Psoriasis is an autoimmune skin condition that causes scaly, itchy, and painful patches to appear on the skin. This condition affects more than 125 million people worldwide.
Psoriasis can appear differently depending on:
- what type it is
- the severity of the flare-up
- the color of your skin
In fact, psoriasis patches often appear quite differently on black skin versus white skin.
In this article, we’ll explore:
- what psoriasis looks like on darker skin
- how this condition is diagnosed
- treatment options for psoriasis flare-ups
The difference in prevalence is likely due to genetics but can also be affected by a lack of proper diagnosis in patients of color.
Because black skin has a higher melanin content than white skin, this can affect the way that certain skin conditions appear, including psoriasis.
On white skin, psoriasis usually appears as pink or red patches with silvery-white scales. On black skin, psoriasis appears more as purple patches with gray scales. The patches can also appear as a dark brown color.
Psoriasis patches on black skin may also be more widespread, which can make it difficult to distinguish between other conditions.
It’s important to remember that because black skin comes in many different shades, there’s no “rule” for how psoriasis will appear on people of color.
Generally, psoriasis patches appear more purple or brown the darker someone’s skin is. However, for black people with lighter skin, these patches may look like those that appear on white skin.
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- Plaque psoriasis. This is the most common type of psoriasis, accounting for over 80 percent of psoriasis cases. This type of psoriasis causes red or purplish patches with silvery-white or gray scales. It commonly affects the “exposed” areas of the skin, such as the knees and elbows, as well as the scalp.
- Inverse psoriasis. As opposed to plaque psoriasis, inverse psoriasis commonly appears in the folds of skin, such as the armpits, groin, or under the breasts. These patches can also appear as red or purple, but do not contain any scales.
- Guttate psoriasis. This type of psoriasis affects roughly 8 percent of people with the condition and commonly appears during childhood. This type appears as small, circular spots on the limbs and torso.
- Pustular psoriasis. This type of psoriasis affects the hands, feet, or other surfaces of the skin and appears as red skin with white pustules. These pustules appear in cycles after the skin has reddened and can sometimes form scales, like in plaque psoriasis.
- Erythrodermic psoriasis. This is a rare and serious form of psoriasis that’s widespread and resembles plaque psoriasis, with red or purple skin and silvery scales. This type of psoriasis flare-up requires immediate medical attention.
Plaque psoriasis is the most common type of psoriasis in most people with the condition, but the location can differ between people of different skin colors.
For example, psoriasis of the scalp is common in black people, so cross-checking this area of the body can help to confirm a suspected diagnosis.
In addition to the signature psoriasis patches, other symptoms of psoriasis in people of all skin colors may include:
- dry, cracked skin
- burning, itching, or soreness of the patches
- thick nails that appear pitted
- joint swelling and pain
There are other skin conditions that can resemble psoriasis, which sometimes makes diagnosis difficult. These conditions may include:
- Fungal skin infections. Fungal skin infections occur when fungi multiply on the skin or find their way in through an open lesion. These infections usually appear as itchy, scaly rashes.
- Lichen planus. Lichen planus is a skin rash that often appears in conjunction with other autoimmune conditions. It can present in multiple ways, such as purplish skin bumps or white lesions on the mouth.
- Cutaneous lupus. Lupus is an autoimmune condition that causes system-wide inflammation. Cutaneous lupus affects roughly two-thirds of people with lupus and is characterized by rashes on exposed skin areas.
- Eczema. Eczema appears as red, inflamed, peeling, cracked, blistered, or pus-filled on light skin. But on darker skin, the redness may be difficult to see but will look darker brown, purple, or ashen gray. Generally, there are no scales.
In addition to the conditions above, differences in the appearance of psoriasis between skin colors can make it even more difficult to diagnose in people with darker skin.
Still, it’s important that doctors are trained on how to recognize psoriasis and other conditions in people of color.
As a person of color, if you’re concerned that you may have psoriasis, it’s important to make sure that your concerns are being heard.
Advocating for yourself based on your symptoms can ensure a proper diagnosis and timely treatment.
If you think you may have psoriasis, your doctor will perform a variety of examinations to make a diagnosis:
- A physical exam is the quickest and most effective way for a doctor to diagnose psoriasis. They’ll look for the signature psoriasis patches and scaling that’s common in plaque psoriasis.
- A scalp check can also be performed on people with darker skin, as scalp psoriasis is common in people of color. Narrowing down the location of the flare-ups is also important for treatment.
- A skin biopsy may be performed if your doctor feels like they need more confirmation for a diagnosis. During a biopsy, a small amount of skin will be removed and sent to the lab for testing. Your doctor can then confirm whether the condition is psoriasis or something else.
Treatment options for psoriasis are generally the same across the board, regardless of skin color, and vary based on the type of psoriasis you have.
Topical medications are a common treatment option for people with mild to moderate psoriasis.
These creams, ointments, and lotions can:
- help keep the skin moisturized
- soothe itching and burning
- reduce inflammation
In people with scalp psoriasis, medicated shampoo may also be recommended.
Since black hair needs to be washed less frequently, this also means that shampoo treatments for psoriasis may be prescribed differently for people of color.
In the case that topical medications don’t work, people with severe psoriasis may also require systemic medications.
These medications can be taken orally or through an injection to help reduce the inflammatory response associated with psoriasis flare-ups.
UVA and UVB light can be used to reduce the inflammatory response on the skin that happens with psoriasis. This therapy is most often used in combination with other topical or oral treatments.
There are certain triggers that can cause psoriasis to flare-up. These include:
- certain foods
- other infections
Try to limit exposure to your triggers as much as possible to reduce the likelihood of a flare-up.
Psoriasis is a common inflammatory skin condition that affects millions of people around the world of every skin color.
In people with white skin, psoriasis appears as red or pink patches with silvery-white scales. In people with darker skin tones, psoriasis appears as purple or brown patches with gray scales.
Paying close attention to how psoriasis appears on different skin colors can help improve the diagnosis and treatment of this condition in people of color.