Skin of Color Resources for Health Care Providers

People of all races and ethnicities can develop psoriasis. In research to date, psoriasis has been found more frequently among Caucasians (3.6%) than in Asians (2.5%), Latinx (1.9%) and African Americans (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.

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

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 skin affected by psoriasis than patients with lighter skin.

• Active psoriasis flares may be misdiagnosed as post-inflammatory hyperpigmentation (dark patches on the skin).

[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

Additional Research

Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70(3):512-516. doi:10.1016/j.jaad.2013.11.013

Takeshita J, Eriksen WT, Raziano VT, et al. Racial Differences in Perceptions of Psoriasis Therapies: Implications for Racial Disparities in Psoriasis Treatment. J Invest Dermatol. 2019;139(8):1672-1679.e1. doi:10.1016/j.jid.2018.12.032

Takeshita J, Gelfand JM, Li P, et al. Psoriasis in the US Medicare Population: Prevalence, Treatment, and Factors Associated with Biologic Use. J Invest Dermatol. 2015;135(12):2955-2963. doi:10.1038/jid.2015.296

Holmes A, Williams C, Wang S, Barg FK, Takeshita J. Content analysis of psoriasis and eczema direct-to-consumer advertisements. Cutis. 2020;106(3):147-150. doi:10.12788/cutis.0070

Fischer AH, Shin DB, Gelfand JM, Takeshita J. Health care utilization for psoriasis in the United States differs by race: An analysis of the 2001-2013 Medical Expenditure Panel Surveys. J Am Acad Dermatol. 2018;78(1):200-203. doi:10.1016/j.jaad.2017.07.052

Sevagamoorthy A, Bazen A, Shin D, Barg FK, Takeshita J; Patient race affects dermatologists’ assessments and treatment of psoriasis. J Invest Dermatol. 2020;140(7S):S97.)

Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014;7(11):16-24.

Eriksen WT, Raziano VT, Bazen A, Gelfand JM, Barg F, Takeshita J. Concerns About Psoriasis Differ by Race: Implications for Patient-Centered Goal-Setting and Counseling. J Invest Dermatol. 2019; 139(5S, Supplement 1):S37.

Shah SK, Arthur A, Yang YC, Stevens S, Alexis AF. A retrospective study to investigate racial and ethnic variations in the treatment of psoriasis with etanercept. J Drugs Dermatol. 2011;10(8):866-872.

Takeshita J, Augustin M, de Jong E, Lafferty K, Langholff W, Langley R, Leonardi C, Menter A, Alexis A. Psoriasis-Related Quality-of-Life Differs by Race/Ethnicity. J Invest Dermatol. 2019; 139(5S, Supplement 1):S148.

Gelfand JM, Stern RS. “The prevalence of psoriasis in African Americans: results from a population-based study.” J Am Acad Dermatol. 2005 Jan;52(1):23-6.