Psoriasis Covers More Body Surface Area For People Of Color
African Americans often have psoriasis that is more widespread. One study revealed that African Americans reported that up to 10% of their body surface area was affected by psoriasis, while Caucasians reported only 1 to 2%.
Psoriasis is also more commonly found on the scalp in people of color than it is in Caucasians.
Itching Psoriasis Plaques Can Cause Scars
Scarring from psoriasis isnt common, but it can happen. Scarring doesnt typically occur unless people scratch or manipulate their plaques, says Michelle Pelle, MD, a dermatologist in San Diego. This can cause trauma to the skin and result in linear scarring . Plaque psoriasis can also cause skin to become dry, then crack and bleed, which can sometimes lead to scarring.
In some cases, psoriasis treatments can contribute to the problem. Overuse of topical steroids, for example, can thin the skin and cause changes to its collagen structure. This can lead to an atrophic scar or even stretch marks, notes Dr. Kassouf.
While can be an effective treatment for plaque psoriasis, it stimulates the skins pigment cells, which can make discoloration caused by plaques more noticeable, and occasionally permanent. This was more of a problem with older forms of light treatment, Kassouf notes. “Newer, narrow band UVB therapy has significantly minimized the risk of permanent pigment changes, but there is still some risk.
Is Psoriasis Hereditary
Although psoriasis is not contagious from person to person, there is a known hereditary tendency. Therefore, family history is very helpful in making the diagnosis.
There are many effective psoriasis treatment choices. The best treatment is individually determined by the treating doctor and depends, in part, on the type of disease, the severity, and amount of skin involved and the type of insurance coverage.
For mild disease that involves only small areas of the body , topical treatments , such as creams, lotions, and sprays, may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriatic plaque may be helpful.
For moderate to severe psoriasis that involves much larger areas of the body , topical products may not be effective or practical to apply. This may require ultraviolet light treatments or systemic medicines. Internal medications usually have greater risks. Because topical therapy has no effect on psoriatic arthritis, systemic medications are generally required to stop the progression to permanent joint destruction.
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Treating Skin Of Color
For some psoriasis patients, getting the right diagnosis isnât always so black and white. And once minorities receive the proper diagnosis, they often face unique risks, challenges and stigmas.
Editor’s note: This story was updated on 06/17/2020. NPF has released a statement regarding the current racial injustice in the U.S.
When Brenda Kong was diagnosed with psoriasis in 1993, her family had been in the U.S. about 11 years. âMy parents spoke limited English, and there isnât a word in our language for psoriasis,â says Kong, who was born in Cambodia and whose parents spoke Khmer. âThey didnât understand what it was, and for a long time, they couldnât understand why Western doctors couldnât heal me.â
Kong, now 37, was diagnosed with psoriasis at 13 and psoriatic arthritis at 22. As an active young athlete, she tried to hide her skin by wearing long socks when she played volleyball and tennis, but her condition was difficult to conceal. Her parentsâ friends offered unsolicited advice about which foods to cut from her diet and which herbal teas to drink. Theyâd ask embarrassing questions and lift her sleeves to examine her skin. âThey were trying to help, but when youâre a teenager, youâre sensitive to everything,â says Kong, who lives in Oakland, California.
What Does Psoriasis Look Like On Black Skin
Around 125 million people worldwide have psoriasis. A 2014 study involving more than 6,000 people found that the prevalence of psoriasis was about 1.9 percent in Black participants and 3.6 percent in white participants. But psoriasis rates among Black folks may be even higher IRL.
Psoriasis can be easy to spot on white skin. It shows up as pink or red lesions with silvery scales. But on Black skin, lesions tend to be purple or violet with gray scales. This might make the condition harder to diagnose.
PSA: According to the National Psoriasis Foundation, people with darker skin receive incorrect diagnoses or go undiagnosed with psoriasis more often than light-skinned people.
Anyone can have psoriasis. It isnt exclusive to one ethnic group or age group. But symptoms can vary based on your skin type and tone.
Heres how the most common forms of psoriasis appear on Black skin.
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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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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.
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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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Avoid alcohol
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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.
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What Injections Or Infusions Are Available For Psoriasis
Recently, a new group of drugs called biologics have become available to treat psoriasis and psoriatic arthritis. They are produced by living cells cultures in an industrial setting. They are all proteins and therefore must be administered through the skin because they would otherwise be degraded during digestion. All biologics work by suppressing certain specific portions of the immune inflammatory response that are overactive in psoriasis. A convenient method of categorizing these drugs is on the basis of their site of action:
Drug choice can be complicated, and your physician will help in selecting the best option. In some patients, it may be possible to predict drug efficacy on the basis of a prospective patient’s genetics. It appears that the presence of the HLA-Cw6 gene is correlated with a beneficial response to ustekinumab.
Spectrum Of Treatment Options
Although psoriasis presents differently on various skin types, color doesnât necessarily determine treatment options. Patients should consult with their health care providers to personalize their treatment plans. Creams, ointments and topical steroids are typically the first line of defense against psoriasis, while more severe cases require more aggressive therapies.
âWhen people of color present with psoriasis, especially African-American patients, they often have more hyperkeratotic, or thicker-scaled lesions,â says McMichael. âThat means the lesions are going to take a longer time to control, with medication at higher potency levels.â
If creams donât help, phototherapy can be very effective for people with darker skin pigment, she says, noting the lack of research on treatment for skin of color, as most studies predominantly feature white patients. That situation is changing, however. In 2017, the Patient-Centered Outcomes Research Institute awarded an $8.6 million contract to one of Takeshitaâs colleagues, Joel Gelfand, M.D., a board-certified dermatologist whose clinical work focuses on general dermatology and psoriasis. The PCORI contract is for a clinical trial called LITE. The purpose of LITE is to study the effectiveness and safety of 12 weeks of home-based versus office-based phototherapy for the treatment of psoriasis, and the effects of phototherapy across skin tones.
Aimee Perez
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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
Symptoms Are The Same But Can Look Different
Symptoms of psoriasis do not vary by skin tone, says Dr. Finney. And yet, despite having the same symptoms psoriasis can look somewhat different on deeper skin tones. On dark skin, the plaques may appear purple or grayish and thicker compared to the pink-red scaly plaques that appear on Caucasian skin, explains Dr. Finney. And once healed, psoriasis may leave behind dark or light skin patches, which are more apparent in people of color.
Additionally, Dr. Sodha says that redness is typically less apparent in those with darker skin, though youll still see thickened, scaly patches of skin just like anyone else with plaque psoriasis. Patients with darker skin types are frequently troubled by light and dark discoloration of the skin after treatment that can take months to resolve or, in some cases, be permanent, adds Dr. Finney.
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People Of Color With Psoriasis Are More Likely To Be Misdiagnosed
In darker-skinned individuals, there are other skin conditions that can look quite similar to psoriasis, including , , and cutaneous . Often a is needed to determine the true disease. However, when this is not done, patients are more likely to receive an improper diagnosis. Unfortunately, the longer the delay in receiving proper treatment, the more the disease can progress.
Psoriasis Cases Tend To Be More Severe
For people with psoriasis, research shows that the condition impacts nearly every aspect of their lifewhat medicines they take, what they eateven what they wear. Dr. Sodha says that people with skin of color appear to have more extensive psoriasis at the time of diagnosis, with more surface area involvement. To this point: A study in the Journal of the American Academy of Dermatology found that Asians and Hispanics are both more likely to have more severe psoriasis than Caucasian counterparts.
The same study says that Asians have reported having greater body surface area involvement compared to Caucasians with psoriasis, though the reason for this is still unknown. But one theory is that disparities in access to health care, as well as ethnic differences in utilization of dermatology services, could contribute to differences in severity. Ultimately, we need more diverse studies done in order to determine why and how psoriasis outcomes are so different across skin colors.
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Prevalence And Skin Tone Considerations
Psoriasis affects more than 8 million people in the United States and 125 million around the world, according to the National Psoriasis Foundation. Additionally, the prevalence of psoriasis in white people is 2.5% and is 1.3% in African Americans. And about one-third of people who have psoriasis also have a relative who also has the condition. This means that genetics are a risk factor for the development of the condition.
Psoriasis is considered a systemic disease because it affects more than one part of the body or the entire body. It is also an autoimmune disease caused by an overactive immune system, where the immune system launches an inflammatory response against its own body. With psoriasis, inflammation targets the skin.
Psoriasis is characterized by patches of abnormal skin called plaques. These are dry, itchy or painful and red in color. However, they may appear purple in people with darker skin. The severity of these plaques varies from small, localized patches to complete body coverage. Psoriasis plaques can occur anywhere on the body, including inside the mouth, on the scalp, and on the genitals.
Severe disease in psoriasis involves skin involvement in more than 10% of the body. The severity of the disease may be worse for people with darker skin. In fact, Asians and African Americans with psoriasis may have greater body surface involvement.
Successful Management Of A Black Male With Psoriasis And Dyspigmentation Treated With Halobetasol Propionate 001%/tazarotene 0045% Lotion: Case Report
Introduction
A fixed combination lotion of HP 0.01% and TAZ 0.045% was developed utilizing a novel polymeric emulsion technology, which allows for rapid and uniform distribution of HP and TAZ, humectants, and moisturizers on the skin.10 Phase 3 clinical data have demonstrated efficacy and tolerability of HP/TAZ lotion in patients with moderate-to-severe localized plaque psoriasis.14,15 Here, we present a case report of a Black male with moderate plaque psoriasis who was successfully treated with once-daily HP/TAZ lotion over 8 weeks, with resolution of skin dyspigmentation by week 12.
Case Report
FIGURE 1.Target lesion. Patient was treated with HP 0.01%/TAZ 0.045% lotion once daily for 8 weeks, with 4-week posttreatment follow-up at week 12.
HP, halobetasol propionate TAZ, tazarotene.
FIGURE 2. Additional lesion. Patient was treated with HP 0.01%/TAZ 0.045% lotion once daily for 8 weeks, with 4-week posttreatment follow-up at week 12.
HP, halobetasol propionate TAZ, tazarotene.
The patient achieved treatment success with HP/TAZ lotion, with an improvement to almost clear at week 4 that was maintained posttreatment at week 12 . Improvements in affected BSA and signs of psoriasis at the target lesion were also observed early following treatment with HP/TAZ lotion and maintained up to 4 weeks posttreatment. The patient had substantial improvements in QoL during the study, with DLQI score decreasing from 9 at baseline to 1 at weeks 4 and 8.
Discussion
Disclosures
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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.
Treatments For Specific Areas
Eyelids
To treat this area, your doctor may recommend:
- Special corticosteroids to treat scaling. But donât overuse them. If they get into your eyes, they can lead to glaucoma or cataracts.
- The eczema drugs crisaborole ointment, pimecrolimus , or tacrolimus . They don’t cause the side effects of steroids. They can sting the first few days you use them.
Be careful when you treat psoriasis around your eyes. The skin on eyelids is delicate and gets damaged easily. Tell your doctor about any problems you have.
Psoriasis in the eye is very rare. If you have it, your eyes can be painfully dry. You may need antibiotics to treat an eye infection if you get one.
Ears
Psoriasis medications can put your eardrum at risk, so be cautious when you apply any inside the ear. Your doctor may recommend:
- A prescription corticosteroid you can drip in your ear or apply to the outside of your ear canal
- Calcipotriene or tazarotene usually mixed with a corticosteroid cream or ointment
Mouth and Nose
- Steroid creams or ointments that are made for moist areas
- Rinsing often with a saline solution to relieve pain
- Low-potency corticosteroids like hydrocortisone 1% ointment
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