Plaque Psoriasis On Black Skin

Scarring Is More Prevalent In Dark Skin

As previously mentioned, psoriasis patients with darker skin tones are more susceptible to post-inflammatory hyperpigmentation or scarring than their Caucasian counterparts. This simply means that when a person with darker skin has a flare-up of psoriasis, it will leave behind discoloration on the skin even after the rash itself has healed. Unfortunately, the best way to avoid scarring is to avoid flare-ups altogether, though we know thats not always realistic. A few things you can do to prevent scarring include not scratching, moisturizing often, and protecting your skin from the sun, as we know sun damage is a surefire way to make scarring worse.

• Psoriasis Prevalence:Journal of the American Academy of Dermatology. . Psoriasis prevalence among adults in the United States. ucdavis.pure.elsevier.com/en/publications/psoriasis-prevalence-among-adults-in-the-united-states

• Psoriasis in Skin of Color:Journal of Clinical Aesthetic Dermatology. . Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. ncbi.nlm.nih.gov/pmc/articles/PMC4255694/

What Are The Different Types Of Psoriasis

According to a 2014 studyTrusted Source, psoriasis affects almost 6.7 million adults in the United States. There are multiple types of psoriasis, including:

• Plaque psoriasis. This is the most common type of psoriasis, accounting for over 80 percent of psoriasis cases. This type of psoriasis causes red or purplish patches with silvery-white or gray scales. It commonly affects the exposed areas of the skin, such as the knees and elbows, as well as the scalp.
• Inverse psoriasis. As opposed to plaque psoriasis, inverse psoriasis commonly appears in the folds of skin, such as the armpits, groin, or under the breasts. These patches can also appear as red or purple, but do not contain any scales.
• Guttate psoriasis. This type of psoriasis affects roughly 8 percent of people with the condition and commonly appears during childhood. This type appears as small, circular spots on the limbs and torso.
• Pustular psoriasis. This type of psoriasis affects the hands, feet, or other surfaces of the skin and appears as red skin with white pustules. These pustules appear in cycles after the skin has reddened and can sometimes form scales, like in plaque psoriasis.
• Erythrodermic psoriasis. This is a rare and serious form of psoriasis thats widespread and resembles plaque psoriasis, with red or purple skin and silvery scales. This type of psoriasis flare-up requires immediate medical attention.

How Is Psoriasis Diagnosed

If you think you may have psoriasis, your doctor will perform a variety of examinations to make a diagnosis:

• A physical exam is the quickest and most effective way for a doctor to diagnose psoriasis. Theyll look for the signature psoriasis patches and scaling thats common in plaque psoriasis.
• A scalp check can also be performed on people with darker skin, as scalp psoriasis is common in people of color. Narrowing down the location of the flare-ups is also important for treatment.
• A skin biopsy may be performed if your doctor feels like they need more confirmation for a diagnosis. During a biopsy, a small amount of skin will be removed and sent to the lab for testing. Your doctor can then confirm whether the condition is psoriasis or something else.

Treatment options for psoriasis are generally the same across the board, regardless of skin color, and vary based on the type of psoriasis you have.

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What Are The Clinical Features Of Psoriasis

Psoriasis usually presents with symmetrically distributed, red, scaly plaques with well-defined edges. The scale is typically silvery white, except in skin folds where the plaques often appear shiny with a moist peeling surface. The most common sites are scalp, elbows, and knees, but any part of the skin can be involved. The plaques are usually very persistent without treatment.

Itch is mostly mild but may be severe in some patients, leading to scratching and lichenification characterised by thickened leathery skin and increased skin markings. Painful skin cracks or fissures may occur.

When psoriatic plaques clear up, they may leave brown or pale marks that can be expected to fade over several months.

Plaque Psoriasis And Its Reach: The Scalp And Beyond

According to the American Academy of Dermatology, at least 50 percent of people with plaque psoriasis will experience a bout of scalp psoriasis. Plaque psoriasis on the scalp may require different treatment than plaque psoriasis on other parts of the body.

Medicated ointments, shampoos, and careful removal of scales can help treat scalp psoriasis. Sometimes, systemic medications must be used to clear plaque psoriasis on the scalp.

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Skip Shaving During Flares

Shaving with psoriasis can worsen areas of plaques and lead to scars, especially for people affected by the Koebner phenomenon, a reaction that causes new plaques to form on the site of a skin infection or injury. Even shaving an area where the skin is normal can be risky because you might cause a small abrasion and the psoriasis may then jump to that area, explains Kassouf.

How Is Psoriasis Diagnosed And Treated

Psoriasis often has a typical appearance that a primary care doctor can recognize, but it can be confused with other skin diseases , so a dermatologist is often the best doctor to diagnose it. The treatment of psoriasis usually depends on how much skin is affected, how bad the disease is , or the location . Treatments range from creams and ointments applied to the affected areas to ultraviolet light therapy to drugs . Many people who have psoriasis also have serious health conditions such as diabetes, heart disease, and depression. Some people with psoriasis also have an inflammatory condition which affects their joints, called psoriatic arthritis.

Psoriatic arthritis has many of the same symptoms as other types of arthritis, so a rheumatologist is often the best doctor to diagnose it. The treatment of psoriatic arthritis usually involves the use of drugs .

Psoriatic disease may be treated with drugs or a combination of drugs and creams or ointments.

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Treatment And Skin Color

While psoriasis can appear different on skin tones, skin color doesnt often determine treatment options. You may still ask your healthcare provider to personalize your treatment for your skin type and color, especially because darker skin may be more harshly affected by some psoriasis treatments.

Treatments for psoriasis may include:

Topical creams/solutions: These are the first-line treatment for most people with psoriasis. Steroid creams are commonly used in treating psoriasis. Other topical treatments include anthralin, vitamin D-3, and vitamin A creams and ointments to manage skin flare-ups. Many of these products are available only with a prescription. Over-the-counter creams include those containing aloe vera, capsaicin, salicylic acid, and coal tar. Products containing salicylic acid and coal tar may come in different forms for managing psoriasis-affected skin, including as lotions, foams, creams, tars, bath gels, and shampoos. Salicylic acid and coal tar have been approved by the U.S. Food and Drug Administration for treating psoriasis.

Systemic medicines: When topical treatment methods dont help, your healthcare provider may prescribe systemic drugs, which are available in pill or liquid form, or as injections. Systemic drugs are prescription drugs that affect the entire body. They include traditional disease-modifying antirheumatic drugs , such as methotrexate, and biologic drugs, such as Humira, which are prescribed to people with moderate to severe psoriasis.

What Is Cdc Doing About Psoriasis

In 2010, CDC worked with experts in psoriasis, psoriatic arthritis, and public health to develop a public health perspective that considers how these conditions affect the entire population. The resulting report is Developing and Addressing the Public Health Agenda for Psoriasis and Psoriatic Arthritis pdf icon. You can read a short article about the agendaexternal icon in The American Journal of Preventive Medicine.

CDCs National Health and Nutrition Examination Survey , an intermittent source of national psoriasis data, has included questions about psoriasis as late as the 2013-2014 cycle. A recent analysis of NHANES data estimates that 7.4 million adults had psoriasis in 2013external icon.

• Psoriasis causes patches of thick red skin and silvery scales. Patches are typically found on the elbows, knees, scalp, lower back, face, palms, and soles of feet, but can affect other places . The most common type of psoriasis is called plaque psoriasis.
• Psoriatic arthritis is an inflammatory type of arthritis that eventually occurs in 10% to 20% of people with psoriasis. It is different from more common types of arthritis and is thought to be related to the underlying problem of psoriasis.
• Psoriasis and psoriatic arthritis are sometimes considered together as psoriatic disease.

Who is at risk for psoriasis?

Anyone can get psoriasis. It occurs mostly in adults, but children can also get it. Men and women seem to have equal risk.

Can I get psoriasis from someone who has it?

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Light And Dark Patches May Appear When Psoriasis Clears

When psoriasis clears on medium to darkly colored skin, you may see lighter or darker patches of skin where the psoriasis once was. These patches are NOT scars and will eventually disappear. Clearing can take 3 to 12 months or longer.

Your dermatologist may call these patches dyspigmentation .

If the dark patches bother you, tell your dermatologist. Treatment that you apply directly to the skin may help dark patches clear more quickly.

What Is Chronicplaque Psoriasis

Chronic plaque psoriasis is the most common presentation of psoriasis. It presents as small to large, well-demarcated, red, scaly and thickened areas of skin. It most likely to affect elbows, knees, and lower back but may arise on any part of the body.

It tends to be a relatively persistent or chronic pattern of psoriasis that can be improved with treatment but is difficult to clear completely with topical treatments alone. It is characterised by large flat areas of psoriasis with a typical silvery scale. These plaques may join together to involve very extensive areas of the skin, particularly on the trunk and limbs. It is often accompanied by scalp and nail psoriasis.

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Treatments Are Equally Effective

Treatment for psoriasis is typically the same across the board for all races, however, there are certain factors, like hair type, that may affect a physicians suggested treatment plan for a patient with say, scalp psoriasis. Hair care practices in African American patients are very different than those in Caucasian patients, so this can influence how we treat scalp psoriasis, says Joshua Zeichner M.D., who serves as the director of Cosmetic & Clinical Research in Dermatology at Mount Sinai Hospital in New York City. Its important to tailor a prescription regimen to the personal needs and preferences of the patientfor instance, if someone is only washing their hair once per week or every other week, we can’t necessarily use the same treatments as we would if they were washing daily, as over-washing can lead to increased dryness and damage to the hair itself.

As for skin tone, Dr. Sodha says there are no off-limit treatments. We follow the same algorithm of treatment using topical therapies for less severe disease, followed by light therapy and systemic treatments for patients needing a more aggressive approach. Dr. Finney agrees: Treatments in psoriasis are the same across all ethnic groupsthe only minor difference is that when light treatment is chosen, higher doses may be required in darker skin tones due to the increased amount of melanin present in the skin, he says.

When To See A Doctor

Anyone who notices unusual changes in their skin should see a doctor.

Individuals with a diagnosis of psoriasis should follow their treatment plan and see their doctor if symptoms persist or worsen, or if treatment results in adverse effects.

There is currently no cure for plaque psoriasis, but many treatment options are available, depending on the individual and the severity of symptoms.

Options include:

• reduce dryness and cracking
• improve itching

Various topical treatments are available from a pharmacist or for purchase online, with or without a prescription.

It is best to check first with a doctor or pharmacist before choosing a topical treatment, as some may suit an individual better than others. In certain cases, there may not be enough scientific evidence to confirm that they are safe to use or work.

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Impact Of Underdiagnosis Of Plaque Psoriasis In Black And Hispanic Americans

Underdiagnosed plaque psoriasis in Black and Hispanic Americans can severely impact their quality of life and more training can help clinical decisions.

Systemic presentation of plaque psoriasis can vary by skin tone, which presents diagnostic challenges to physicians and as a result, individuals with darker skin tones are likely underdiagnosed in the US. This trend may negatively impact the quality of life and cost billions in lost productivity while also reducing the size of the plaque psoriasis market by over 89,000 cases.

According to GlobalDatas upcoming report Plaque Psoriasis: Epidemiology Forecast to 2030, the number of cases in the US is expected to increase at an annual growth rate of 0.93% between 2020 and 2030. This translates to 7,477,000 cases in 2020 and 8,171,000 by 2030. Plaque psoriasis makes up 85% of psoriasis regardless of race and is characterised by red, flaky and itchy raised plaques that can also be painful. Among darker skin tones, however, the clinical manifestations can differ as plaques can appear more violaceous as opposed to erythematous and plaques may also be thicker. As a result, while psoriasis is more common in people with European ancestry, it is also likely underdiagnosed in non-whites.

Related Report

Patients With Psoriasis Skin Of Color Experience Disparities In Identification Treatment

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Identifying and treating psoriasis in skin of color present a unique set of challenges for practitioners, leading to a call for advanced education.

Disparities have been shown in how the disease is identified due to its presentation in non-white skin types, while treatment disparities and mental health impacts in individuals with skin of color have also been identified.

Image Source: Junko Takeshita, MD, PhD, MSCE.

Diagnosing psoriasis often leads with identifying erythema. The red, scaly patches common to the condition are generally easy to spot on lighter skin, but in skin of color, erythema presents much differently.

There are many features of psoriasis that present similarly across skin types. For example, the symmetrical distribution of psoriasis on the body and well-circumscribed nature of psoriasis plaques. An important difference that clinicians need to keep in mind is that the pink-to-red color that is typically seen with psoriasis on light skin often appears more purple or brown in darker skin types, assistant professor of dermatology and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, said. Sometimes the scale that accompanies psoriasis is so thick that it is difficult to appreciate that underlying color of the plaque itself.

Treatment disparities and challenges

Developing a treatment plan

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Quality Of Life And Disease Severity

Studies suggest the quality of life effect on people with darker skin is far worse than it is for people with fair skin. Potential reasons may include the long-lasting effect of psoriasis, especially in the development of pigment abnormalities. Cultural perceptions of the disease may also adversely affect the quality of life, as psoriasis tends to be a condition of stigma and misconception. This was confirmed by a study reported in 2011 by the Journal of Drugs in Dermatology noting that African Americans and Asians were more profoundly affected by psoriasisboth physically and emotionallythan people with fair skin.

Disease severity may also be a problem for people with darker skin. A study reported in 2017 in the Journal of the American Academy of Dermatology aimed to determine differences in severity based on ethnicity. The studys researchers examined a database of ethnically diverse psoriasis patients who were seen at the University of San Franciscos Department of Dermatology. What they found was that African Americans, Hispanics, and Asians had more severe psoriasis than the white study subjects.

The Same Treatments Stand No Matter What The Patients Skin Tone May Be

Thankfully, there are a variety of options when it comes to treating psoriasis. You can combat the condition with topical steroids and phototherapy or with oral medications and biologics for more severe cases. I the biologics, because of the superior way that they control the disease with a simple injection every few weeks, Dr. Hartman says. Most of these medications can be self-injected, so you can safely administer them at home to treat your psoriasis without worrying about frequent trips back to the doctor’s office.

Coping with psoriasis in between treatments can be tricky since there’s no true cure for the condition, but there are topical remedies like these soothing dermatologist-approved lotions that might provide some relief in the meantime.

The bottom line: This immune disease might be more prevalent in patients with lighter skin, but people with Black skin can also suffer from psoriasis and are more likely to have severe cases of it if they do. Lesions can look purple-gray or dark brown. If you think you may have psoriasis, check with a derm.

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What Causes Psoriasis Patches

Psoriasis patches are caused when the skin production process becomes accelerated and inflammatory cells move into the dermis . Traditionally, skin cells replace themselves approximately every 27 days, however, the skin cells in those with psoriasis often replace themselves within just a few days. This sped-up process does not allow for old skin cells to fall away from the skin thus causing skin cells to build on top of one another, creating patches of rough, scaly skin.

What are the different types of psoriasis?

The most common type of psoriasis is plaque psoriasis, which accounts for over 80% of cases. Plaque psoriasis appears as red to purplish plaques or patches on the skin with silvery-white or gray scales. These patches commonly appear on the elbows, knees, scalp, belly button, and upper buttocks but may appear almost anywhere!.

Other types of psoriasis include:

Your dermatologist can help you identify which type of psoriasis you may be experiencing.

How do you treat psoriasis?

Although psoriasis is a chronic skin condition, there are many treatments available from your dermatologist to help clear up your skin and alleviate itching and discomfort. Mahoney Dermatology Specialists is the local dermatologist that Pinellas residents trust for Cutting edge treatment of psoriasis. Treatment options include many different topical preparations, ultraviolet light therapy, and oral or injectable medications for psoriasis relief.