Psoriasis and Skin Tones: Inequalities and Additional Factors
Psoriasis, a common immune-mediated condition affecting more than 7.5 million adults in the United States, presents differently in people of color compared to white people, leading to challenges in diagnosis and treatment.
Hispanic people, for example, are more likely to experience more severe psoriasis, including pustular psoriasis. People of color may only receive topical treatments or no treatment at all, which can greatly affect their quality of life.
According to a 2017 analysis, white people have a higher percentage of mild to moderate psoriasis severity compared to Asian, Hispanic, Black, and Middle Eastern people. This discrepancy may be due to a lack of exposure to and knowledge about biologics, a newer form of medication that provides targeted intervention and can potentially lead to better disease outcomes.
Clinical trials for biologics often lack representation from people of color, leading to underutilization of these effective treatments. A greater percentage of people of color face difficulties in seeking medical care due to factors such as lack of access, difficulty taking time off from work, and arranging for child care.
Psoriasis in people of color often appears as violaceous, hyperpigmented, or hypertrophic plaques, rather than the classic red, scaly plaques seen in lighter skin. This atypical presentation can lead to misdiagnosis or missed diagnosis, particularly if a person does not have access to a specialist or seeks care at the emergency room or urgent care.
Dr. Flor Mayoral, a dermatologist, notes that 'Red' may look violaceous or gray if someone has really dark skin. Limited data exist on the specific effects of psoriasis on people of color, which can affect clinical practices and public perception of the condition.
Moreover, psoriasis profoundly affects quality of life more in people with skin of color but there is still a need for more research on how psoriasis presentation and response to treatment vary across racial groups. Asian people are more likely to present with scalp, pustular, and erythrodermic psoriasis and are more likely to have severe cases.
Black people are less likely than white people to develop psoriatic arthritis, but are more likely to have scalp psoriasis, violaceous lesions, less noticeable inflammation, and postinflammatory hyperpigmentation and hypopigmentation.
In summary, early recognition, tailored treatment plans, and addressing racial disparities in clinical research for psoriasis care in people of color are crucial. Clinicians hold the key to overcoming these barriers, and being caring clinicians can help ensure that all patients receive the best possible care.
References: 1. National Psoriasis Foundation. (2021). Psoriasis in People of Color. Retrieved from https://www.psoriasis.org/about-psoriasis/psoriasis-in-people-of-color 2. Mayoral, F. (2020). Psoriasis in People of Color. Dermatology Times. Retrieved from https://www.dermatologytimes.com/view/psoriasis-in-people-of-color 3. American Academy of Dermatology. (2021). Psoriasis. Retrieved from https://www.aad.org/public/diseases/psoriasis 4. National Psoriasis Foundation. (2019). The Impact of Psoriasis on People of Color. Retrieved from https://www.psoriasis.org/about-psoriasis/impact-of-psoriasis/impact-on-people-of-color 5. National Psoriasis Foundation. (2018). Psoriasis in Asian People. Retrieved from https://www.psoriasis.org/about-psoriasis/psoriasis-in-people-of-color/asian-people
- The unique characteristics of psoriasis in people of color, such as violaceous, hyperpigmented, or hypertrophic plaques, necessitate tailored treatment plans.
- Many clinical trials for biologics, a newer form of medication for psoriasis, lack representation from switchers, or individuals who have already tried other treatments, particularly from people of color.
- The science of skincare and dermatology must address diversity-and-inclusion, as people of color may only receive topical treatments or no treatment at all for psoriasis.
- With more severe psoriasis cases, seekers are disproportionately affected by financial constraints due to the cost of various medical-conditions and health-and-wellness treatments.
- Dermatology specialists who are aware of the differing presentations of psoriasis in skinned-care among various racial groups, like Asian, Hispanic, Black, and Middle Eastern people, can reduce instances of misdiagnosis and missed diagnoses.
- Businesses in the health-and-wellness industry have a role to play in bridging gaps in representation and resources for people of color who suffer from psoriasis.
- The field of dermatology must prioritize extensive research on race-and-mental health, as the profound impact of psoriasis on quality of life is more pronounced in people of color.
