Psoriasis is more than a simple skin condition. It’s a long-term disease that makes skin cells grow too fast. This causes dry, scaly patches that can feel itchy or sore.
Most people think of psoriasis as red, flaky skin. But that’s only true for lighter skin tones. Psoriasis in darker skin tones looks different. It can be purple, brown, or gray instead of red.
Because of this, doctors sometimes mistake it for something else. This can delay treatment, making symptoms worse. Psoriasis in darker skin tones can look quite different. Knowing about this helps people get the right care faster.
How Is Psoriasis Different In Those With Darker Skin?
Psoriasis isn’t just a “white skin” condition. That’s a common myth. It affects people of all backgrounds, including Black, Hispanic, and Asian individuals.
However, psoriasis prevalence seems lower in these groups. But is it really? Maybe not. Many cases go undiagnosed or misdiagnosed. Doctors often miss it because psoriasis looks different on darker skin.
The National Psoriasis Foundation is working to change that. They want more people to recognize how psoriasis shows up in all skin tones. More awareness means better care for everyone.
Unique Characteristics Of Psoriasis In People Of Color
The clinical presentation of psoriasis varies significantly depending on skin tone. Psoriasis looks different on dark and light skin. On lighter skin, it’s red with silvery scales. On darker skin, psoriasis patches can be deep purple, gray, or dark brown. This can confuse doctors who don’t see it often.
Instead of spotting psoriasis, they may think it’s eczema, lichen planus, or a fungal infection. That means some people wait too long for the right treatment. Knowing these differences helps doctors and patients catch early and treat it faster.
What Does Psoriasis Look Like On Darker Skin?
Psoriasis looks different on darker skin. The plaques are often thicker and stand out more. Even after healing, the skin may not look the same.
Dark spots (hyperpigmentation) or light patches (hypopigmentation) can stay for months. These changes are more noticeable on darker skin tones. This can make flare-ups even more frustrating.
Imagine a healing scratch leaving a dark mark—it’s like that, but bigger. This is why psoriasis can be more distressing for people with darker skin. This dyspigmentation can persist for months, even after the psoriasis symptoms have resolved.
- Post-inflammatory hyperpigmentation (dark spots)
- Hypopigmentation (light patches)
Psoriasis can darken the skin, but not in the way you might think. Psoriasis doesn’t actually make the skin darker. But after a flare-up heals, it can leave behind spots. These spots can be darker or lighter than the rest of the skin. This happens more often in people with dark skin tones.
This happens because psoriasis causes intense inflammation, which disrupts melanin production. As the skin heals, it may produce excess melanin (causing dark spots). Or it may lose pigment (causing light patches). These changes can last for months, even after the psoriasis symptoms fade.
So, psoriasis itself doesn’t “permanently” darken the skin. But it can lead to noticeable pigmentation changes. These are often more pronounced in darker skin tone.
What Ethnicity Is Prone To Psoriasis?
Psoriasis can affect anyone, regardless of ethnicity. However, research suggests that individuals of Northern European descent have a higher prevalence. Just because psoriasis is more common in white people doesn’t mean it’s rare in others. The real problem is that many cases in people with dark skin tones are missed or misdiagnosed.
For example, psoriasis can look different on dark skin, making it harder to spot. This often leads to delays in getting the right treatment. But with the right care, people of all skin tones can manage psoriasis.
What Is The Biggest Trigger For Psoriasis?
Psoriasis triggers vary from person to person, but some of the most common include:
- Stress: Emotional and physical stress can lead to flare-ups.
- Infections: Strep throat has been linked to guttate psoriasis.
- Cold Weather: Dry skin and lack of sunlight can worsen symptoms.
- Certain Medications: Beta-blockers and lithium can trigger or worsen psoriasis.
- Skin Trauma: Scratches, burns, and even bug bites can cause new psoriasis plaques to form. It’s a phenomenon known as the Koebner response.
Why Is Psoriasis Often Misdiagnosed In Skin Of Color?
Many textbooks on dermatology focus on how psoriasis looks on white skin. But psoriasis in Black skin can look different. The spots might not be red or scaly, as seen in white skin. They can appear darker, sometimes gray or purple.
Thus, doctors sometimes mistake psoriasis in Black skin for other skin problems. It can be confused with eczema, lupus, or fungal infections. When this happens, treatment can be delayed or wrong, making it harder to manage the condition. Recognizing psoriasis in dark skin tones is important to get the right care.
Differences In Clinical Presentation
Common Symptoms
Psoriasis symptoms are generally the same across skin tones. But how they appear can be drastically different. In darker skin, inflammation may not appear red but instead look purple, dark brown, or gray. Additionally, scaling can be more subtle but still leads to intense itching.
Symptom Visibility In Darker Skin
Psoriasis lesions on darker skin tend to blend in more due to their deeper hue. So, it’s harder for patients and doctors to recognize flare-ups early. This can lead to more severe psoriasis before a proper diagnosis is made.
Types Of Psoriasis Commonly Observed
- Plaque Psoriasis (Chronic Plaque Psoriasis): The most common form. It leads to thick, scaly patches.
- Scalp Psoriasis: Often mistaken for dandruff, leading to delayed treatment and hair loss.
- Guttate Psoriasis: Triggered by infections and characterized by small, drop-like lesions.
- Inverse Psoriasis (Flexural Psoriasis): Found in skin folds. It’s often misdiagnosed as a fungal infection.
- Pustular Psoriasis: A rarer but more severe form. It causes white pustules on inflamed skin.
- Erythrodermic Psoriasis: A medical emergency. In this stage, the skin becomes red and sheds in large sheets.
- Palmoplantar Psoriasis: Affects the hands and feet, often mistaken for contact dermatitis.
- Nail Psoriasis: Can cause pitting, thickening, and discoloration of the nails.
Identification Of Thick Plaques
Plaques can be thicker on darker skin, which means they may take longer to heal. The darker skin underneath might also show more noticeable changes in color. It happens after the plaque fades. It’s like when you rub a spot on a dark table; it leaves a mark that’s harder to remove. This can make the healing process seem slower, and the skin’s color might stay different for a while.
Dyspigmentation And Its Variability
Post-inflammatory hyperpigmentation and hyperpigmentation (light spots ) are more common in darker skin. This can make treating them harder. When we get scars or irritation, the skin can change color.
Challenges In Diagnosis
Potential for Misdiagnosis
Psoriasis is frequently mistaken for:
- Eczema
- Fungal infections
- Lichen planus
- Discoid lupus
Importance Of Skin Type Awareness
Training doctors to recognize psoriasis in all skin colors is important. This helps ensure accurate diagnosis and effective treatment.
Treatment Strategies For Psoriasis
Topical Medications
- Topical Corticosteroids: The most commonly prescribed treatment.
- Topical Treatments: Includes vitamin D analogs, coal tar, and salicylic acid.
- Topical Steroids: Used to reduce inflammation and scaling.
Systemic Treatments
- Biologics: Target the immune system to reduce inflammation.
- Methotrexate & Cyclosporine: Used for severe psoriasis.
Phototherapy Considerations / Uv Therapy
Darker skin tones may require higher doses of UV therapy, but care must be taken to avoid the risk of skin cancer.
Lifestyle Adjustments For Management
- Moisturizing Regularly: Helps manage dry skin.
- Dietary Changes: Anti-inflammatory diets may help.
- Stress Reduction: Meditation and yoga can be beneficial.
Conclusion
Psoriasis in darker skin needs more visibility in medical literature. We need more studies focused on non-white patients. This will help doctors diagnose and treat psoriasis better. Doctors need more training to understand these differences. Educating and pushing for more inclusive research will make psoriasis care better.
FAQs
1.Why Can’t You Wear Black With Psoriasis?
You can, but it’s tricky. Psoriasis causes flaky, dry skin that sheds constantly. Dark clothes make those flakes more visible, like dandruff on a black sweater. If you love black, try fabrics that don’t cling to dry skin, like cotton or silk.
2.How To Tell If It’s Psoriasis Or Eczema?
Psoriasis feels thick, scaly, and dry. Eczema is itchy, red, and often oozes. Psoriasis patches have well-defined borders, while eczema looks more spread out. If you’re unsure, check your elbows, knees, or scalp—psoriasis loves those spots!
3.Do Dark-Skinned People Get Eczema?
Yes! Eczema affects all skin tones. In darker skin, it may look brown, gray, or purple, not red like in lighter skin. It’s also easy to mistake for dry skin, so many people go undiagnosed.
4.What Is The Worst Type Of Psoriasis?
Erythrodermic psoriasis is the most serious. It turns most of your skin red, swollen, and painful. It can cause fever, chills, and dehydration, making it a medical emergency. If your skin suddenly looks burned or sheds in sheets, get help fast.
5.Can Psoriasis Go Away On Its Own?
Not really. It may fade for a while, but it always comes back. Psoriasis is a lifelong condition, though some people go years without a flare. Managing stress, diet, and skincare can help keep it under control.
6.What Is The Normal Color Of Psoriasis?
It depends on your skin tone. On lighter skin, it’s red with silvery-white scales. On darker skin, it looks purple, gray, or dark brown. The color difference makes diagnosis tricky.
7.What Looks Like Psoriasis But Isn’t?
Many conditions mimic psoriasis. Eczema, fungal infections, lupus, and contact dermatitis can look similar. Even dry skin can be confusing! A skin biopsy can confirm if it’s really psoriasis.
Dr. Vivian Shi is a board-certified dermatologist and an Assistant Professor of Medicine in Dermatology at the University of Arizona where she directs the Eczema and Skin Barrier Specialty Clinic. She has extensive clinical and research experience in eczema and repair of the skin’s natural protective barrier