Psoriasis looks and feels different on people with darker skin. These differences may affect diagnosis, treatment, and quality of life for people of color.
Some 125 million people worldwide are thought to have this chronic skin condition. In the U.S., statistics show that it affects 3.6% of white people, 1.9% of African-American people, and 1.6% of Hispanic people.
But some scientists think people of color actually have higher rates of psoriasis than those numbers reflect. For one thing, doctors may find it more difficult to identify psoriasis in darker skin. These populations also tend to be underrepresented in research studies.
Diagnosing Psoriasis in People of Color
Darker-skinned people with psoriasis often notice dark brown or purplish-gray spots, or plaques, on their skin. (It may be harder to see than on light skin, where it’s often pinkish or red.) The scales that cover the plaques tend to look grayish.
In Hispanic people, the psoriasis is sometimes salmon-colored, and the scales silvery or white.
Psoriasis plaques also tend to be thicker in people of color and to cover a larger portion of the body. One study found that among people of various ethnicities with psoriasis, Asian people had the largest affected area of skin.
Doctors say scalp psoriasis is common among people of color, particularly in the Asian population. But it can be difficult to diagnose in Black people since the plaques aren’t as easy to see and it can mimic other conditions like seborrheic dermatitis.
Because psoriasis can be harder to diagnose in people of color, doctors may need to rely on clues other than visible plaques, such as:
- Joint pain (from psoriatic arthritis)
- Nail pitting, which is indentations or pits on your nails
- A raised rash on your tongue called geographic tongue
If they’re still having trouble diagnosing your condition, your doctor can do a biopsy, which can rule out other scaly skin disorders like eczema and fungal infections.
Another issue that may contribute to under-diagnosis of psoriasis in people of color is the fact that many have inadequate health insurance. They also may have less access to skin specialists. One study that looked at non-Hispanic minorities found they were 40% less likely to see a dermatologist for psoriasis than non-Hispanic white people.
Treating Psoriasis in Darker Skin
Once you get a diagnosis, treatments for psoriasis are similar no matter your skin tone. Most people start with ointments or creams you spread on your skin. If your psoriasis is more serious, you can use medications you take by mouth or as a shot. You might also try UV light therapy (phototherapy).
But thicker plaques may mean you need to use stronger medicines or use them for a longer time. You might also need higher doses of light therapy.
You and your doctor should also talk about the dark patches (hyperpigmentation) and light spots (hypopigmentation) that psoriasis can leave behind. Darker skin is more prone to these spots.
They aren’t usually permanent, but can take months or years to clear up. Early, effective treatment can prevent them. Light therapy, while it can help clear your psoriasis, may make them more noticeable. Bleaching creams might lighten dark spots, but don’t use them until your psoriasis has cleared.
If you have scalp psoriasis, talk to your doctor about your personal and cultural hair care practices. For example, your doctor may ask you to wash your hair frequently with a medicated shampoo. But this treatment may not be practical for Black people with natural afro-textured hair or who use texturizers, relaxers, braiding, or hairpieces.
Disparities in Treatment
Research suggests that many people with psoriasis don’t get adequate treatment. Some doctors believe this is especially true for minorities,
While there’s little direct research on the topic, one study found that Black people with psoriasis were less familiar with biologics, which are highly effective, injectable medications. Other research has shown that Black people are 69% less likely to have been prescribed a biologic than white psoriasis patients.
Undertreatment can also result from the lack of access to dermatologists or inadequate health insurance.
There’s also been little research focused on psoriasis in people of color. More studies could help scientists better understand how the condition might differ in different ethnic groups.
Psoriasis and Quality of Life
Black and Hispanic people reported in one study that psoriasis had a bigger effect on their quality of life than white psoriasis patients reported. Study participants filled out a questionnaire that discussed their physical symptoms as well as the effect on their emotions and daily activities.
In another study, 72% of minorities said psoriasis hurt their quality of life, compared to 54% of white people with the condition. They also reported more feelings of self-consciousness, helplessness, and anger.
Scientists think this is not only because of the pain of psoriasis and the disfiguration from hyper- and hypopigmentation, but may also reflect a greater stigma against skin disorders among some minority communities. Racism could compound these feelings of stigmatization.
If your psoriasis has led to negative emotions like anger, shame, and sadness, talk to your doctor or a therapist.