Psoriasis on Black Skin vs. White Skin

What does psoriasis on black skin look like?

One U.S. study found that out of 12,625 participants, the prevalence of psoriasis was 1.5% in black people compared to 3.6% in white people. However, some research suggests that the prevalence of psoriasis in people of color may be underestimated.

The difference in prevalence is likely due to genetics but may, in part, be due to a lack of proper diagnosis in people of color.

Because darker skin has a higher melanin content than lighter skin, this can affect the way that certain skin conditions appear, including psoriasis.

On light skin, psoriasis usually appears as pink or red patches with silvery-white scales. On dark skin, psoriasis appears more as purple plaques with gray scales. The patches can also appear dark brown.

It’s important to remember that because people of color have varying shades of dark skin, there is no “rule” for how psoriasis will appear on their skin tone.

Research reviews from 2014 and 2018 point out that there may even be differences in the prevalence and presentation of psoriasis in people with West African ancestry versus people with East African ancestry.

Generally, psoriasis patches appear more purple or brown the darker your skin is. However, for Black people with lighter skin, these plaques may look like those that appear on light skin.

Pictures of psoriasis on black skin

What are the different types of psoriasis?

There are multiple types of psoriasis, including:

• Plaque psoriasis: Accounting for about 90% of cases, plaque psoriasis is the most common type across all races. It 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: Inverse psoriasis commonly appears in skin folds, such as the armpits, groin, or under the breasts. These patches can also appear red or purple but don’t contain any scales.
• Guttate psoriasis: Affecting about 8% of people with psoriasis, guttate psoriasis appears as small, circular spots on the limbs and torso. It commonly appears during childhood.
• Pustular psoriasis: Pustular psoriasis affects the hands, feet, or other skin surfaces 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. Asian and Hispanic people are more likely to develop pustular psoriasis. Research suggests that a better understanding of how the disease presents and its course over time in these populations could be helpful in addressing this disparity.
• Erythrodermic psoriasis: This rare and serious form of psoriasis resembles plaque psoriasis, with red or purple skin and silvery scales widespread over your body. Erythrodermic psoriasis flare-ups require immediate medical attention. It’s more common in people of Asian background.

Where is psoriasis likely to occur on the body?

As mentioned above, different types of psoriasis tend to affect different parts of the body. However, some locations are more common among people of color.

For example, Black people are more likely to develop psoriasis on their scalp. Cross-checking this area of the body can help to confirm a suspected diagnosis.

Recent research also suggests that Black people are more than six times as likely to develop psoriasis on the palms of their hands and soles of their feet. This is called palmoplantar psoriasis and can appear as plaque or pustular psoriasis, or a mix of different types. It’s also about twice as common in males.

Can psoriasis be mistaken for something else?

Psoriasis can mimic other skin conditions, which can sometimes make determining the correct 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 an autoimmune disorder that causes a skin rash, often due to an infection or stress. It can present in multiple ways, such as purplish skin bumps or white lesions in the mouth.
• Cutaneous lupus: Lupus is an autoimmune condition that causes system-wide inflammation. As many as 85% of people with lupus develop skin symptoms (cutaneous lupus), which often appear as dark purple or dark brown rashes on people with dark skin.
• Eczema: Eczema appears as red, inflamed, peeling, cracked, blistered, or pus-filled rashes on light skin. But on darker skin, the redness may be difficult to see and may 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.

Research from 2021 suggests that doctors, especially those who are not dermatologists (skin specialists), are less prepared to identify common skin conditions in people with dark skin. The researchers stress the importance of proper training among medical professionals to recognize skin 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.

How do doctors diagnose psoriasis on dark skin?

If you think you may have psoriasis, a doctor will perform a variety of examinations to make a diagnosis. These may include:

• a physical exam to look for signature psoriasis plaques and scaling
• a scalp check, as scalp psoriasis is common in people of color
• a skin biopsy, to give more information to help determine the most appropriate diagnosis

What is the treatment for psoriasis on dark skin?

Treatment options for psoriasis are generally the same regardless of skin color. They vary based on the type of psoriasis you have.

Topical treatments

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

They include:

• moisturizers
• steroids
• retinoids, like tazarotene (Tazorac)
• anti-inflammatories

In people with scalp psoriasis, a doctor may recommend medicated shampoo.

Black people typically need to wash their hair less frequently, so doctors may alter how they prescribe shampoo treatments for people of color.

Systemic treatments

If topical medications do not work, people with severe psoriasis may also require systemic medications.

Some of these medications are taken orally to help reduce the inflammatory response associated with psoriasis flare-ups.

Others like biologics, healthcare professionals inject into a vein or under your skin. Research suggests that Black people are less likely to use biologics, likely due to cultural preferences or socioeconomic factors.

According to a 2023 review of research, brodalumab (Siliq) was the most effective biologic for Black people with psoriasis. Guselkumab (Tremfya) was more effective in white people, and ixekizumab (Taltz) was more effective in Asian and Latino people.

UV therapy

Some people use UVA and UVB light to reduce the inflammatory response on the skin that occurs with psoriasis. People most often use light therapy in combination with other topical or oral treatments.

Lifestyle changes

Certain triggers can cause psoriasis to flare up. These include:

• stress
• injury
• alcohol
• certain foods
• medications
• infections

Try to limit exposure to your triggers as much as possible to reduce the likelihood of a flare-up.

Takeaway

Psoriasis is a common inflammatory skin condition that affects millions of people around the world of every skin color.

In people with light skin, psoriasis appears as red or pink plaques with silvery-white scales. In people with darker skin, 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 skin condition in people of color.

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