Not recognizing this shade difference may be why some doctors confuse psoriasis with everyday skin irritation, eczema, a drug reaction, or even an infection in people of color, Dr. Robinson says. But there are other clues that may point to psoriasis.
For example, “you can touch the patient and feel that the inflamed area is usually warm,” Dr. McKinley-Grant says. A thorough dermatologist will ask about your family history since the condition can (but not always) have genetic roots, she adds. In case your doc is uncertain, they might also take a small biopsy (a skin sample) and examine it to be sure of the diagnosis and rule out any other skin conditions.
2. Rare types of psoriasis tend to be more common in people of color.
While plaque psoriasis is the most prevalent form of the condition, “there are also rare subtypes that appear more frequently in certain racial and ethnic groups,” Dr. Robinson says. For example, researchers have found that pustular psoriasis—which appears as inflamed, scaly, pus-filled bumps4—is more common among Asian and Hispanic communities.5
Asian people are also more likely to have erythrodermic psoriasis,5 which covers the body in a red, burn-like rash and can be fatal if it’s not treated quickly. What’s more, Asian and Black people tend to be more vulnerable to scalp psoriasis, in which plaques pop up around the scalp, hairline, forehead, back of the neck, and on the skin around the ears.6
This is important to know because getting an accurate diagnosis can be complicated if you’re dealing with a form of psoriasis that’s rarer in white people, according to Dr. Robinson, especially if you’re seeing a doctor who’s not experienced in treating darker skin. (You can check out our resources below to help you find a doctor who is well-versed in treating darker skin tones.)
3. Certain treatments may not be ideal for your skin color and hair type.
While there is still no cure for psoriasis, there are plenty of treatment options to help keep the symptoms at bay, no matter how much melanin is in your skin. These include prescription-strength creams and ointments, phototherapy, oral and injectable medications, and scalp oils and shampoos, among others.
However, special considerations need to be made for a few treatments. One, for example, is phototherapy, which involves exposing the skin to a controlled amount of ultraviolet light. “People with darker skin tones require higher doses of phototherapy in order for it to be effective,” Dr. Takeshita says. However, phototherapy can tan the skin and make any unwanted dark spots you have even darker, which people of color are especially susceptible to, according to the AAD. If that’s the case for you, standing in a light box a couple of times a week may not be the best way to go.
For scalp psoriasis, you also need to think about your natural hair texture, how often you prefer to wash it, and how you like to style it, Dr. Robinson says. Frequent shampooing with medicated formulas, which may be recommended in combination with oral medication, can help to remove the scales, but if you have dry hair or washing often doesn’t align with your hair care routine, there are other options out there to help keep your hair as happy as possible.