“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.
Next week, she’ll ask the U.S. Congress to help her fill in the gaps.
On Oct. 22, McMichael will join other speakers at a special Congressional briefing on psoriasis and skin of color. The briefing, which is being organized by the National Psoriasis Foundation, will bring together doctors, patients and lawmakers in an effort to improve diagnosis and treatment of psoriasis in people of all ethnicities.
Because there is so little research on how psoriasis impacts people of color, doctors sometimes fail to properly diagnose the disease in these patients.
Problems with diagnosis and treatment
“People think it’s eczema, they think people are picking at their skin, that it’s a fungal infection, you name it,” McMichael said. One reason for the mistakes, McMichael said, is that psoriasis can have a different appearance in different skin types. For instance, in African-American patients, psoriasis can look more violet than red, and the scales can be thicker than they are in fairer skin.
Because of these mistakes, people of color sometimes have to wait much longer to get the proper medication.
“A common disorder that can be really well treated is not being addressed because of inaccurate diagnoses,” McMichael said.
For many people of color, not getting the right treatment is a problem that starts long before patients see a doctor, according to Dr. Paul Wallace, a Beverly Hills dermatologist with Wallace Medical Group, Inc., who will also speak at the briefing. That’s because access to care is an issue that affects many diverse populations.
“For many people of color, they can’t even get access to one dermatologist,” he said. And if they can, they may not be able to afford treatments, he added.
“What becomes a problem with some ethnicities is that they are not aware of how to find doctors who are able to care for their skin,” she said. They may only be able to see their primary care physician, she explained, who might not be aware of the most up-to-date psoriasis treatments.
When patients suffer, the economy suffers
Jumping through hoops to obtain an accurate diagnosis and subsequent treatment can generate a ripple effect of negative consequences. For the patient, in addition to the physical suffering, this also typically leads to missed days at work, which in turn can lead to reduced paychecks and, in some cases, limited or lost employment. For many with untreated psoriasis, other consequences can be social isolation that can trigger depression and other challenges.
When this happens, it’s not only the patient who suffers. The economy does as well. Psoriasis patients who see a dermatologist and get the right diagnosis and treatment quicker, McMichael said, use fewer medical resources.
Getting their psoriasis under control also helps patients stay on top of their work responsibilities and other activities, which keeps them, and their employers, in better financial shape, Wallace said.
“When you take very functional individuals out of the work force for some period of time, we lose productivity as a nation,” he said.
Urging Congress to take action
Congress can help address these issues, Wallace and McMichael said.
“Lack of access, lack of appropriate diagnosis, and then lack of resources to get the medication that would work best,” Wallace summarized. “For all intents and purposes, this is something that can be controlled, and needs to be worked on from a legislative point-of-view.”
Take access to care, for instance. Congress could help by providing greater support for programs that train health care providers willing to work in medically underserved areas. Such programs help expand access to care for all, particularly persons of color.
Another issue lawmakers can focus on is the growing challenge of affordable access to prescription medications that are keeping patients with psoriasis from treating or fully treating their disease. “There are times when patients are not approved for drugs because of the way insurance companies are structured,” McMichael said. “When you go to Congress and you talk about these things, they put pressure on companies to open their eyes and say, ‘yes, this is a big problem.’”
Congress can also help by increasing funding for researchers to study psoriasis in skin of color, and for young doctors to be better trained in treating this patient population.
“There is precious little research in skin of color,” McMichael said. “We need to make a really big dent in understanding why it’s different, why it looks different, why it’s sometimes harder to treat—or even if it really is harder to treat,” she said.
Progress has been made, she said. Academic institutions across the country have centers dedicated to studying psoriasis in skin of color. Researchers interested in this topic have started to come together too, she said. McMichael is the president of the Skin of Color Society, a group of dermatologists working to advance the diagnosis and treatment of skin diseases in people of color.
On top of specific policy solutions, the briefing is also meant to increase awareness of psoriasis, and how it affects people of color across the country.
Wallace hopes the briefing will help lawmakers understand what their constituents with psoriasis go through on a daily basis.
“I would like for them to really understand the daily emotional and physical toll that this disease has on these patients, and how they are so misunderstood by the general population,” he said. “It’s far more than a skin disease.”
Driving discovery, creating community
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