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Psoriasis

Psoriasis Skin of Color Alexis

Psoriasis in Skin of Color: Are there differences in Presentation and Treatment?

By | Sessions | No Comments

While previously thought to be a rare diagnosis in non-white racial ethnic groups, more recent data has shown that psoriasis in patients with skin of color is much more common than was once thought. Dr. Andrew Alexis spoke during the Skin of Color Seminar Series (now Skin of Color Update) in New York City on May 5th, 2018 on this condition and on the important differences in clinical characteristics, diagnosis, and treatment of psoriasis in skin of color.

Beginning with the diagnosis of psoriasis in skin of color, it is important to be aware that the classic red plaque typically seen in Caucasian skin may appear more violaceous or even red-brown in our skin of color patients.  This can be confusing with the similar appearing, but histologically unique entity, lichen planus. Pay close attention to the distribution of the plaques—extensor surfaces and asymptomatic will favor psoriasis whereas flexural and pruritic may favor lichen planus. Other conditions that may be more common in our skin of color patients such as sarcoidosis or hypertrophic discoid lupus also need to be considered.

Once a diagnosis of psoriasis is established, it is important to understand the intricacies of treating the psoriasis in skin of color patients. For example, when treating psoriasis of the scalp, it is important to select practices and treatments that are compatible with the patients’ hair care regimen and hair texture. It is critical to determine how frequently patients are washing their hair and how feasible it is for patients to use a daily solution or medication on the scalp. One potential option shown to have clinical benefit is a mixture of calcipotriene and betamethasone dipropionate in a castor oil vehicle.

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Excerpt provided with permission. Originally published by Next Steps in Dermatology. All rights reserved.

Treating Scalp Psoriasis in Women of African Descent

By | Sessions, Skin of Color Update Agenda | No Comments

Dr. Andrew Alexis is the Chair of the Department of Dermatology at Mount Sinai St. Luke’s and Mount Sinai Roosevelt. He is also Associate Professor of Dermatology at the Icahn School of Medicine at Mount Sinai. Dr. Alexis is the Co-Chair of the Skin of Color Seminar Series in New York City. During the 2017 conference he provided practical pearls and treatment outlines for skin of color patients with scalp psoriasis.

Dr. Alexis recommends selecting a treatment regimen that is compatible with the patient’s hair care practices including less frequent hair washing in women of African descent (typically once per week to once every other week). Daily hair washing, especially with most prescription shampoos, is often associated with increased hair dryness and breakage. In addition, it is also very time consuming for most women of African descent due to common styling practices.

Suggested Regimen for African-American Females:

  • Once weekly washing with prescription shampoo. This may be increased to two times a week depending on the severity and patient preferences
  • Continue with usual conditioner
  • Once weekly topical fluocinolone acetonide in peanut oil vehicle applied to the scalp for 6-8 hours overnight prior to washing or several times per week without washing
  • Once to twice daily application of POTENT topical steroid in vehicle that is compatible with hair care practices and hair texture (e.g. lotion, emollient foam, oil > gel, solution, ethanolic foam) Ask the patient for vehicle preferences
  • Alternative: calcipotriene and betamethasone dipropionate topical suspension daily

Attendees at the Skin of Color Seminar Series May 5-6 in NYC will have the opportunity to dig deeper into psoriasis treatment in skin of color patients as Dr. Alexis gives his latest updates, pearls and therapeutic insights and also personally answers attendees’ most pressing questions.