Skin of Color Resource Center

People of all races and ethnicities can develop psoriasis. Psoriasis has been found more frequently among White individuals (3.6%) than in Asian individuals (2.5%), Hispanic individuals (1.9%), and African American individuals (1.5%). [1] This difference may be because psoriasis has been more easily identified in people with lighter skin and misidentified in people with darker skin types. [2] But there may be more people with skin of color living with psoriasis than is reported. African American and Hispanic/Latine patients may also experience greater impacts from psoriasis on their quality of life.

Psoriasis may look different on different skin types. On darker skin types, psoriasis may look salmon, dark brown, purple, or violet with grayish scale. [2,3] On lighter skin, psoriasis often looks red with a silvery scale on top. [2]

Here are more ways that psoriasis may look different on darker skin types [2]:

• Plaques may be thicker and have more scaling.
• Patients may have more body surface area (BSA) affected by psoriasis than patients with lighter skin.
• Patients may have more dyspigmentation (hypo and hyperpigmentation) and less redness (erythema).

It is important that health care providers look at more than the color of the affected skin when diagnosing psoriasis on skin of color. To make a diagnosis, your health care provider will look at your skin, nails, and scalp. They may also do a skin biopsy, which is when a small skin sample is removed and looked at under a microscope.

Since psoriasis can look like other skin conditions, on any color of skin, it is important to make sure you are getting a correct diagnosis. Psoriasis on darker skin may look like eczema, lichen planus, sarcoidosis, cutaneous T cell lymphoma, or even discoid lupus. Prurigo nodularis is another skin condition that may be mistaken for psoriasis.

To get a correct diagnosis, it is best to see a dermatologist. Also, it may help to see a dermatologist who has experience diagnosing psoriasis in people who have the same skin color as you. If you feel that you are not getting a correct diagnosis, you can get a second opinion from another provider.

Visit the Health Care Provider Directory to find providers who are experienced in treating psoriasis and patients of all skin colors.

Although skin affected with psoriasis may look different depending on your skin color, the treatment options are the same. However, there are two important factors to discuss with your health care provider when it comes to treatment if you have darker skin.

• UV (ultraviolet) radiation used in phototherapy (also called light therapy) may make the skin temporarily darker. Talk with your provider if you are concerned about this side effect. The amount of light needed for treatment may also differ with darker skin types.
• If you have scalp psoriasis, talk with your provider about treatments that would work for your hair type and how frequently you wash your hair. Some medicated shampoos require daily use, which can cause dryness and breakage in patients with coarser hair texture. Ask your provider if you can get your topical treatment in a different form, such as an oil, lotion, foam, or other solution. This can help increase the likelihood of sticking with your treatment plan.

Some traditional cultural therapies or practices may cause psoriasis to worsen from the Koebner phenomenon. The Koebner phenomenon occurs when new psoriasis plaques appear on previously healthy skin where an injury to the skin occurs. Traditional Asian healing practices, such as cupping, coining, and moxibustion, can lead to the Koebner phenomenon. Scalp scratching, which is practiced by some members of African American communities, can also cause the Koebner phenomenon.

[1] Armstrong AW, Mehta MD, Schupp CW, Gondo GC, Bell SJ, Griffiths CEM. Psoriasis Prevalence in Adults in the United States [published online ahead of print, 2021 Jun 30]. JAMA Dermatol. 2021;e212007. doi:10.1001/jamadermatol.2021.2007

[2] Kaufman BP, Alexis AF. Psoriasis in Skin of Color: Insights into the Epidemiology, Clinical Presentation, Genetics, Quality-of-Life Impact, and Treatment of Psoriasis in Non-White Racial/Ethnic Groups [published correction appears in Am J Clin Dermatol. 2018 Feb 16;:]. Am J Clin Dermatol. 2018;19(3):405-423. doi:10.1007/s40257-017-0332-7

[3] Can You Get Psoriasis if You Have Skin of Color? AAD.org. https://www.aad.org/public/diseases/psoriasis/treatment/could-have/skin-color. Accessed April 26, 2021.