How to diagnose, treat psoriasis in skin of color

| Melissa Leavitt

How often do you see psoriasis in skin of color? Do psoriasis patients of color get the same red patches that Caucasian patients do? Should patients of color undergo phototherapy? Get answers to these questions in a National Psoriasis Foundation webinar featuring Dr. Seemal Desai, secretary and treasurer of the Skin of Color Society.

As a dermatologist in private practice in Plano, Texas, Desai often sees patients of color. With immigrant populations continuing to increase all over the country, most dermatologists will be able to say the same in the years to come, he said.

Dr. Seemal Desai

Distinct clinical features and treatment needs of psoriasis patients of color can make caring for this condition a challenge. Here are five tips from Desai’s webinar on diagnosing and treating psoriasis in skin of color.

  1. Don’t overlook psoriasis as a possible diagnosis.

Despite what you may think, psoriasis in people of color is no less common than it is in Caucasian patients, Desai said. According to a 2014 study in the Journal of the American Academy of Dermatology, prevalence of psoriasis among Caucasians in the United States is about  3.5 percent. But, Desai said, according to the same study, prevalence in African Americans is almost 2 percent, and in Hispanics it’s about 1.5 percent. “Psoriasis in darker skin types and in skin of color is out there, and it is being under-recognized,” he said.

  1. Don’t mistake the signs of psoriasis for something else.

Lichen planus. Cutaneous lupus. Fungal infections. These are just some of the conditions that psoriasis in skin of color may be mistaken for, leading to frequent misdiagnosis. Research shows that delaying proper diagnosis and treatment of psoriasis can lead to a worse prognosis long-term, said Desai. If a patient isn’t improving on the treatment you’ve prescribed, he recommends performing a skin biopsy to determine if what you’re seeing is actually psoriasis.

  1. Think purple, not red.

Psoriasis in skin of color can look different than it does in Caucasian skin. For one thing, discoloration is likely to be more violaceous than red. On top of that, scaling is less prominent, and cutaneous involvement can be more widespread, Desai said. Familiarizing yourself with the distinct clinical features of psoriasis in skin of color can save time and resources, and lead to better health outcomes for your patients. “Proper diagnosis leads to proper treatment, and really, you’ve changed people’s lives,” Desai said.

  1. Get in your patients’ hair.

Scalp psoriasis is common in patients of color, Desai said. But treating it can be particularly tough. To make sure you come up with a treatment plan your patients will stick to, ask them about their hair. For instance, said Desai, daily washing with a medicated shampoo may not be a realistic option for African Americans. For those patients, a better treatment schedule might be washing once or twice a week. Make sure to ask about styling practices too, added Desai. It may be necessary to advise your patients to stay away from chemical relaxers or other things that can lead to hair breakage.

  1. Keep in mind cultural stigmas

“There is social stigma associated with skin disease in skin of color patients,” said Desai. These stigmas may at times keep patients of color from seeking treatment for their psoriasis, he explained. Some may feel embarrassed about their condition or may not want to get undressed for a thorough exam. “Be patient with the patient!” Desai advised. It may take one or two visits to establish rapport. Taking the time to show empathy with these patients will help build credibility and make it easier for you to deliver the best care possible.

Register here for the CME-accredited webinar to learn more about psoriasis in skin of color.

Need for more research and education

One of the major challenges in effectively treating psoriasis in skin of color is the lack of research on how psoriasis impacts this patient population. 

“What we know about skin of color in terms of psoriasis could fit on a page or two. That’s not the case with psoriasis in other ethnicities,” said Dr. Amy McMichael, the chair of dermatology at Wake Forest Baptist Medical Center in North Carolina.

Last October, McMichael spoke at a National Psoriasis Foundation-organized congressional briefing on psoriasis and skin of color.



The briefing, which also featured Dr. Paul Wallace, a dermatologist with Wallace Medical Group, Inc., and NFL player Jonathan Scott, highlighted the need for increased funding to expand research and training on psoriasis in skin of color.  It also called for policy changes to improve access to care in this patient population. 

On Feb. 25, NPF continues its efforts to improve care for patients of color with a webinar for patients presented by Wallace. The webinar will discuss symptoms and treatment options for psoriasis in skin of color. Register here to participate.

Driving discovery, creating community

For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.

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