Psoriasis in Skin of Color

Seemal Desai, MD, offers tips on how to diagnose and treat psoriasis in skin of color as well as shares resources dermatologists can use to feel more confident providing care to these patients.

Dr Desai is president and medical director for Innovative Dermatology, PA, in Plano, TX, and clinical assistant professor of dermatology at the University of Texas Southwestern in Dallas.

Transcript
Dr Desai: Psoriasis in skin of color can be a challenge. We know that psoriasis is a chronic papulosquamous disease, and one of the hallmarks that we typically tend to think about is the classic erythematous or pink, bright red scaly patch or plaque typically on the elbows, knees, sometimes the scalp, and of course, other anatomical areas that all would be familiar with.

One of the key challenges in patients with skin of color is that the redness or erythema may be more difficult to distinguish and oftentimes looks more of like a brownish, purplish discoloration, and oftentimes the scaling that we see in psoriasis in skin of color is not as common as the thick silver, micaceous scale that we see in lighter skin tone.

I think when we examine patients from different racial and ethnic backgrounds, particularly those dealing with conditions like psoriasis or other inflammatory skin disease, cultural competency is a key component of what we need to be aware of for these populations.

We need to think about everything from what are cultural beliefs in coming to see a doctor, spanning to how the family unit potentially interacts in terms of care. For example, someone with psoriasis in skin of color who is African American may not feel comfortable with you prescribing a medicated shampoo and telling them to use it daily. That may not even be something that they feel comfortable discussing when they only are used to shampooing once a week. We also need to keep in mind that there are skin care practices related to skin care products, homeopathic and natural products, oils, botanicals, hair care products as well. I think all of those things are critically important.

One of the things that I find most impactful is trying to develop an understanding of where is the patient coming from? Don't be afraid to ask the question, how often do you wash your hair? Do you use oils? Do you use any special ethnic products? Do you use anything different than a prescription? Also, in terms of your body skin, have you been told that your skin looks or feels a certain way? Are there family history or family barriers to you coming to see a board-certified dermatologist? A lot of times, there's stigma associated with skin disease in many cultures.

I think all of those things play an important role of what we do to really make sure these patients have the best possible outcome. One of the most challenging things we need to keep in mind is that the medical literature and our dermatological literature still needs more work in terms of images and standardized photography for patients with darker skin tones.

Much of the work that's been done by organizations like the Skin of Color Society, for example, and others like the AAD has been designed to make sure that skin of color dermatology remains relevant and at the forefront of our educational and both patient-based needs in skin of color, but we still need more images in our image banks, in our databases, in our learning sets for residents, as well as in publications.

There continues to be an unmet need, and I really do hope that board-certified dermatologists can unite as a community to help tackle that.