Dermatologists must be knowledgeable about differences among people of color with psoriasis and to tailor their approach to diagnosis and treatment accordingly.
At the 2023 Fall Clinical Dermatology Conference held in Las Vegas, Andrew F. Alexis, MD, MPH, and Mona Shahriari, MD, presented “The Many Shades of Plaque Psoriasis: Considerations for Treating Skin of Color,” sharing their knowledge about treating psoriasis in patients of color. The conference is a 4-day CME course that provides a comprehensive update on the diagnosis and treatment of a variety of conditions related to medical, surgical, and cosmetic dermatology.
Psoriasis, Drs. Alexis and Shahriari note, presents differently in people with different skin tones. This creates some “clinical and therapeutic nuances,” Dr. Alexis points out, suggesting that dermatologists and other healthcare professionals “broadening their color palate” when treating persons of color.
Key points discussed at the conference included:
Skin Tone and Presentation:
Psoriasis manifests itself differently in individuals with darker skin tones versus those with lighter skin tones. In people of color, psoriasis lesions may be darker or more hyperpigmented than the surrounding skin. These dark spots can be mistaken for other skin conditions, making diagnosis and treatment more challenging.
When assessing disease severity, dermatologists look for erythema, a redness in the skin. However, erythema may not appear red in melanin-rich skin, but it can present as violet, gray, or brown.
Delayed Diagnosis:
Due to the atypical presentation of psoriasis in people of color, there may be a delay in diagnosis or misdiagnosis. It is important for individuals with melanin-rich skin to consult a dermatologist with expertise in treating psoriasis in people of color to ensure accurate diagnosis and appropriate treatment.
Cultural Considerations:
Cultural beliefs and practices influence how individuals from different racial and ethnic backgrounds perceive and manage psoriasis. Therefore, dermatologists must take cultural sensitivities and preferences into consideration when providing healthcare and treatment options.
Treatment Options:
Dermatologists should consider an individual patient’s skin type and color should be considered when determining treatment for psoriasis. Some treatments may be less suitable for individuals with darker skin tones due to the risk for hypopigmentation, or lightening of the skin, or hyperpigmentation, darkening of the skin.
Psychosocial Impact:
Psoriasis can have a significant psychosocial impact on individuals, regardless of their skin tone. However, the stigma associated with visible skin conditions may be intensified in people of color. Support and education can help individuals cope with the emotional and social aspects of living with psoriasis.
Research and Representation:
Clinical research and studies on psoriasis often underrepresent people of color. This can result in a limited understanding of how treatments work and their efficacy in diverse populations. Therefore, support for more inclusive research is essential to better serve all individuals with psoriasis.
Finally, it is important for dermatologists to be knowledgeable about these differences and to tailor their approach to diagnosis and treatment accordingly. Additionally, individuals with psoriasis, regardless of their racial or ethnic background, should seek medical advice and support from healthcare professionals experienced in managing this condition.
