Dermatologist Weighs In: Why Psoriasis Looks Different on Dark Skin

Dealing with any chronic skin condition can be frustrating, but psoriasis may be the most stubborn and persistent of all. It's an incredibly visible skin disorder that can affect anyone, regardless of skin color. However, a recent study has shown that people with dark skin may be more likely to suffer from psoriasis than those with lighter skin tones. About 1.9 percent of Black Americans have psoriasis, while the same research shed light on 1.6 percent of Hispanic Americans who suffer from the same condition. Some researchers consider these rates higher as the condition gets undetected and may be misdiagnosed. This is due to several factors, including the fact that dark skin is more prone to hyperpigmentation, making it difficult to diagnose and treat psoriasis. But that doesn't mean you must stay stuck in this cycle forever. It's still possible to work towards a better life for your skin. The first step towards improving your skin's health is understanding the condition itself and identifying how it appears on dark skin.

What does psoriasis look like on dark skin?

Psoriasis is an autoimmune disorder that causes skin cells to grow and reproduce too quickly, resulting in raised patches of red, scaly skin. It is a chronic condition that can flare up and worsen with certain triggers, such as stress, changes in temperature, or certain medications. On darker skin, the patches of psoriasis are often the same color as the surrounding skin and can be harder to see.

What types of psoriasis can you have with dark skin?

Plaque psoriasis

This is the most common type of psoriasis that affects all skin tones and it's characterized by raised, red patches covered with a silver-colored scale. These patches often appear on the elbows, knees, scalp, and lower back but can occur anywhere on the body. On dark skin, the patches may appear purple with gray scales that are easily mistaken for rash or dry skin. The patches may also appear darker, thicker, and raised, with a dry and rough texture. Additionally, they may be more itchy and uncomfortable than other skin tones.

Inverse psoriasis

It is a form of psoriasis that may be harder to detect but easier to diagnose as it is prevalent on dark skin. It typically appears in the areas where your skin rubs against itself, such as the armpits, groin, and underneath the breasts. On dark skin, inverse psoriasis can appear as smooth, shiny red or purple patches. These patches may be large or small and can be itchy or sore. They may also become inflamed and have white or yellowish scales on the surface. In addition to the patches, inverse psoriasis may cause other symptoms, such as burning or stinging sensations, pain, and dry and cracked skin. People with inverse psoriasis may also experience hair loss in the affected areas.

Guttate Psoriasis

A type of psoriasis that is characterized by small, drop-like lesions that usually appear on the torso, arms, and legs. It often occurs without warning, and you might notice small red, scaly patches on the skin.

For people with darker skin tones, including African American, Hispanic, and Asian skin, these lesions can appear darker than on lighter skin tones. The lesions of guttate psoriasis on dark skin can range from light pink to dark purple or brown. They usually have a raised, bumpy texture and can be scaly. The lesions may also be itchy or tender. It is important to note that guttate psoriasis is not contagious and does not spread from person to person.

Pustular psoriasis

According to the National Psoriasis Foundation only 3% living with psoriasis will develop this type. It is characterized by small, raised bumps on the skin (pustules) containing white, yellow, or pink fluid. These bumps can be itchy and painful and may be accompanied by redness and swelling. On darker skin, pustular psoriasis can appear differently than on other skin tones. The bumps may appear more raised and raised patches of skin may be more visible. The bumps usually occur in clusters, ranging in size from a few millimeters to a few centimeters. In addition, the pus-filled bumps may have a white or yellowish color, making them more noticeable on dark skin. The condition is usually caused by an underlying skin condition, such as eczema, or by an infection. In some cases, it can also be triggered by medications or stress.

Erythrodermic psoriasis

This rare form of psoriasis may look like regular plaques, but it is more serious. It is characterized by fiery red skin that is covered in scales and can be incredibly painful. The condition can affect any skin tone, however, it is widespread on darker skin tones and you may notice it turning deep or red-brown. The scaling and flaking of the skin can also be more pronounced, causing the skin to have a rough texture. Additionally, the affected area may be more prone to itching and burning. It is triggered when your immune system starts to malfunction, triggering an inflammatory reaction from your body that causes new skin cells to form too quicky. Overproduction of skin cells causes the condition. In black skin, the condition can be especially painful as the skin is already prone to dryness. This dryness can be further exacerbated by the presence of erythrodermic psoriasis, making the affected area more prone to cracking and bleeding.

How to treat psoriasis on dark skin

The treatment of psoriasis in dark skin requires an individualized approach. While some treatments, such as phototherapy and topical medications, can reduce the symptoms of psoriasis, it is important to recognize that darker skin can be more sensitive to certain treatments. Therefore, it is essential to talk to your dermatologist before starting any treatment plan. In addition to traditional treatments, it is also essential to make lifestyle changes to help manage psoriasis in dark skin. These include avoiding triggers, such as stress, temperature changes, and certain medications; wearing loose, breathable clothing; and avoiding harsh soaps or cleansers. Additionally, it is essential to use sunscreen to protect the skin and keep it from becoming inflamed. By understanding the unique challenges that dark skin can present when diagnosing and treating psoriasis, your dermatologist will advise you on the best possible care for the condition.

Many topical treatments are available to help nourish the skin and protect it from harm. Here is our rundown of the best options for all forms of psoriasis.

Topical Corticosteroids

These anti-inflammatory medications are a top-line treatment for psoriasis and are derived from the natural corticosteroid hormones produced by the adrenal glands. Among other important functions, corticosteroids control inflammatory responses in the body, which makes them an ideal anti-inflammatory agent to reduce swelling and redness caused by lesions. They come in ointment and cream forms and can be applied directly to the affected area. It is essential to use them according to the instructions given by your doctor, as overuse can lead to skin thinning and other adverse effects.

Topical retinoids (Tazarotene, Tazorac, Avage and others)

Retinoids are derived from vitamin A and control the growth of cells on the skin. They can help reduce the redness and scaling associated with psoriasis and can also help prevent the formation of new lesions. These medications are usually applied to the skin once or twice a day.

Vitamin D analogues

They work by binding to vitamin D receptors on the skin, which helps to reduce inflammation and decrease the production of skin cells. This ultimately helps to reduce the severity of psoriasis symptoms. Calcipotriene is a synthetic form of vitamin D that reduces the production of skin cells and decreases inflammation. It is available as a topical ointment or solution and should be applied to the affected skin area. Calcitriol is a natural form of vitamin D that suppresses the immune system's activity, thereby reducing inflammation and decreasing skin cell proliferation. It is available as an oral capsule or topical solution.

Why mineral SPF matters for psoriasis?

Sun protection is an important factor in managing psoriasis and reducing flare-ups. Look for a mineral sunscreen made of natural zinc oxide that will not cause a reaction or further irritate the skin. Most importantly, you want to look for an SPF product compatible with darker skin.

Rooted in science, Sunsolve MD formulations bring medically led expertise into mineral SPF skincare. In addition to providing maximum protection, they are specifically formulated for psoriasis-prone skin in mind. The new generation of intelligent solutions provides a transparent and lightweight sun shield with zero white cast.

Sunsolve MD Calming Mineral Serum SP50 is formulated with Sunsolve MD's anti-redness complex. This nourishing, rich mineral SPF formula visibly corrects the look of skin redness and offers a calming, restorative effect to the skin.

Sunsolve MD CeraPol-3 Technology TM: patented anti-inflammation technology designed to soothe the skin's barrier at the lipid level.

SunsolveMD SolveDNAReverseTM: reverses DNA photo sun damage powered by a complex repair enzyme.

SunsolveMD EnviroSolveTM: Protecting the skin from 97% UV radiation and HEV (blue) light while reducing pollution-induced free radicals.

References

Tara D Rachakonda, Clayton W Schupp, April W Armstrong, Psoriasis prevalence among adults in the United States, March 2014, https://pubmed.ncbi.nlm.nih.gov/24388724/

Amanda Barrell, Psoriasis on black skin: What to know, April 30, 2019, https://www.medicalnewstoday.com/articles/325068

R. Torsekar and Manjyot M. Gautam, Topical Therapies in Psoriasis, 2017 Jul-Aug, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5518573/

Gulbahar Sarac, Tuba Tulay Koca, and Tolga Baglan, A brief summary of clinical types of psoriasis, 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175084/