Psoriasis Manifests Itself As Scaly Patches That Are Often Painful And Itchyand This Looks Different On Different Skin Tones
Stress, illness, or injury to the skin can all cause flare-ups, says New York dermatologist Tiffany Jow Libby, MD.
On white skin, this often appears as thick red plaques that have a silvery scale and are most commonly found on the arms, shoulders, chest, and legs, says Dr. Hartman.
On patients of color, the redness of psoriasis skin lesions can appear more subtly and often presents as a purplish-gray or dark brown color, says Dr. Libby. And while the scaliness of these lesions is still present, it usually appears as white or gray, she adds.
The after-effects of psoriasis flare-ups are different in darker skin, too. When psoriasis lesions resolve, they may also leave a patch of discoloration, either a dark or lighter-colored spot, that tends to linger for months, she says.
Since psoriasis looks different on Black skinand there’s not enough education about what this looks likeit’s often misdiagnosed, says Dr. Hartman.
Studies show that when African American patients do have psoriasis, they often have more extensive disease involvement as compared to Caucasian patients, Dr. Libby says.
That means it’s a good idea to be vigilant about spotting symptoms and bringing them to your doctor’s attention.
Look for well-demarcated areas of flaking dry skin that may have some redness or purple-fray associated with it, suggests Dr. Libby. Youre most likely to find these lesions on the scalp, elbows, knees, torso, buttocks, and even nails, but they can appear in other places, too.
How To Get A Diagnosis For Psoriasis On Black Skin
The only way to know for sure that you have psoriasis is to go to a dermatologist.
Theyll perform a physical exam, looking for signature signs of psoriasis like lesions, scaling, or flaking skin.
Your doc may also do a skin biopsy, removing a small amount of your skin to test it for psoriasis. This is a good option if a physical exam isnt 100 percent accurate.
Effects Of Psoriasis On People With Darker Skin
A study by the National Psoriasis Foundation on psychosocial impacts of psoriasis found that psoriasis may have a more significant perceived impact on people with darker skin.
In the study, 72% of people with non-White skin tones reported an impact from psoriasis on their quality of life, versus 54% of White people.
Some of the concerns from people with darker skin about their psoriasis included self-consciousness, frustration, helplessness, and anger. Researchers observed that the negative impact on quality of life might be due to:
- Having more visible discoloration of the skin
- Different cultural perceptions of skin ailments
In addition, 23% of Black patients in the study stated that they had “very severe psoriasis” compared to 8% of White people.
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Psoriasis On Black Skin Vs White Skin
Psoriasis is an autoimmune skin condition that causes scaly, itchy, and painful patches to appear on the skin. This condition affects more than 125 million people worldwide.
Psoriasis can appear differently depending on:
- what type it is
- the severity of the flare-up
- the color of your skin
In fact, psoriasis patches often appear quite differently on black skin versus white skin.
In this article, well explore:
- what psoriasis looks like on darker skin
- how this condition is diagnosed
- treatment options for psoriasis flare-ups
research study found that the prevalence of psoriasis was 1.3 percent in black patients compared to 2.5 percent in white patients.
The difference in prevalence is likely due to genetics but can also be affected by a lack of proper diagnosis in patients of color.
Because black skin has a higher melanin content than white skin, this can affect the way that certain skin conditions appear, including psoriasis.
On white skin, psoriasis usually appears as pink or red patches with silvery-white scales. On black skin, psoriasis appears more as purple patches with gray scales. The patches can also appear as a dark brown color.
Psoriasis patches on black skin may also be more widespread, which can make it difficult to distinguish between other conditions.
Its important to remember that because black skin comes in many different shades, theres no rule for how psoriasis will appear on people of color.
What Are The Types Of Psoriasis
In children, common types of psoriasis include:
Plaque psoriasis. This is the most common type of psoriasis. It causes plaques and silvery scales, usually on the knees, elbows, lower back, and scalp. They can be itchy and painful and may crack and bleed.
Guttate psoriasis. This type often shows up after an illness, especially strep throat. It causes small red spots, usually on the trunk, arms, and legs. Spots also can appear on the face, scalp, and ears.
Inverse psoriasis. This causes smooth, raw-looking patches of red skin that feel sore. The patches develop in places where skin touches skin, such as the armpits, buttocks, upper eyelids, groin and genitals, or under a womans breasts.
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Psoriasis Treatment In Skin Of Color
- The Dermatology Times
- New York, NY
When it comes to treating psoriasis in non-white patients, there is a paucity of data on differences of epidemiology, clinical presentation and approaches to treatment. Although psoriasis appears to have a lower prevalence in non-white racial ethnic groups, including African Americans, it is by no means an uncommon or rare disease, said Andrew Alexis, MD, MPH, associate professor of dermatology at the Icahn School of Medicine at Mount Sinai, director of The Skin of Color Center at Mount Sinai, and site chair of the department of dermatology at Mount Sinai St. Lukes and Mount Sinai West. The clinical presentation of psoriasis in darker skinned individuals can vary, based primarily on the visual appearance. For example, because of the background melanin pigmentation, the erythema may look more violaceous, hyperpigmented or dark brown or gray, added Dr. Alexis. Therefore, one has to train the eye to detect psoriasis-related erythema in darker skin types.
– Andrew Alexis, MD, MPH, Associate Professor, Dermatology, Icahn School of Medicine at Mount Sinai, Director, The Skin of Color Center at Mount Sinai, Site Chair, Department of Dermatology, Mount Sinai St. Lukes-Mount Sinai West
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The Link Between Psoriasis And The Immune System
No one ever really considered that the immune system had any real role in psoriasis, or its painful outbreaks. Not until a new drug Cyclosporine was offered to arthritis patients. What happened next was both surprising and unexpected. Patients who were prescribed the immune suppressing drug for their arthritis symptoms , began to report a decrease in their skin attacks. Without warning, researchers were faced with the theory that the immune system could be causing psoriasis.
It didnt take long before researchers began to figure out the mystery of psoriasis in regards to how the immune system can impact it.
The Role of the Immune System on the Skin
The immune system is responsible for standing guard and attacking any invaders which penetrate the body. Since the skins main job is to act as the bodys first defense mechanism against invasion, it is no wonder that the immune system works in close connection with each layer of the skin. Heres how it all works:
1. Immune cells patrol the entire body for dangers. Psoriasis on African American Skin Pictures
2. When an invader is detected, these immune send out chemical and nervous system messages to the immune system to ready itself for an attack
True Vs Pseudo Koebners Responses
A true Koebners response occurs alongside preexisting autoimmune conditions that affect the skin. A pseudo Koebners response is when an infection, such as viral warts or molluscum contagiosum, spread lesions across the injured skin.
If a person has an existing autoimmune disease, Koebners can be brought on by damage to the skin. Examples of trauma that may bring on Koebners phenomenon include:
- Animal or insect bites
- Tuberculosis test
Limited case studies have suggested that Koebners phenomenon may occur in people without preexisting autoimmune skin conditions. However, the overall body of research indicates that the condition is most closely associated with autoimmune conditions that affect the skin, such as psoriasis, vitiligo, and lichen planus.
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How Dermatologists Can Help
While many African Americans are dealing with these skin conditions, most dont ever seek the help of a skilled dermatologist who can help heal your skin and minimize the long-term effects of skin care issues. A dermatologist is your partner in protecting, repairing, and enhancing the appearance of your skin, so dont hesitate to reach out to a local practitioner at U.S. Dermatology Partners to find out more. Use our convenient online form to request an appointment with a knowledgeable practitioner near you!
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Understand Your Treatment Options
For the most part, Black skin responds to most psoriasis treatments in the same way white skin does. One possible exception is phototherapy, as the light used to treat psoriasis can worsen dyspigmentation darkening or lightening of patches of skin caused by flare-ups. Ask your dermatologist about this risk if they recommend phototherapy for you.
Note too that scalp psoriasis is more common in Black people. However, treating the scalp often involves frequent use of medicated shampoo plus medication applied directly to the scalp, which may be drying to African-American hair, causing it to break easily and be difficult to style. Talk to your dermatologist about other options if shampooing this frequently isnt a good match with your hair care routine.
Traditional Treatment Cautions Pictures Of Psoriasis On An African American
You make an appointment to see your doctor because your psoriasis is flaring. He takes a look and then whips out his prescription pad to order one of the following:
. A prescription strength topical treatment
. oral and injection therapy
. over the counter drugs
Any of these treatments may work fine to relieve your symptoms and make you feel better for now. The trouble with conventional treatment methods is that they rarely work to cure the underlying cause of this skin condition and that can leave you suffering repeat attacks. Still it is important to know what helps are available, and how they may help or hurt your chance of treatment success.
Topical Ointments Pictures of Psoriasis on an African American
Topical ointments are used at the first sign of psoriasis. If caught early enough they can sometimes stave off a full-blown attack. Unfortunately, most people report becoming immune to them when used often, which makes them useless for long term use. Still, using the occasional cream or gel can help relieve some of your symptoms. Steroids
Both topical and internal steroids can be prescribed to help ease psoriasis swelling inflammation and itching. Immunomodulators
An immune suppressing drug that was originally used to help transplant patients beat organ rejection, Cyclosporine helps to inhibit T lymphocyte production so that scaly plaque is unable to grow on the surface of the skin.
Oral Retinoid Pictures of Psoriasis on an African American
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How Psoriasis Appears On Darker Skin
Although the lesions on all skin types can be painful, itchy, and filled with pus, Hartman points out that psoriasis on white skin usually appears as thick plaques with a silver scale and are most commonly found on the arms, chest, legs, and shoulders.
This isnt necessarily the case for Black patients or individuals with darker pigmented skin, however. People with more melanin in their skin may develop psoriasis lesions that appear violet, dark brown, or gray. Since psoriasis looks different on Black skin and there’s not enough education about what this looks like it’s often misdiagnosed, says Hartman.
Individuals with darker skin are also more likely to find psoriasis lesions on the scalp, elbows, knees, torso, buttocks, and even nails the areas affected can also vary in size, although its not exactly known why. In the case of scalp psoriasis, people should work with their dermatologist to create a hair care regimen that works for their specific type of hair.
The after-effects of psoriasis also differ among individuals with heavier pigmented skin. Depending on the severity of the outbreak, Hartman says that lesions from psoriasis can leave spots of discoloration or post-inflammatory dyspigmentation for months after a flare-up resolves. Dermatologists caution Black patients not to confuse this with active psoriasis, and recommend against using topical steroid treatments on the inflamed areas.
Where Is Psoriasis Likely To Occur On The Body
Plaque psoriasis is the most common type of psoriasis in most people with the condition, but the location can differ between people of different skin colors.
For example, psoriasis of the scalp is common in black people, so cross-checking this area of the body can help to confirm a suspected diagnosis.
In addition to the signature psoriasis patches, other symptoms of psoriasis in people of all skin colors may include:
- dry, cracked skin
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Home Remedies For Psoriasis
Psoriasis is a recurring autoimmune disorder, characterized by itchy or sore patches of thick, red skin with silvery scales often occurring on your elbows, knees, scalp, back, face, palms and feet. Oddly enough, while it affects your skin, psoriasis actually begins deep on the inside in your immune system. Per the International Federation of Psoriasis Associations, 125 million people worldwide about 2 to 3 percent of the total population suffer from psoriasis.
Though it can be hard to diagnose because it can look like other skin diseases, heres what we know. A problem within your immune system causes psoriasis. In a process called cell turnover, skin cells grow deep in your dermis before rising to the surface. This typically takes about one month. With psoriasis, the process is complete in a matter of days. Because your cells are rising entirely too fast, youre left with the unsightly skin woe.
Even more, theres no cure. In fact, psoriasis symptoms tend to come and go as they please. In saying that, many factors can worsen or soothe the ailment.
Factors that worsen psoriasis:
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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.
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