Search online for psoriasis images, and you'll mostly find photos of white people. But that doesn’t reflect the reality of this skin condition. People with dark skin get psoriasis, too. Fewer African Americans and Hispanic people have a diagnosis than white people. But that doesn’t necessarily mean fewer people of color live with psoriasis. This skin condition is often missed or undertreated in people of color.
When you don’t get treatment for psoriasis, you could end up with more severe symptoms. Research shows that Black and Hispanic people report more embarrassment and problems in their daily life from psoriasis than white people do.
With so few images of psoriasis on brown skin, it's important to learn what psoriasis looks like on skin of color and what treatments are available. Then you can have an informed talk with your doctor and get the help you need to manage your skin symptoms.
Psoriasis in People of Color
More than 7.5 million adults in the United States have psoriasis. White people are more likely to be diagnosed with this condition, but psoriasis also affects other racial groups, too. Nearly 2% of Hispanic Americans and 1.5% of Black Americans have a diagnosis of psoriasis.
The real numbers of people who have the condition are probably higher. A lack of access to health care and other barriers prevent many people of color from getting diagnosed and treated.
What Does Psoriasis Look Like on Darker Skin?
How psoriasis looks depends a lot on your skin tone. On light skin, the plaques appear red. On dark skin, they may look brown or purple, which can make them harder to see.
Dark or light scar-like spots are another sign of psoriasis on dark-toned skin. The spotting is due to the effects of psoriasis inflammation on skin pigment cells, and it should fade in time.
Psoriasis tends to be more severe and widespread in people of color. In studies, Black people had psoriasis over more parts of their body than white people – including on their scalp.
The appearance of psoriasis plaques on dark skin can be easy to confuse with other skin conditions. Psoriasis sometimes looks like lupus or a skin rash called lichen planus.
Disparities in Diagnosis
There are a few possible reasons that more people of color don’t get a diagnosis.
For starters, on average, people of color are less likely to have health insurance than are white people.
Fewer people of color see a dermatologist – the type of doctor who treats psoriasis. In one study, Black, Asian, and other people from minority groups were about 40% less likely to see a dermatologist for psoriasis than were white people.
Even when people of color do see a dermatologist, they may not get the right diagnosis. Some dermatologists say they're less confident diagnosing psoriasis on dark skin. The scale dermatologists use to assess psoriasis was developed for white skin. It may not be as accurate for people of color.
Biologic drugs are the most effective treatment for moderate to severe psoriasis. Yet fewer people of color get a prescription for these medications. In one study, the odds of getting a biologic were a whopping 69% lower among Black people than among white people with psoriasis.
It’s possible that doctors don’t offer the drugs because they assume their Black patients won’t take them. Research shows that doctors are more likely to describe Black patients than white ones as non-adherent or non-compliant with the doctor’s advice.
People of color may not ask their doctor for biologic drugs or may be afraid to take them if their doctor offers them, because they're not familiar with these medicines.
One possible reason for the lack of awareness is that almost 93% of characters in TV psoriasis ads are white, one study found. When you don't see yourself represented in ads for psoriasis treatments, you may not realize that these treatments are right for you.
What People of Color Need to Know
To make sure that you get the right diagnosis and treatment, learn the symptoms of psoriasis. On darker skin, you might see:
- Thick brown or purple patches covered with gray scales
- Dry, cracked skin
See a dermatologist for these symptoms. Ask your primary care doctor to recommend a dermatologist, or search the American Academy of Dermatology's online directory. A doctor of color or someone who has experience treating darker skin may be more familiar with psoriasis on dark skin.
Make sure the dermatologist you see does a thorough skin exam to rule out other conditions. That includes a check of your nails, scalp, the palms of your hands, and the soles of your feet. They may also need to do a biopsy, which involves removing a small piece of your skin to look at it under a microscope.
When your doctor prescribes a treatment, make sure you understand how it will help and how it might affect you. For example, prescription shampoos that treat scalp psoriasis involve washing your hair more often. In people of color, too much hair washing can lead to dryness and breakage. To protect your hair, you might ask your doctor if you can instead wash once a week with a medicated shampoo and then apply a corticosteroid cream or solution to your scalp daily.
Some psoriasis treatments work differently on people of color. Phototherapy uses light to clear your skin. If you have darker skin, your doctor may need to use a higher dose of light for this treatment to work.
Your treatment should always be tailored to you and based on things like your race, your health, and how severe your psoriasis is.
Photo Credit: Natalia Gdovskaia / Getty Images
American Academy of Dermatology Association: "Psoriasis: Signs and Symptoms," "Psoriasis Treatment: Biologics."
Cutis: "Content Analysis of Psoriasis and Eczema Direct-to-Consumer Advertisements."
JAMA Dermatology: "Psoriasis Prevalence in Adults in the United States."
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JAMA Network Open: “Examination of Stigmatizing Language in the Electronic Health Record.”
Health Affairs: “Negative Patient Descriptors: Documenting Racial Bias In The Electronic Health Record.”
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: "Health Coverage by Race and Ethnicity, 2010-2019."
National Psoriasis Foundation: "Psoriasis and Skin of Color."
Penn Medicine News: "Racial Minorities Less Likely to See a Doctor for Psoriasis."
The Journal of Clinical and Aesthetic Dermatology: "Psoriasis in Skin of Color: Epidemiology, Genetics, Clinical Presentation, and Treatment Nuances."