for nearly 30 years. She’s South Asian and has often visited older, white male dermatologists. Ruparelia says she felt intimidated by these doctors and uncomfortable asking questions. Today, her dermatologist is of the same background and gender.
“I feel like it's much easier to speak with her because I can share my problems. She took time to listen, but also understood my unique situation. I know that she's willing to find a treatment that supports me.”
Another barrier to care for people of color is undertreatment. Research shows Black people with psoriasis are less likely than white people to get biologics. These are treatments made from living organisms. You take them as a shot for moderate to severe psoriasis. But health insurance doesn’t always cover this type of treatment. Or your insurance company could require you to try another medicine first before covering it.
How Can Doctors Improve Psoriasis Care for People of Color?
Diversity in medical training and research
More inclusive medical training can help doctors better diagnose and treat people of color. There are now efforts to include a broader range of skin tones in educational courses, textbooks, and other resources.
Lynn McKinley-Grant, MD, a board-certified dermatologist, professor of dermatology, and past president of the Skin of Color Society, suggests students learn to diagnose skin diseases face-to-face with people from different racial and ethnic backgrounds.
“If you've trained in the middle of Minnesota and you haven't seen any brown skin, then there should be an effort to make sure people take a rotation or two in places where there are varying skin types,” she says.
There’s also a lack of diversity in psoriasis research. Studies show psoriasis treatments are safe and work well in people of all skin tones. The problem is researchers have mainly studied them in white people with the condition. One review found that 84% of people who join clinical trials for psoriasis are white.
The dermatology community has started to recognize the need for more racial diversity in clinical trials. Researchers are making more of an effort to include a wider range of people in dermatology studies to understand how treatments affect different groups.
‘Let the patient educate you a little’
McKinley-Grant and other dermatologists stress the importance of doctors listening to people of color, both during diagnosis and treatment.
“If a patient tells you, ‘This is where I itch,’ ‘This is what's burning me,’ and the doctor can't see it, and their training has been focused on one skin type, then they have to listen and trust what the patient is seeing,” McKinley-Grant says. “Let the patient educate you a little.”
Ruparelia says many health care professionals have compassion fatigue, brought on by a packed schedule.
“After you've seen 10 people who are complaining about their skin, maybe you’re tired of hearing it. But if there's a way to listen to every patient like it's the first time you've heard it – take time to look at their skin and really give them a chance to express what they're experiencing – I think it would make a huge difference.”
The Skin of Color Society also encourages doctors to ask their patients which treatment they prefer. For instance, some people of color will want to avoid phototherapy because it causes temporary skin tanning. Black women with scalp psoriasis may have unique concerns about hair texture, how often they wash their hair, and hair styling.
When both people of color and their doctors are aware of how psoriasis affects this group, they can better work together to find the best treatment.
Photo Credit: Jasmin Meridan / Getty Images
Lynn McKinley-Grant, MD, Howard University College of Medicine, Washington, DC.
Reena Ruparelia, psoriasis advocate, Toronto.
American Journal of Clinical Dermatology: “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.”
Skin of Color Society: “Psoriasis in Patients of Color.”
Cutis: “Racial Disparities in Dermatology Training: The Impact on Black Patients.”
JAMA Dermatology: “Assessment of Black Patients' Perception of Their Dermatology Care.”
National Psoriasis Foundation: “Psoriasis and Skin of Color.”
Journal of the American Academy of Dermatology: “Healthcare utilization for psoriasis in the United States differs by race: an analysis of the 2001-2013 Medical Expenditure Panel Surveys.”
Kaiser Family Foundation: “Disparities in Health and Health Care Among Black People,” “Disparities in Health and Health Care: 5 Key Questions and Answers.”
National Cancer Institute: “Biological Drug (Definition).”
CDC: “Racism and Health.”
Center for American Progress: “Health Disparities by Race and Ethnicity.”