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.
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.
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:
- 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
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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.
Treating Psoriasis On Black Skin
While psoriasis medications can help control outbreaks in many people, Black people are often undertreated. Compared to white people, theyre not only less likely to be treated with biologics , according to a study published in December 2015 in The Journal of Investigative Dermatology, but they sometimes receive only topical medications or no treatment at all, according to the National Psoriasis Foundation.
Black people who have psoriasis were also less familiar with biologics as a treatment option compared to white people, according to a study published in February 2019 in the Journal of Investigative Dermatology, despite the fact these medications are highly effective at treating the skin condition, regardless of a persons pigmentation.
Dr. Hartman points out that undertreatment among Black patients is not due to a lack of concern or care for their health. Disparities such as a lack of access to quality medical care and healthcare insurance in the Black community have been well documented and contribute significantly to Black patients with psoriasis not being treated adequately.
Other research published by Dr. Takeshita has shown that dermatologists are less confident about diagnosing psoriasis in people with darker skin than those with lighter skin.
Contrary to what has been displayed in the media, psoriasis can affect people of any race. And a growing number of providers agree that we need more diverse representation and information for Black people with psoriasis.
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Psoriasis On Hands Pictures
The picture of Psoriasis on hands depends on the kind of the condition. They recognize a common form of the disease with specific silver scales, which appear also on the elbows. The so-called erythrodermic psoriasis often affects the palms causing dry skin, itching and flaking all over the touched area. The skin loses elasticity, becomes tougher and gets covered with a corneal layer.
Such psoriasis on hands can be of severe form and that means that it penetrates inside the organism provoking ulcers, kidney failure. There are atypical forms, which can be found on the creases. This form of the disease is usually followed by lesion of feet with the same symptoms. Moreover, there is psoriatic arthritis a painful condition causing physical limits. It can attack a lot of joints but in the hands it is very severe and appears after the skin symptoms become obvious.
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.
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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.
How Is Psoriasis Assessed
Psoriasis should be assessed at diagnosis, before your first referral to a specialist, every time you see a specialist and to assess your response to treatment. Psoriasis may be assessed by your doctors using a variety of scores which measure the severity in your skin and joints, how psoriasis is affecting your mood and your activities of daily living and whether you are at risk of heart disease.
These scores include the PASI and DLQI
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What Does A Psoriatic Arthritis Rash Look Like
A psoriatic arthritis rash can present differently for different patients. For example, one person can have just a few patches near their scalp or elbow while other people can have them on the majority of their body.
One of the most common ways it shows up is as plaque psoriasis, says Dr. Haberman. Plaque psoriasis causes red, slightly raised patches with silvery scales covering them on the elbows, knees, scalp, or in or around the belly button and lower back.
Other types of psoriatic rashes include:
- Erythrodermic psoriasis: generalized redness and scaling of a large portion of the body
- Guttate psoriasis: small, tear-dropped dots or lesions, usually on the trunk, upper arms, and thighs
- Inverse psoriasis: flat, red, shiny psoriasis patches in areas where the skin folds, such as elbows, knees, groin, armpit, or underneath the breast
- Pustular psoriasis: small, fluid-filled blisters, known as pustules, which often develop on the palm of the hands and feet
The reason a psoriatic rash can be hard to diagnose is that it can present in such different ways, says Dr. Haberman. Also, a psoriatic rash can mimic or be easily mistaken for other skin conditions, including:
- Tinea versicolor
Quality Of Life Concerns
Psoriasis has an impact on quality of life and is associated with significant comorbidities, including cardiovascular disease, diabetes, metabolic syndrome, mental health and psoriatic arthritis. However, Dr. Takeshita shares that compared to white patients, evidence shows that Black, Asian and Hispanic patients with psoriasis report greater quality of life impact, regardless of disease severity. However, the evidence is less clear with regards to the impact health care disparity has on comorbidities. âWe have very little information about potential disparities in diagnosis or treatment of psoriatic arthritis, for example,â says Dr. Takeshita. âAs for other comorbidities, such as cardiovascular comorbidities, we know that among the general population there are racial/ethnic disparities in the prevalence of cardiometabolic disease and their related outcomes. It is unclear if these disparities are compounded among psoriasis patients but, to date, we donât have any evidence that they are.â
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What If Its Not Psoriasis
Psoriasis is sometimes mistaken for other skin conditions. Heres what they usually look like on dark skin:
- Eczema. This common condition is known for reddish, raised lesions. You also might have purple, dark brown, or gray patches.
- Lichen planus. This autoimmune condition can cause white lesions or purplish bumps. In some cases it can appear inside your mouth.
- Fungal skin infections. These can happen when the fungus among us infects your skin. This type of infection can make your skin itch, burn, or crack.
- Cutaneous lupus erythematosus. This chronic autoimmune condition affects about two-thirds of folks with lupus. It can cause discolored patches on your skin.
What Kind Of Doctor Treats Psoriasis
There are several types of doctors who may treat psoriasis. Dermatologists specialize in the diagnosis and treatment of skin disorders, including psoriasis. Rheumatologists specialize in the treatment of joint disorders, including psoriatic arthritis. Family physicians, internal medicine physicians, rheumatologists, dermatologists, and other medical doctors may all be involved in the care and treatment of patients with psoriasis.
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Learning To Live With A Disease Thats Hard To Hide
Whats more, the increased inflammation that happens as a result of the disease puts psoriasis patients at a higher risk of cardiovascular disease and diabetes. And about 30% of psoriasis patients also go on to develop a type of inflammatory arthritis called psoriatic arthritis . When she was in high school, Bridges became one of those patients.
With psoriasis spots all over her body and joint pain keeping her from exercising throughout her teen years, Bridges often felt so down that she denied her diagnoses. Id tell myself things like, Oh, youre sore because you were running around too much yesterday,’ she says. I always tried to blame my symptoms on something else.
Yet as much as she tried, she couldnt outrun her psoriasisand she realized that learning to accept her condition would make life easier in the long run. It was an interesting process wrapping my head around the fact that my psoriasis and PsA wont go away, Bridges says. Any time I have a flare, its a reminder that I have this disease. And even if Im in remission, its nerve-racking knowing it can come back.
One day, I realized I dont have to apologize for my condition. It was as if every time Id felt uncomfortable since I was diagnosed at age 7 had actually worked to build my resilience.
How To Treat Psoriasis
In order to find the most appropriate medication and therapy the particular case should be discussed with a physician as far as different types of the disease at various stages can be cured in many ways taking into account the peculiarities of the certain health grounds. When the first signs of psoriasis are diagnosed, topical treatment is applied, but if the case is neglected other options can be tried. Biologic drugs are used when there is no response to other methods.
Psoriasis on face treatment includes them also. But, the most common prescription is systemic medications administered orally or by injection. They influence the body in the whole. Nail psoriasis treatment can require additional options like steroids applied at or injected into the nail cuticle. Psoriasis elbow treatment like any other types can include biologics, systemic medications, light therapy and others methods.
There are a lot of ways to cure the disease but none of them provide the full recovery, unfortunately.
Pictures of people with psoriasis
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What Can I Do To Help
- Discuss your psoriasis and how it affects your life with your GP or dermatologist and identify treatment goals.
- Manage your risk factors for heart disease and stroke with your GP.
- Adopt a healthy lifestyle: eat a balanced diet, try to lose weight if you are overweight and exercise regularly.
- Stop smoking if you smoke.
- If you drink excessive alcohol, reducing your intake might be helpful.
- Reduce stress, where possible.
- Take your medications as recommended by your GP or dermatologist.
If you have pain in your joints discuss with your GP or dermatologist.
Psoriasis Causes And Risk Factors
Doctors arenât sure what causes psoriasis, but they know that genes and your immune system play a major role. About 40% of people with psoriasis have a close family member with the disease. Many of the genes linked to psoriasis are those that help run your immune system. In addition to your genes, these things can make you more likely to get psoriasis:
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What Can Cause Plaque Psoriasis
Research has shown that psoriasis is an autoimmune disease .
This means your immune system, which usually protects your body from getting sick, has become too active, causing symptoms like plaques, redness, and those flakes that feel like they go wherever you do.
Genes may also make it more likely for some people to develop plaque psoriasis than othersmeaning psoriasis can run in families.
Scientists are exploring how genes pass down psoriasis from one generation to the next.
Some symptoms can be triggered by things we experience in everyday life. Common triggers of psoriasis include:
- Injury to the skin
- Certain medicines for depression, lupus, irregular heartbeat, and pain
- Changes in weather that dry out the skin
Treatments For Specific Areas
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.
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
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