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. Let’s examine some of the clinical characteristics and overall experience of psoriasis in patients with skin of color. 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. However, African Americans and Hispanics appear to be more negatively impacted by psoriasis. Based on a quality-of-life questionnaire, one study found these two groups reported worse physical and psychological symptoms resulting from psoriasis than Caucasians. Additionally, the National Psoriasis Foundation reported 72% of minorities stated that psoriasis affected their lives, as opposed to 54% of Caucasians. 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. Once the psoriasis plaques clear up, patients of color are also more likely to find the affected skin is noticeably darker or lighter than it was previously. This change in appearance can last for up to a year, and for some patients can be quite distressing. 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. However, when this is not done, patients are more likely to receive an improper diagnosis. Unfortunately, the longer the delay in receiving proper treatment, the more the disease can progress. 5. People of color with psoriasis may follow different treatment paths than their Caucasian counterparts. It may 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. Cultural preferences and practices must also be taken into account when making treatment decisions. In the case of scalp psoriasis, doctors should consider the patient’s hair care routine and help develop a plan that works in conjunction with it. In addition, some patients may already use herbal treatments or therapies that are native to their cultures, and it is important that doctors take the time to assess for this in order to avoid potential adverse reactions to the treatment prescribed. Thankfully, we’re continuing to learn more and more about the nuances of this disease in people of color. Doctors are speaking on behalf of their minority patients to increase awareness and advocate for proper management of psoriasis. Research is increasing in this area as well. In the meantime, as always, if you have any concerns about your psoriasis and its treatment, check in with your doctor. Communication is key to develop a plan that works best for you.