Psoriasis is a skin condition that can affect people of all races and ethnicities. However, so far, a great deal of psoriasis research has mostly focused only on people with white skin. The references and descriptions available to doctors often exclude information about those with darker skin.

Psoriasis may be more easily detected in individuals with lighter skin, as the majority of research has centered on those with white skin. The symptoms on darker skin may be harder to recognize, which leads to misdiagnosis and inadequate psoriasis treatment for Black people.

If you have darker skin and suspect you have psoriasis, you’ll need to know the signs of the condition, as well as what you might need to receive a proper diagnosis and treatment from your health care provider.

How Common Is Psoriasis in Black Populations?

Psoriasis affects a wide range of people of all ages and sexes. According to the National Psoriasis Foundation, psoriasis is more commonly diagnosed in white Americans (3.6 percent) than African Americans (1.9 percent). This number may not reflect how many Black people in the U.S. actually have psoriasis due to underdiagnosis of the condition in Black people and inequalities in health care access.

Genetics may play a role in a person’s likelihood of developing psoriasis. However, studies on which genes may be associated with psoriasis have mainly focused on people of European or Asian descent. As a result, researchers have less insight into which genes are most common among Black people with psoriasis.

For example, a variation of the gene HLA-Cw6 appears strongly associated with the risk of psoriasis. Globally, this gene is found more frequently among people of African descent (15.09 percent) than in people of European heritage (9.62 percent). However, this finding does not match up with American studies that show white people being more affected by psoriasis than Black people.

Notably, researchers have also found that psoriasis is less common among Western Africans than Eastern Africans. Most African Americans are genetically linked more closely to Western Africans. This observation suggests another possible reason psoriasis may be less common among African Americans.

What Does Psoriasis Look Like on Darker Skin?

Psoriasis can look different from person to person and on different skin tones. In general, on dark skin, psoriasis may appear as a darker shade than the surrounding healthy skin. It may look salmon-colored, dark brown, violet, or purple with a gray scale on top. Psoriasis plaques on dark skin can be thicker, with more scaling, than plaques on white skin.

Discoloration can remain long after psoriasis plaques heal. Black people may also be more likely to have post-inflammatory hyperpigmentation that leaves dark spots after trauma or inflammation has healed. Active psoriasis can sometimes be mistaken for hyperpigmentation, leading to inadequate treatment of active flare-ups.

Types of Psoriasis

Various types of psoriasis may look different on darker skin.

Plaque Psoriasis

Plaque psoriasis is the most common form of psoriasis. Plaques are clearly defined, thick patches of darker-colored skin with a scaly white or silver coating. Plaques can range from purple to gray to brown.

Plaque psoriasis usually appears on the elbows, knees, lower back, or scalp. With scalp psoriasis, health care providers should consider hair care needs when prescribing topical treatments. Some medicinal treatments and shampooing regimens may be too harsh on Black hair. Many African Americans do not wash their hair every day, so some topical therapies may not be appropriate.

Guttate Psoriasis

Guttate psoriasis is thought to be triggered by an infection, such as strep throat, and typically occurs in children and young adults. This type of psoriasis appears as small, raised bumps covering the torso, legs, and arms. On light skin, the bumps usually appear red or salmon-colored. On Black skin, guttate psoriasis may appear as darkened spots on the skin.

Inverse Psoriasis

Inverse psoriasis usually appears as smooth, shiny patches found in skin folds such as the armpits, groin, and under the breast. The color of the rash is usually darker than the surrounding skin and may be purple or brown.

Palmoplantar Psoriasis

Palmoplantar psoriasis occurs on the hands or feet. It can appear as discolored, dry, thick skin on the palms or the soles of the feet. Pustules will sometimes appear, and this is called pustular psoriasis. The pain caused by this type of psoriasis often affects your quality of life because it can limit the activities you’re able to do.

Nail Psoriasis

According to the National Psoriasis Foundation, about half of people with psoriasis have it on their nails. Common symptoms include:

• Tiny dents in the nails (called pitting)
• Crumbling nails
• Changes in nail shape
• Detached nails
• Yellow or brown nail discoloration

Erythrodermic Psoriasis

Erythrodermic psoriasis is a rare but very serious type of psoriasis that affects the entire body. It causes chills and swelling, while the skin may look burned. On lighter skin, erythrodermic psoriasis may look red, and on darker skin, it may look purple or gray. If psoriasis covers large parts of your body in sheets rather than individual bumps or plaques, and you feel a racing heartbeat and body temperature fluctuations, contact your doctor immediately.

Is Psoriasis More Severe for Black People?

Black people may be more likely to have severe psoriasis than white people. A study from The Journal of Clinical and Aesthetic Dermatology found that African Americans with psoriasis reported 3 percent to 10 percent of their body surface area had psoriasis, compared with 1 percent to 2 percent of the body for white study participants.

A survey by the National Psoriasis Foundation found that African American participants were more likely to report that they had very severe psoriasis (23 percent) compared to Caucasian participants (8 percent).

It is not known why African Americans tend to have more severe psoriasis, but it could be due to delayed diagnosis, inadequate treatment, or less access to dermatology services.

Quality of Life

Another survey by the National Psoriasis Foundation found that Black people with psoriasis or psoriatic arthritis were more likely to also have depression than white and non-Latinx individuals. Black people were also more likely to say that having psoriasis affects their quality of life and social activities.

How Is Psoriasis Diagnosed?

A doctor specializing in treating skin conditions (dermatologist) can diagnose psoriasis based on the appearance of your rash. The dermatologist will look at your skin and ask you about your symptoms, medical history, and family history.

Many dermatologists are not familiar with the way psoriasis presents on Black skin or skin of color. If they cannot make a diagnosis by observing your skin, they may take a biopsy (a skin sample) to examine it under a microscope.

One study found that people with skin of color were four times as likely to need a biopsy to confirm a psoriasis diagnosis. Psoriasis on darker skin can look like other diseases, such as pityriasis rosea or lichen planus. Waiting for biopsy results can further delay diagnosis and treatment. The same study cited in the journal Cutis found that people with skin of color had to wait three times as long to receive a psoriasis diagnosis.

Treatment Considerations for Black Skin

Psoriasis is different for everyone, and there isn’t one best treatment for psoriasis. Your options may include:

• Topical therapy — Treatments applied directly to the skin
• Phototherapy — Also called light therapy
• Systemic therapy — Oral or injected medications that work all over your body

Although skin color doesn’t usually change how well treatments work, there are some instances when it should be considered. Skin color can affect phototherapy results and can cause the affected skin to become darker. People with darker skin may need a higher dose of phototherapy. However, many doctors do not feel comfortable increasing the dose because they do not have the necessary experience. If you are interested in phototherapy, you may need to consult a dermatologist familiar with phototherapy on darker skin.

Special attention may be required when treating scalp psoriasis in Black individuals.

Daily hair washing is not usually recommended for Black hair. However, scalp psoriasis treatments can involve more frequent washing to remove scaling, as well as using medicated shampoos. If topical scalp treatments will not work with your hair care needs, be sure to tell your doctor, so you can explore other options.

If your psoriasis is severe, your doctor may recommend a biologic medication. As found in the journal Archives of Dermatological Research, although Black people can have more severe psoriasis, a study of people receiving Medicare benefits found that Black individuals were less likely to be taking a biologic medication.

Learn more about biologics for psoriasis.

New psoriasis treatments are currently being researched through clinical trials. Historically, clinical trials for psoriasis have rarely included people of color. However, the American Academy of Dermatology has started a three-year plan to improve diversity and inclusion in dermatology.

Psoriasis can affect people of any skin color. However, individuals with dark skin may have difficulty getting the right diagnosis and treatment. Health care providers need to understand the differences in psoriasis for dark skin so that they can manage it properly. Talk to your dermatologist about the best treatment options for you.

Talk With Others Who Understand

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Have you been diagnosed with psoriasis? Do you have any tips for managing psoriasis on skin of color? Did you find this article helpful? Share your experience in the comments below, or start a conversation by posting on your Activities page.