Table of ContentsView AllTable of ContentsPrevalenceSymptomsCausesDiagnosisTreatmentFAQs
Table of ContentsView All
View All
Table of Contents
Prevalence
Symptoms
Causes
Diagnosis
Treatment
FAQs
This article is part ofHealth Divide: Skin Conditions and Darker Skin, a destination in our Health Divide series.
Psoriasis, anautoimmuneskin disease, can look different on Black people and other people of color than on White people. It is sometimes harder to see on darker skin than on lighter skin. It can also be harder to conceal when severe and make those affected feel more self-conscious.
On light skin, psoriasis causes dry, red, itchy patches with silvery scales known asplaques. But, on dark skin, the plaques may be a dark brown or a purplish gray and can be easily confused for other skin conditions.
This article describes how psoriasis differs in people of color as well as conditions psoriasis is commonly mistaken for on Black skin. It also takes a look at some of the nuances involved in the diagnosis and treatment of psoriasis in people with darker skin tones.
Zoe Hansen / Verywell Health
How Common Is Psoriasis in Black People?
Psoriasis can affect anyone but is far more common in White people. Comparatively, Black people in the United States are anywhere from two to six times less likely to have psoriasis.Black children are similarly four times less likely than White children to have the disease.
Overall, less than 2% of Black adults in the United States have psoriasis, according to the ongoing National Health and Nutrition Examination Survey (NHANES).
Psoriasis Symptoms on Black Skin
Psoriasis doesn’t look the same on dark skin as it does on light skin.
In Black people, there will be a lower risk oferythema(superficial reddening) than what is seen in White people. On the other hand, there will be a higher risk ofhyperpigmentation(darker skin discoloration) orhypopigmentation(the lightening of skin) than in White people.
A person with darker skin may feel changes in the skin but not see them when the symptoms are mild. However, when symptoms are severe, they are more likely to have noticeable skin discoloration than what might be seen on lighter skin.
Disease Severity in Black PeopleAlthough psoriasis is less common in Black people, they are more likely to experience severe symptoms. For White people, psoriasis typically covers 1% to 2% of the body surface. Black people tend to experience psoriasis on 3% to 10% of the body surface.
Disease Severity in Black People
Although psoriasis is less common in Black people, they are more likely to experience severe symptoms. For White people, psoriasis typically covers 1% to 2% of the body surface. Black people tend to experience psoriasis on 3% to 10% of the body surface.
Scalp psoriasis also tends to be more common and severe in Black people. Genetics may play a role as well as washing naturally textured hair less often to prevent hair breakage.
The differences in symptoms can have an extreme emotional impact on Black people with psoriasis. According to a 2014 study in theJournal of Clinical and Aesthetic Dermatology, 72% of minorities said that psoriasis lowered their quality of life compared to only 54% of White respondents. This included feelings of self-consciousness, frustration, helplessness, and anger.
The Impact of Psoriasis on Mental Health
Differences in Causes and Risk Factors
No one knows the exact cause of psoriasis. With that said, a person’s genetics is thought to heavily influence their risk for the disease, while environmental factors such as infections, smoking, or air pollution are thought to trigger the onset or recurrence ofpsoriasis symptoms.
In terms of genetics, studies suggest that some of the genes closely linked to psoriasis affect racial and ethnic groups differently. A surprising number of these genes—known as ERAP1, FBXL19, HLA-C, IFIH1, IL4, IL13 IL23A, IL23R, IL23B, IL28RA, NOS2, NFKBIA, REL, TNAIP3, TNIP1, TRAF3IP2, and TYK2—appears solely linked to people of White European descent.
A rare exception is HLA-Cw6, a gene mutation seen almost twice as often in Black people than in White people. Several others, like LCE3C and LCE3B, are seen in people of European or Asian descent.
Julie Bang / Verywell
Differences in Diagnosis
Because psoriasis can look vastly different in people of color, there is a risk of misdiagnosis. This is because psoriasis on Black skin can mimic other skin conditions, including:
Diagnostic ChallengesBecause of the difficulty in diagnosing psoriasis on darker skin, people of color are four times more likely to require a skin biopsy to diagnose the disease and wait three times longer for a definitive diagnosis compared to White people.
Diagnostic Challenges
Because of the difficulty in diagnosing psoriasis on darker skin, people of color are four times more likely to require a skin biopsy to diagnose the disease and wait three times longer for a definitive diagnosis compared to White people.
Differences in Psoriasis Treatment
Skin color usually doesn’t determine which types oftreatmentare available for people with psoriasis.
With that said, a person’s socioeconomic status may influence their access to certain treatments. This was not only due to theunequal access to medical carein the United States but also to the fact that Black people tend to be less receptive to injectable drugs like Humira or to those they find unfamiliar, according to a 2019 study in theJournal of Investigative Dermatology.
There are also subtle differences in treatment approaches for Black people and other people of color. Among them:
When to See a Healthcare Provider
According to theNational Psoriasis Foundation, you should see a dermatologist if you are living with psoriasis and:
Summary
Psoriasis can be harder to detect on the skin of Black people than of White people. Even when symptoms are seen, they can mimic other diseases like acanthosis nigricans, which also causes dark patches of skin. Because of this, psoriasis may not be recognized in Black people until the symptoms are severe and harder to treat.
For reasons that are not entirely clear, Black people also tend to experience worse psoriasis symptoms covering larger areas of skin. They also may not respond as well to certain treatments such as phototherapy and require more aggressive therapies.
How Psoriasis Is Treated
Frequently Asked QuestionsPsoriasis can initially be less visible on darker skin tones. However, when psoriasis clears on medium to dark skin tones, lighter or darker skin discoloration may be left behind in the affected areas. This discoloration is not permanent and usually disappears in three months to a year.Psoriasis lesions usually look like thickened areas of skin with a scaly crust. These lesions are usually itchy and may bleed if scratched. In Black people, psoriasis may appear violet with grey scales. Psoriasis may also appear dark brown and be less visible in darker skin tones.
Frequently Asked Questions
Psoriasis can initially be less visible on darker skin tones. However, when psoriasis clears on medium to dark skin tones, lighter or darker skin discoloration may be left behind in the affected areas. This discoloration is not permanent and usually disappears in three months to a year.
Psoriasis lesions usually look like thickened areas of skin with a scaly crust. These lesions are usually itchy and may bleed if scratched. In Black people, psoriasis may appear violet with grey scales. Psoriasis may also appear dark brown and be less visible in darker skin tones.
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Alexis AF, Blackcloud P.Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances.J Clin Aesthet Dermatol. 2014;7(11):16-24.American Academy of Dermatology.Can you get psoriasis if you have skin of color?.Rachakonda TD, Schupp CW, Armstrong AW.Psoriasis prevalence among adults in the United States.J Am Acad Dermatol.2014;70:512–6. doi:10.1016/j.jaad.2013.11.013Wu JJ, Black MH, Smith N, Porter AH, Jacobsen SJ, Koebnick C.Low prevalence of psoriasis among children and adolescents in a large multiethnic cohort in southern California.J Am Acad Dermatol. 2011 Nov;65(5):957-64. doi:10.1016/j.jaad.2010.09.005National Psoriasis Foundation.Treating skin of color.Kamiya K, Kishimoto M, Sugai J, Komine M, Ohtsuki M.Risk factors for the development of psoriasis.Int J Mol Sci.2019 Sep;20(18):4347. doi:10.3390/ijms20184347National Library of Medicine.Acanthosis nigricans.Blake SC, Daniel BS.Cutaneous lupus erythematosus: A review of the literature.Int J Womens Dermatol. 2019 Jul 31;5(5):320-329. doi:10.1016/j.ijwd.2019.07.004Gandhi J, Agrawal S, Gupta S, Verma K, Mohite A.Pattern of Papulosquamous Disorders in Children: A Clinico-Epidemiological Study.Cureus. 2022 Jan 13;14(1):e21194. doi:10.7759/cureus.21194National Organization for Rare Disorders.Lichen Planus.National Eczema Association.Seborrheic Dermatitis.Dickerson T, Pratt A, O’Quinn M, et al.Racial disparities in the diagnosis of psoriasis.Cutis. 2022 Aug;110(2 Suppl):26-8. doi:10.12788/cutis.0576Takeshita J, Eriksen WT, Raziano VT, et al.Racial differences in perceptions of psoriasis therapies: implications for racial disparities in psoriasis treatment.J Invest Dermatol.2019 Aug;139(8):1672–9. doi:10.1016/j.jid.2018.12.032National Psoriasis Foundation.Dermatologist.
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Alexis AF, Blackcloud P.Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances.J Clin Aesthet Dermatol. 2014;7(11):16-24.American Academy of Dermatology.Can you get psoriasis if you have skin of color?.Rachakonda TD, Schupp CW, Armstrong AW.Psoriasis prevalence among adults in the United States.J Am Acad Dermatol.2014;70:512–6. doi:10.1016/j.jaad.2013.11.013Wu JJ, Black MH, Smith N, Porter AH, Jacobsen SJ, Koebnick C.Low prevalence of psoriasis among children and adolescents in a large multiethnic cohort in southern California.J Am Acad Dermatol. 2011 Nov;65(5):957-64. doi:10.1016/j.jaad.2010.09.005National Psoriasis Foundation.Treating skin of color.Kamiya K, Kishimoto M, Sugai J, Komine M, Ohtsuki M.Risk factors for the development of psoriasis.Int J Mol Sci.2019 Sep;20(18):4347. doi:10.3390/ijms20184347National Library of Medicine.Acanthosis nigricans.Blake SC, Daniel BS.Cutaneous lupus erythematosus: A review of the literature.Int J Womens Dermatol. 2019 Jul 31;5(5):320-329. doi:10.1016/j.ijwd.2019.07.004Gandhi J, Agrawal S, Gupta S, Verma K, Mohite A.Pattern of Papulosquamous Disorders in Children: A Clinico-Epidemiological Study.Cureus. 2022 Jan 13;14(1):e21194. doi:10.7759/cureus.21194National Organization for Rare Disorders.Lichen Planus.National Eczema Association.Seborrheic Dermatitis.Dickerson T, Pratt A, O’Quinn M, et al.Racial disparities in the diagnosis of psoriasis.Cutis. 2022 Aug;110(2 Suppl):26-8. doi:10.12788/cutis.0576Takeshita J, Eriksen WT, Raziano VT, et al.Racial differences in perceptions of psoriasis therapies: implications for racial disparities in psoriasis treatment.J Invest Dermatol.2019 Aug;139(8):1672–9. doi:10.1016/j.jid.2018.12.032National Psoriasis Foundation.Dermatologist.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Alexis AF, Blackcloud P.Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances.J Clin Aesthet Dermatol. 2014;7(11):16-24.American Academy of Dermatology.Can you get psoriasis if you have skin of color?.Rachakonda TD, Schupp CW, Armstrong AW.Psoriasis prevalence among adults in the United States.J Am Acad Dermatol.2014;70:512–6. doi:10.1016/j.jaad.2013.11.013Wu JJ, Black MH, Smith N, Porter AH, Jacobsen SJ, Koebnick C.Low prevalence of psoriasis among children and adolescents in a large multiethnic cohort in southern California.J Am Acad Dermatol. 2011 Nov;65(5):957-64. doi:10.1016/j.jaad.2010.09.005National Psoriasis Foundation.Treating skin of color.Kamiya K, Kishimoto M, Sugai J, Komine M, Ohtsuki M.Risk factors for the development of psoriasis.Int J Mol Sci.2019 Sep;20(18):4347. doi:10.3390/ijms20184347National Library of Medicine.Acanthosis nigricans.Blake SC, Daniel BS.Cutaneous lupus erythematosus: A review of the literature.Int J Womens Dermatol. 2019 Jul 31;5(5):320-329. doi:10.1016/j.ijwd.2019.07.004Gandhi J, Agrawal S, Gupta S, Verma K, Mohite A.Pattern of Papulosquamous Disorders in Children: A Clinico-Epidemiological Study.Cureus. 2022 Jan 13;14(1):e21194. doi:10.7759/cureus.21194National Organization for Rare Disorders.Lichen Planus.National Eczema Association.Seborrheic Dermatitis.Dickerson T, Pratt A, O’Quinn M, et al.Racial disparities in the diagnosis of psoriasis.Cutis. 2022 Aug;110(2 Suppl):26-8. doi:10.12788/cutis.0576Takeshita J, Eriksen WT, Raziano VT, et al.Racial differences in perceptions of psoriasis therapies: implications for racial disparities in psoriasis treatment.J Invest Dermatol.2019 Aug;139(8):1672–9. doi:10.1016/j.jid.2018.12.032National Psoriasis Foundation.Dermatologist.
Alexis AF, Blackcloud P.Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances.J Clin Aesthet Dermatol. 2014;7(11):16-24.
American Academy of Dermatology.Can you get psoriasis if you have skin of color?.
Rachakonda TD, Schupp CW, Armstrong AW.Psoriasis prevalence among adults in the United States.J Am Acad Dermatol.2014;70:512–6. doi:10.1016/j.jaad.2013.11.013
Wu JJ, Black MH, Smith N, Porter AH, Jacobsen SJ, Koebnick C.Low prevalence of psoriasis among children and adolescents in a large multiethnic cohort in southern California.J Am Acad Dermatol. 2011 Nov;65(5):957-64. doi:10.1016/j.jaad.2010.09.005
National Psoriasis Foundation.Treating skin of color.
Kamiya K, Kishimoto M, Sugai J, Komine M, Ohtsuki M.Risk factors for the development of psoriasis.Int J Mol Sci.2019 Sep;20(18):4347. doi:10.3390/ijms20184347
National Library of Medicine.Acanthosis nigricans.
Blake SC, Daniel BS.Cutaneous lupus erythematosus: A review of the literature.Int J Womens Dermatol. 2019 Jul 31;5(5):320-329. doi:10.1016/j.ijwd.2019.07.004
Gandhi J, Agrawal S, Gupta S, Verma K, Mohite A.Pattern of Papulosquamous Disorders in Children: A Clinico-Epidemiological Study.Cureus. 2022 Jan 13;14(1):e21194. doi:10.7759/cureus.21194
National Organization for Rare Disorders.Lichen Planus.
National Eczema Association.Seborrheic Dermatitis.
Dickerson T, Pratt A, O’Quinn M, et al.Racial disparities in the diagnosis of psoriasis.Cutis. 2022 Aug;110(2 Suppl):26-8. doi:10.12788/cutis.0576
Takeshita J, Eriksen WT, Raziano VT, et al.Racial differences in perceptions of psoriasis therapies: implications for racial disparities in psoriasis treatment.J Invest Dermatol.2019 Aug;139(8):1672–9. doi:10.1016/j.jid.2018.12.032
National Psoriasis Foundation.Dermatologist.
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