Special Considerations When Treating Skin Of Color
Compared to white patients, African American patients may experience a higher degree of dyspigmentation but a lower amount of erythema, as well as more extensive disease involvement. Dr. Takeshita thinks that addressing the post-inflammatory dyspigmentation that is more likely to occur among individuals with darker skin types is one of the biggest challenges in treating psoriasis in skin of color. âOne approach should be prevention by ensuring appropriate and timely treatment of active psoriasis. It is important to also educate patients with darker skin types about the possibility of post-inflammatory dyspigmentation so they know that it is not active psoriasis and that it is not usually permanent,â says Dr. Takeshita. âThe dyspigmentation, or âscarringâ as it is referred to by many patients, is something that is of particular concern among Black patients with psoriasis as we learned from our interview studies.â
Scalp psoriasis is another area of special concern in patients with skin of color. Dr. Takeshita suggests providers ask about each patientâs hair care practices so that they can recommend a treatment plan that is compatible with the patientâs hairstyle, type of hair , and care regimen.
How Psoriasis Is Different For People Of Color
It doesnt seem entirely surprising that a skin disease could present differently in people of various ethnicities and skin colors. However, in the case of psoriasis, these differences sometimes make it challenging for non-Caucasian patients to receive a proper diagnosis.
Lets examine some of the clinical characteristics and overall experience of psoriasis in patients with skin of color.
Skin Areas Affected By Psoriasis Are Not Typically Red
The way psoriasis appears in darker-skinned patients is often different than what is seen in their lighter-skinned counterparts. While most Caucasians will present with reddened patches of skin, African Americans may have psoriasis that is dark brown or violet in color. The scales of psoriasis are often thicker as well.
Once the psoriasis plaques clear up, patients of color are also more likely to find the affected skin is noticeably darker or lighter than it was previously. This change in appearance can last for up to a year, and for some patients can be quite distressing.
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Can It Be Mistaken For Something Else
There are other skin conditions that can resemble psoriasis, which sometimes makes diagnosis difficult. These conditions may include:
- Fungal skin infections. Fungal skin infections occur when fungi multiply on the skin or find their way in through an open lesion. These infections usually appear as itchy, scaly rashes.
- Lichen planus. Lichen planus is a skin rash that often appears in conjunction with other autoimmune conditions. It can present in multiple ways, such as purplish skin bumps or white lesions on the mouth.
- Cutaneous lupus. Lupus is an autoimmune condition that causes system-wide inflammation. Cutaneous lupus affects roughly two-thirds of people with lupus and is characterized by rashes on exposed skin areas.
- Eczema.Eczema appears as red, inflamed, peeling, cracked, blistered, or pus-filled on light skin. But on darker skin, the redness may be difficult to see but will look darker brown, purple, or ashen gray. Generally, there are no scales.
In addition to the conditions above, differences in the appearance of psoriasis between skin colors can make it even more difficult to diagnose in people with darker skin.
Still, its important that doctors are trained on how to recognize psoriasis and other conditions in people of color.
As a person of color, if youre concerned that you may have psoriasis, its important to make sure that your concerns are being heard.
Advocating for yourself based on your symptoms can ensure a proper diagnosis and timely treatment.
Why 7 Deadly Diseases Strike Blacks Most
Health care disparities heighten disease differences between African-Americans and white Americans.
Several deadly diseases strike black Americans harder and more often than they do white Americans.
Fighting back means genetic research. It means changing the system for testing new drugs. It means improving health education. It means overcoming disparities in health care. It means investments targeted to the health of black Americans. And the evidence so far indicates that these investments will pay health dividends not just for racial minorities, but for everyone.
Yet we’re closer to the beginning of the fight than to the end. Some numbers:
Why?
Genes definitely play a role. So does the environment in which people live, socioeconomic status — and, yes, racism, says Clyde W. Yancy, MD, associate dean of clinical affairs and medical director for heart failure/transplantation at the University of Texas Southwestern Medical Center.
Yancy says that all humans have the same physiology, are vulnerable to the same illnesses, and respond to the same medicines. Naturally, diseases and responses to treatment do vary from person to person. But, he says, there are unique issues that affect black Americans.
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Psoriasis In The Black Skin: A Lack Of Representation
The Internet is flooded with images of white people who have psoriasis, but there arent nearly as many pictures of Black people who have psoriasis. This often leads people to the conclusion that psoriasis mainly develops in people with lighter skin which couldnt be further from the truth.
In fact, about 1.9 percent of Black Americans have psoriasis, according to a study published in the March 2014 issue of the Journal of the American Academy of Dermatology. The same research found that 1.6 Hispanic Americans had psoriasis, and 3.6 percent of white Americans had psoriasis.
Despite these statistics, a whopping 93 percent of all main characters who were featured in TV commercials and advertisements about psoriasis, including treatments and products, over a two-week period in 2018 were white, according to a study published in September 2020 in the journal Cutis. Black and Asian main characters only represented about 6 percent and 1 percent. The findings of this study, conducted by Junko Takeshita, MD, PhD, and other researchers, are important because advertisements are a main source of health-related information for the public.
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.
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What Are Symptoms Of Psoriasis
Symptoms of psoriasis can be mild to severe, and can be in small, limited areas of the body such as the scalp, knees, elbows, hands and feet, or it can be widespread covering much of the body surface in including the face, arms, and legs. Psoriasis can come and go, with flares and periods of remission . Symptoms can also vary depending on the type of psoriasis you have.
Common symptoms of psoriasis include:
- Dry, red, thick skin, covered by silvery scales
- Skin rashes
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.
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How Is Psoriasis Treated
There is no cure for psoriasis but there are many treatments that can help to keep it under control.
Mild psoriasis is usually treated with products applied to the skin. These include:
- moisturisers
- corticosteroid creams or ointments
- vitamin D preparations
You may also receive ultraviolet light therapy. This can slow down the production of skin cells.
If your psoriasis needs stronger treatment, you may be prescribed oral medicines or injected medicines to reduce the immune response. Two new medicines for severe psoriasis are now subsidised for people with psoriasis in Australia, Tremfya and Ilumya.
The best thing you can do to improve the psoriasis is quite smoking and limit how much alcohol you consume.
You can help manage your psoriasis by:
- taking your prescribed treatment regularly to help prevent flare-ups
- reducing stress
- having a healthy lifestyle and eating a healthy diet
If You Have Psoriasis Your Child May Not
Psoriasis is a hereditary condition, but it does not necessarily mean that you will pass it on to your children. According to the National Psoriasis Foundation, around 10% of people inherit one or more of the genes associated with psoriasis. However, less than 3% of the population will actually develop the condition.
The reasons some people do not develop psoriasis are because they dont have the right collection of genes and they have not been exposed to specific triggers. This means that both environmental factors and genes play a role in whether a person develops psoriasis.
This also means that just because you have psoriasis does not mean your child will develop the condition. Their risk for psoriasis is increased, but only if other risk factors are present and trigger the disease.
Nothing is certain and information on genetics is based on risk statistics. Plenty of women with psoriasis have healthy babies that grow up without health problems and never develop psoriasis.
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Specialty Ranks Next To Last In Diversity A Movement Started In 1999 Is Trying To Change That
byElizabeth Hlavinka, Staff Writer, MedPage Today September 24, 2020
After seeing a handful of providers who failed to accurately diagnose her, a young Black woman with severe psoriasis that would often interrupt her sleep came to Kindred Hair & Skin Center outside of Baltimore.
She had been struggling with intense itchiness for 2 years, but was never biopsied. Instead, she was diagnosed with eczema and repeatedly prescribed topicals that did not work. At one point, the woman was even prescribed psychiatric medication and told her condition was a symptom of anxiety, said Chesahna Kindred, MD, who operates the clinic in Columbia, Maryland. Kindred is also an associate professor at Howard University and the chair of the dermatology section of the National Medical Association .
“You can’t call yourself a dermatologist without knowing psoriasis,” said Kindred, the patient’s new provider. “The fact that she was diagnosed with anxiety and she had psoriasis was a disservice.”
It’s not uncommon for people of color to be misdiagnosed or overlooked in dermatology, and psoriasis in these patients may be more likely to go undiagnosed or untreated. Black patients have also been shown to receive lower rates of treatment for common conditions such as acne.
More recently, an analysis of COVID-19 skin manifestations depicted in medical literature suggested racial bias, with none of the 130 images portraying patients with Black or brown skin.
Skin of Color Underrepresented
What Are The Symptoms Of Psoriasis
- Psoriasis may not have any associated symptoms, but it can be itchy and painful. Certain sites such as the scalp, lower legs and groin can be particularly itchy. If psoriasis affects the hands and feet, painful fissures can develop and these can affect use of the hands and walking. Severe psoriasis on the body can also develop cracks which are painful and can bleed.
- Psoriasis can affect the nails and lifting away of the nail from the finger can be painful.
- Psoriatic arthritis produces pain, swelling and stiffness in one or more joints, particularly in the morning.
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Lack Of Black Female Voices And Advocates
As I began to search the internet for psoriasis images and articles, I was immediately disheartened. I found countless images of people who looked nothing like me. Their psoriasis looked nothing like mine.
I spent days searching online for Black stories and images, in hopes of finding anyone who may have been enduring the same struggles I was going through.
I finally found an article written a few years back by a Black woman who runs a psoriasis support group. I read her story and was nearly brought to tears by her decades of suffering because doctors had no idea how to properly treat her Black skin.
I also felt discouraged, as though Id have to endure more suffering along my psoriasis journey because theres still little advancement for treating psoriasis on Black skin.
It wasnt until I found a young Black woman on social media, whod been living with psoriasis for over two decades, that I began to become hopeful. Her story and images gave me hope.
I connected with both women online. As a result, I have felt more empowered to share my story.
The voices of Black women and other women of color are virtually nonexistent within the psoriasis community. Im determined to be that voice and show women of color that a full life with psoriasis is possible.
Can I Pass Psoriasis On To My Children
While psoriasis is not contagious, it does have a genetic component, which means it can be inherited. About 40% of patients with psoriasis have a family history of the disease. However, just because you have psoriasis does not mean you will always pass it on to your children. If one parent has psoriasis, there is about a 10% chance of passing it on to offspring. If psoriasis affects both parents, there is a 50% chance of passing it on to their children.
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Disadvantages In Low Sunlight
Dark-skinned people living in low sunlight environments have been recorded to be very susceptible to vitamin D deficiency due to reduced vitamin D synthesis. A dark-skinned person requires about six times as much UVB than lightly-pigmented persons. This is not a problem near the equator however, it can be a problem at higher latitudes. For humans with dark skin in climates of low UVR, it can take about two hours to produce the same amount of vitamin D as humans with light skin produce in 15 minutes. Dark-skinned people having a high body-mass index and not taking vitamin D supplements were associated with vitamin D deficiency. Vitamin D plays an important role in regulating the human immune system and chronic deficiencies in vitamin D can make humans susceptible to specific types of cancers and many kinds of infectious diseases. Vitamin D deficiency increases the risk of developing tuberculosis five-fold and also contributes to the development of breast, prostate, and colorectal cancer.
Be Your Strongest Advocate
If you feel like your doctor or their staff members arent listening to your concerns, it is important to speak up. Nobody knows your body better than you do, so tell them about what is ailing you, especially if you feel like you are being dismissed.
It is also important to ask questions about diagnostic testing and treatments. If you are unsure about whether a treatment will help or about side effects, say something.
If you think you have been misdiagnosed, you are allowed to seek out a second opinion. Find a different doctor, and let that person know why you think you have been misdiagnosed. Share what you learned about your symptoms and triggers to help a new doctor determine appropriate testing to reach a correct diagnosis.
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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.
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.
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