August is Psoriasis Awareness Month. At Skin of Color Update 2024, Amy McMichael, MD, FAAD, delivered a comprehensive presentation on the unique challenges of diagnosing and treating psoriasis in patients with skin of color. She emphasized the importance of early recognition, tailored treatment plans, and addressing racial disparities in clinical research.
Unique Presentation in Skin of Color
Psoriasis often appears differently in darker skin tones, with violaceous or hypertrophic plaques, hyperpigmented thin plaques, or guttate (raindrop-like) lesions rather than the classic red, scaly plaques seen in lighter skin. Dr. McMichael recommended biopsy confirmation, especially since the appearance may evolve during treatment.
Treatment Strategies
- Topicals: Ultrapotent topical steroids are often first-line, but non-steroidal alternatives (e.g., calcipotriene, roflumilast, tapinarof) may be used to reduce steroid-related side effects.
- Systemics: For more severe cases, systemic treatments like methotrexate, cyclosporine, and acitretin can be effective, particularly in hypertrophic lesions.
- Biologics: Although effective across all skin types, biologics are underutilized in patients of color due to limited representation in clinical trials.
- JAK inhibitors and UV phototherapy were also discussed as viable options, especially for refractory disease or patients seeking non-biologic treatments.
Special Considerations
Treating areas like the scalp or groin requires attention to hairstyling practices and vehicle compatibility. Post-inflammatory hyperpigmentation (PIH) is a frequent concern in patients of color, often lingering after psoriasis clears. Dr. McMichael stressed setting realistic expectations and suggested adjunctive use of retinoids or skin-lightening agents alongside psoriasis treatments.
Addressing Disparities
Despite the broad availability of effective therapies, patients of color remain underrepresented in psoriasis research. Dr. McMichael pointed to the VISIBLE trial, which enrolled a racially diverse patient group, as a model for more inclusive studies.
Conclusion
Dr. McMichael underscored the importance of aggressive early treatment, cultural and clinical sensitivity, and diversifying clinical research to improve outcomes for patients of color. Education on pigmentary changes and tailored treatment strategies are key to managing both the physical and psychological impacts of psoriasis in diverse populations.
This session summary was written by Dr. Nidhi Shah and published on Next Steps in Derm.
