It doesn’t seem entirely surprising that a skin disease could present differently in people of various ethnicities and skin colors. However, in the case of psoriasis, these differences sometimes make it challenging for non-Caucasian patients to receive a proper diagnosis.
1) People of color are less likely to have psoriasis, but when they do, it has a greater impact on their quality of life.
Studies have shown Caucasians have a higher incidence of psoriasis as compared to non-Caucasians, though the number of non-Caucasians has increased in recent years. A survey done in 2013 estimated 3.6% of Caucasians over the age of 20 are affected by psoriasis, whereas 1.9% of African Americans and 1.6% of Hispanics suffer from the disease.
2) Skin areas affected by psoriasis are not typically red.
The way psoriasis appears in darker-skinned patients is often different than what is seen in their lighter-skinned counterparts. While most Caucasians will present with reddened patches of skin, African Americans may have psoriasis that is dark brown or violet in color. The scales of psoriasis are often thicker as well.
3) Psoriasis covers more body surface area for people of color.
African Americans often have psoriasis that is more widespread. One study revealed that African Americans reported that up to 10% of their body surface area was affected by psoriasis, while Caucasians reported only 1 to 2%.
Psoriasis is also more commonly found on the scalp in people of color than it is in Caucasians.
4) People of color with psoriasis are more likely to be misdiagnosed.
In darker-skinned individuals, there are other skin conditions that can look quite similar to psoriasis, including lichen planus, sarcoidosis, and cutaneous lupus. Often a biopsy is needed to determine the true disease.
5) People of color with psoriasis may follow different treatment paths than their Caucasian counterparts.
It may be difficult to pin down the correct psoriasis treatment regimen for people of color. For example, phototherapy is commonly used to treat severe cases of psoriasis. Darker-skinned patients may require more intense light exposure to adequately treat the disease. At the same time, these patients are also more likely to experience changes in skin pigmentation following phototherapy, so doctors need to discuss this prior to beginning treatment.