How Psoriasis Varies in Skin Color and Ethnicity

Health Writer
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Psoriasis is a chronic skin condition characterized by dry, thick, raised patches on the skin. It can affect men and women of all ages and ethnicity, but no two cases are the same according to the National Psoriasis Foundation. It may show up differently depending on your skin color or ethnicity. Because of these differences, it can be misdiagnosed or underdiagnosed, according to Dr. Seemal Desai in an interview conducted by the National Psoriasis Foundation.


Prevalence around the world

More than 125 million people are living with psoriasis according to the International Federation of Psoriasis Associations (IFPA). The prevalence of psoriasis among Caucasians is 3.7 percent according to a 2014 study published in the American Journal of Preventative Medicine, 2 percent among African Americans, and 1.6 among Hispanics. Psoriasis is five times more common in people with European ancestors than in people with Asian descent, according to the National Psoriasis Foundation, with prevalence rates of psoriasis in China ranging between .11 to .47 percent according to a study completed in 2014.


Appearance of psoriasis in people of color

There are some differences in how psoriasis shows up in dark skin, according to Dr. Seemal Desai in an interview conducted by the National Psoriasis Foundation. Lesions can be more purple than red. There is less scaling. And scalp psoriasis is more common. A survey completed by 29 dermatologists as reported by the Dermatology Times indicated people of color have more dyspigmentation, thicker plaques, and less erythema.


Misdiagnosis of psoriasis in people of color

Psoriasis plaques may be less visible in people of color because of increased amounts of melanin in the skin, making redness harder to see, according to an article in Dermatology Times. It can be misdiagnosed as other scaly, inflammatory disorders, such as lichens planus.


Differences in treatment

There may be different recommendations for treatment for people of color, especially for scalp psoriasis, because it is not practical to wash hair every day, which might be recommended for Caucasians. Instead, the treatment plan might be a schedule of washing with medicated shampoo once or twice a week. They may also be more comfortable if they refrain from chemical hair treatments, such as relaxers, according to Desai.


Social stigma in people of color

Social stigma may be higher in people of color, according to Desai. They may be reluctant to share their symptoms with their doctor and are less likely than Caucasians to seek treatment, according to a study completed at the University of Pennsylvania.


Psoriasis in people of Hispanic descent

People of Hispanic descent have similar symptoms of psoriasis as Caucasians, but are less likely to seek treatment, according to a study completed in 2017. Because of this, they may have more severe psoriasis at diagnosis, however, the study indicated that Hispanics responded more favorably to several treatments.


Small psoriasis more common in people of Asian descent

In people of Asian descent, “small psoriasis” was more common. This subtype of psoriasis differs from guttate psoriasis in that it may be more moderate, may cover a larger area of the body, and is characterized by small plaques, according to a study completed in 2016.


Comparing psoriasis in Asian and Western cultures

In people of Asian descent with psoriasis, the plaques were mostly localized to knees, elbows, scalp, and lower back/buttocks according to a study completed in 2016, but overall the clinical features were similar to moderate cases of psoriasis in Western cultures.


Treatment options

For the most part, treatment for psoriasis is the same for everyone, no matter their skin color or ethnicity. Phototherapy, however, may be administered differently depending on skin color, with higher doses for people who tan easily or have darker-colored skin, according to the Psoriasis and Psoriatic Arthritis Alliance.