Worldwide, psoriasis affects 125 million people.  Despite this global reach, there is limited information about diagnosing and managing psoriasis in skin of color.
Diagnosing Psoriasis in Skin of Color
Psoriasis is found more frequently in white (3.6 percent) than in African American (1.9 percent) and Hispanic (1.6 percent) populations.  [Editor’s note: The National Psoriasis Foundation (NPF) understands that Hispanic is an ethnic designation; however, it is not possible to ascertain whether the publication meant Hispanic or Latinx.] However, these numbers may not paint the full picture, as psoriasis may be more readily identified in people with lighter skin and it is sometimes misidentified in people with darker skin tones. “Across skin types, many features present similarly, such as the symmetrical distribution of psoriasis on the body and well-circumscribed nature of psoriasis plaques,” shares Junko Takeshita, M.D., Ph.D., M.S.C.E., an assistant professor of dermatology and epidemiology at the University of Pennsylvania Perelman School of Medicine. Differences do exist and are important to recognize, such as “the red color or erythema that is typically seen with psoriasis on light skin often appears more purple or brown in darker skin types. Sometimes the scale that accompanies psoriasis is so thick that it is difficult to appreciate that underlying color of the plaque itself. Nevertheless, psoriasis remains a common condition across skin types and races/ethnicities,” continues Dr. Takeshita.
Is Psoriasis Undertreated?
It is not just differences in diagnosing psoriasis, though. Research shows that many patients with psoriasis are undertreated with only topical medications or receive no treatment at all. Racial/ethnic minority patients may be disproportionally affected by under treatment.  “While it’s not direct data on undertreatment, our research has shown that Black patients with psoriasis are less likely than White patients to get biologic treatment.  So, at least with biologic treatment, the evidence suggests that there is undertreatment among Black patients compared to white patients,” says Dr. Takeshita. In fact, a 2019 study showed that Black patients were less familiar with self-injectable biologics compared to white patients, despite these treatments being efficacious options for psoriasis. This study also showed that Black patients who were biologic-naïve were more likely to have a preference to avoid needles and have a greater concern about adverse effects of treatment. The authors of this study suggest that this poor familiarity may be a result of having less exposure to the treatments (for example, by their treatment provider or through advertising) or a lack of understanding of biologics as a treatment option.