What Black Patients Need to Know About The Effects of Psoriasis

Many people who have psoriasis will experience the telltale sign of itchiness or burning. But for people with differing skin tones, that’s where the similarities may end.

The symptoms of psoriasis, a chronic inflammatory condition, can look different on people with differing skin tones. On lighter skin, plaque psoriasis can appear red; on darker skin, it can be purple or gray-ish.

Unfortunately, many people who’ve searched Doctor Google for psoriasis images on Black skin haven’t found very many answers — and, given this lack of representation, they can leave with possibly with more questions than they had before.

Here’s what you should know about psoriasis — including what it looks like, and why it can go underdiagnosed and undertreated in the Black community.

Psoriasis in the Black Skin: A Lack of Representation

The Internet is flooded with images of white people who have psoriasis, but there aren’t nearly as many pictures of Black people who have psoriasis. This often leads people to the conclusion that psoriasis mainly develops in people with lighter skin — which couldn’t be further from the truth.

How Psoriasis Appears on Darker Skin

Although the lesions on all skin types can be painful, itchy, and filled with pus, Hartman points out that psoriasis on white skin usually appears as thick plaques with a silver scale and are most commonly found on the arms, chest, legs, and shoulders.

This isn’t necessarily the case for Black patients or individuals with darker pigmented skin, however. People with more melanin in their skin may develop psoriasis lesions that appear violet, dark brown, or gray. “Since psoriasis looks different on Black skin — and there's not enough education about what this looks like — it's often misdiagnosed,” says Hartman.

Individuals with darker skin are also more likely to find psoriasis lesions on the scalp, elbows, knees, torso, buttocks, and even nails; the areas affected can also vary in size, although it’s not exactly known why. In the case of scalp psoriasis, people should work with their dermatologist to create a hair care regimen that works for their specific type of hair.

The after-effects of psoriasis also differ among individuals with heavier pigmented skin. Depending on the severity of the outbreak, Hartman says that lesions from psoriasis can leave spots of discoloration or post-inflammatory dyspigmentation for months after a flare-up resolves. Dermatologists caution Black patients not to confuse this with active psoriasis, and recommend against using topical steroid treatments on the inflamed areas.

Treating Psoriasis on Black Skin

Dr. Hartman points out that undertreatment among Black patients is not due to a lack of concern or care for their health. Disparities such as a lack of access to quality medical care and healthcare insurance in the Black community have been well documented and contribute significantly to Black patients with psoriasis not being treated adequately.

Contrary to what has been displayed in the media, psoriasis can affect people of any race. And a growing number of providers agree that we need more diverse representation and information for Black people with psoriasis.

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