Study Highlights Distinct Needs of Patients with Psoriasis, Skin of Color

Maria-Angeliki Gkini, MD

Credit: International Psoriasis Council

A new literature review points to the necessity of educating clinicians on the diagnosis and treatment of psoriasis in patients with skin of color, highlighting the need for educational materials and photo galleries containing all skin types.¹

This literature review was authored in part by Maria-Angeliki Gkini, MD, from the department of dermatology at the Royal London Hospital in the United Kingdom. Gkini et al. noted that much dermatology research highlights conditions faced by patients of European descent in Europe and North America and that there is a general lack of data and images of psoriasis among patients with skin of color.

The investigators highlighted a prior comprehensive 2018 review that covered the significance of racial and ethnic differences in the treatment of psoriasis.²

“The International Psoriasis Council convened a SOC Working Group to raise awareness of the diagnosis and treatment of psoriasis in all people,” Gkini and colleagues wrote. “Members of the IPC developed the present article encapsulating recent literature regarding psoriasis in patients with [skin of color], particularly concerning epidemiology, pathophysiology, genetics, clinical presentation, management, [quality of life] impact, and access to care and research.”¹

Analysis and Findings on Patients with Skin of Color

The investigative team had 2 independent investigators carry out a 2023 systematic review of current literature on management of psoriasis, with the pair implementing a series of databases and a variety of search terms to identify relevant research. The strength of the data contained within each analysis was evaluated following the guidelines established by the Oxford Centre for Evidence-Based Medicine.

The team’s search specifically covered studies released between January 2018 - August 2023 in PubMed/MEDLINE and the Cochrane Library. They focused on research that had been classified as Level I-III evidence based on the aforementioned Oxford criteria.

The investigators highlighted a variety of prior research on psoriasis, noting that the skin disease is becoming more prevalent globally and that it impacts individuals across all racial and ethnic backgrounds. However, many disparities have been noted in the inflammatory condition’s diagnosis and treatment.

White individuals were shown by prior data to be approximately twice as likely to be diagnosed with psoriasis as opposed to non-White populations. The research team pointed to several factors leading to this reportedly lower prevalence of psoriasis among patients with skin of color, including a rise in the likelihood of undiagnosed cases in non-White groups and limited access to dermatologic care.

The team highlighted that genetic factors are also pointed to in prior publicans as contributors to the higher rates in White populations. They also pointed out that psoriasis cases tend to be more severe among those with skin of color compared to White patients.

Additional research highlighted by the investigators showed that those in the skin of color category are less likely to receive biologic therapies, despite their experiencing increased impacts on life quality as a result of the skin condition (P < 0.05). Psoriasis was noted by the team as varying across different skin types in darker skin, with erythema often appearing as purple, lilac, or gray rather than the red or pink hues typically observed in lighter skin tones.

The investigative team expressed that, conversely, violaceous or hyperpigmented lesions have been shown to be less pronounced in patients with psoriasis who are noted as having lighter complexions.

Racial and ethnic minorities found within the US are more likely to report having undiagnosed psoriasis and are also noted as less likely to consult a dermatologist compared to White individuals (P < .01). Such cases of underdiagnosis are compounded by misidentification of psoriasis, particularly in low- and middle-income countries, where erroneous diagnoses may further add to the notable lack of recognition and treatment.

A significant limitation of this study was highlighted by the team and this is that there is inconsistency in how ethnicity, race, and skin of color are defined and applied in existing research. Additionally, they pointed to the fact that the majority of available literature on psoriasis in skin of color populations is centered on North America, thus limiting its applicability to global populations.

“This literature review invokes an important call to action by the IPC,” they wrote. “Education on diagnosing and treating psoriasis in all populations, including patients with [skin of color], must be prioritized. Creating optimal educational materials, including educational photo galleries of all skin tones, is vital to improving the early treatment of psoriasis worldwide.”1

References

1. ^{Gkini, M.-A., Nakamura, M., Alexis, A.F., Londoño-Garcia, A., van de Kerkhof, P.C.M., Doss, N., Griffiths, C.E.M., Kaufman, B., Kleyn, C.E., Lebwohl, M., Redfern, J.S., Takeshita, J., Rajagopalan, M. and El Sayed, M.H. (2025), Psoriasis in People With Skin of Color: An Evidence-Based Update. Int J Dermatol. https://doi.org/10.1111/ijd.17651.}
2. ^{B. P. Kaufman and A. F. Alexis, “Psoriasis in Skin of Color: Insights Into the Epidemiology, Clinical Presentation, Genetics, Quality-Of-Life Impact, and Treatment of Psoriasis in Non-White Racial/Ethnic Groups,” American Journal of Clinical Dermatology 19 (2018): 405–423.}