Psoriasis on Darker Skin

Psoriasis is an autoimmune skin disease that causes raised plaques, scales, or patches on the skin. Though it can appear anywhere on the body, it's commonly found on the scalp, elbows, or knees, and can lead to symptoms such as itching, stinging, or burning skin.

Psoriasis skin lesions may present differently on certain skin tones and can be mistaken for other skin conditions. This article discusses psoriasis on darker skin, symptom management, treatment, and when to see a dermatologist.

Quick Facts About Psoriasis on Darker Skin

Psoriasis Can Affect All Skin Types 

Psoriasis is a chronic autoimmune disease affecting all races and skin types. Psoriasis skin patches can appear differently on certain skin colors.

Patches Aren’t Identical Across Races

Although people of any race, skin type, or skin shade can get psoriasis, it often presents itself differently on light and dark skin:

• On darker skin types, psoriasis may appear violet with grey scales. It may also appear dark brown and be more difficult for providers to diagnose.
• On lighter skin types, psoriasis often appears pink or red with a silvery-white scale.
  

Symptoms of Psoriasis on Darker Skin

Compared to those with lighter skin tones, darker people with psoriasis may have more dyspigmentation (discoloration) of the skin.

Studies show Black psoriasis patients feel they have more severe psoriasis in comparison to other groups. Meanwhile many patients with darker skin tones actually report less erythema, or redness, and are more likely to have violet or dark brown plaques.

Appearance  

Psoriasis can look different in darker skin tones. In addition, when psoriasis clears on medium to dark skin tones, more skin discoloration may be left behind in the affected areas. However, this discoloration is not scarring and usually disappears in three months to a year.

If this skin discoloration is bothersome, talk to a healthcare provider about treatment options. They may prescribe a skin cream to help the affected areas clear faster.

Location 

Psoriasis most commonly presents on the:

• Scalp
• Elbows
• Knees
• Back
• Arms
• Thighs
• Nails

Less commonly, psoriasis can also occur in less visible areas such as the underarms, groin, buttocks, or under the breast. When present in these areas, there may be a higher chance of misdiagnosis because of a suspected fungal or bacterial infection instead of psoriasis.

There is also some self-reported evidence from people of African ancestry who have psoriasis of the scalp that they experience more severe effects in that area. Researchers continue to speculate the cause.

Reasons for Psoriasis Misdiagnosis

Provider Knowledge

Because dark skin is underrepresented in medical textbooks, psoriasis may be more difficult for providers to diagnose on dark skin, which can lead to delays in treatment.

If you have a darker skin tone, it is vital that a healthcare provider has experience working with psoriasis in people with darker skin. Psoriasis treatment may be different for darker skin types, such as the need for higher doses of phototherapy due to higher melanin levels in the skin.

Environmental

Several environmental factors can increase the risk of developing or triggering psoriasis in all skin tones. These factors include:

• Poor nutrition
• Stress
• Skin injury
• Infections, such as strep throat
• Temperature and weather changes
• Air pollution
• Smoking
• Being overweight
  

Effects of Psoriasis on People With Darker Skin

A study by the National Psoriasis Foundation on psychosocial impacts of psoriasis found that psoriasis may have a more significant perceived impact on people with darker skin.

In the study, 72% of people with non-White skin tones reported an impact from psoriasis on their quality of life, versus 54% of White people.

Some of the concerns from people with darker skin about their psoriasis included self-consciousness, frustration, helplessness, and anger. Researchers observed that the negative impact on quality of life might be due to:

• Having more visible discoloration of the skin
• Different cultural perceptions of skin ailments

In addition, 23% of Black patients in the study stated that they had "very severe psoriasis" compared to 8% of White people.

Psoriasis Flare-Up Management on Darker Skin

Skin color usually doesn't determine what types of treatment options are available for people with psoriasis. Talk with a healthcare provider about different treatment options or combinations of best therapies for your psoriasis flare-ups.

Some treatment options may include:

• Creams
• Ointments
• Topical steroids
• Phototherapy

When to See a Dermatologist 

A dermatologist is a healthcare provider who specializes in skin, hair, and nail conditions.

If you think you may have psoriasis or any other unknown skin condition, make an appointment with a dermatologist. This is especially important if the condition worsens or the treatments prescribed by your primary healthcare provider are not working.

Physical Examination

At your appointment, a healthcare provider or dermatologist will gather your past medical history and perform a physical examination to make a diagnosis.

In most cases, healthcare providers diagnose psoriasis by looking at the affected area. Sometimes, they may also collect a skin sample to examine the tissue.

There are no other diagnostic tools or blood tests that can provide a diagnosis for psoriasis.

Questions to Ask 

You may want to write down a list of questions for a healthcare provider or dermatologist before your appointment, so you don't forget to ask them while you are there.

Some of the questions you may want to ask include:

• How did I get psoriasis?
• What are the long-term effects of this skin condition?
• Will psoriasis affect any of my other medical conditions?
• What are my treatment options?
• What treatment options would you recommend?
• How long will treatments take before I see results?
• Are there any side effects of these treatments?

Learning as much as you can about your psoriasis can help you make more educated decisions about the treatment you receive.

Summary

Psoriasis is an autoimmune skin condition that leads to itchy scales and patches on the skin. It can present differently on different skin tones. It's important to understand how psoriasis may affect people with darker skin to prevent disparities in care and accurately diagnose skin conditions.

Skin color shouldn't determine what treatment options are available for people with psoriasis. Talk with a healthcare provider about different treatment options for psoriasis flare-ups.

A Word From Verywell

Having psoriasis can be frustrating and painful, and some people may even feel embarrassed of their skin. But receiving a diagnosis may provide some relief, because there are treatment options that can help.

Reach out to a healthcare provider or a dermatologist in your area who specializes in treating psoriasis on darker skin tones. You may also want to consider learning as much as you can about psoriasis management to help empower yourself with tools that can help you live with this skin condition.