Given psoriasis is a skin condition, it’s not surprising it can look and behave differently on darker skin tones than on lighter ones. The most striking difference is appearance. The hallmark symptom of psoriasis — scaly, red patches of skin — can look purple or grayish on darker skin, according to Corey L. Hartman, MD, a board-certified dermatologist and founder of Skin Wellness Dermatology in Birmingham, Alabama.
Black, Indigenous, and People of Color (BIPOC), especially Black Americans, often have hyperkeratotic lesions as well, meaning the scaly areas are especially thick. What’s more, a study published in The Journal of Clinical and Aesthetic Dermatology found that Black people tend to have more severe symptoms and flare-ups overall as compared with white people.
Despite these differences, Black and darker-skinned people with psoriasis benefit from basically the same treatment as those with lighter skin. That said, if you’re Black and suspect you may have psoriasis or you’ve just been diagnosed with the condition, there are things you may want to keep in mind:
1. Get evaluated and diagnosed as soon as possible.
Early detection of psoriasis is one of the most effective ways to prevent and control flares. For Black Americans, this can be easier said than done, because little research has been done on how psoriasis affects Black people and other people with darker skin tones. This has led to a common misconception that only light skin is susceptible to psoriasis, so the condition is often misdiagnosed.
The discrepancy between ethnicities isn’t all that huge, though: About 1.9 percent of Black Americans and 1.6 percent of Hispanic Americans are affected by psoriasis, compared with 2.5 percent of white Americans.
2. Identify your psoriasis triggers.
This is true of anyone with psoriasis, regardless of skin color, but it’s a vital aspect of self-care. If you know what sets off flare-ups, you can find ways to prevent them. Among the most common triggers are:
- Stress
- Bug bites
- Sunburn
- Infection or illness
- Medications, such as certain beta-blockers, lithium, and some blood pressure treatments
- Extreme weather, such as sweltering heat or extreme cold
Keep a log of your psoriasis symptoms and note what was going on when they flared up. Eventually, patterns will emerge to help you pinpoint your triggers so you can avoid them in the future.
3. Baby your skin.
Anything that irritates skin can lead to a flare. For starters, don’t scratch your skin, no matter how itchy it is. Use a cool compress — rather than your nails — to get relief, and moisturize religiously. Dr. Hartman recommends products that contain mineral oil, such as liquid paraffin or petrolatum, as well as aloe vera gel and coconut oil.
Even fabrics can irritate sensitive skin. In cold weather, when scratchy wool calls your name, layer it over cotton or linen. Year-round, use a fragrance-free detergent, as some scents can also irritate skin.
Finally, try to avoid injuries such as cuts and bug bites. Be careful when preparing foods, clipping your nails, shaving, playing contact sports, and even gardening. Think twice about getting tattoos or piercings.
4. Be smart about sun exposure.
Psoriasis and the sun have an interesting relationship. A study published in the British Journal of Dermatology found exposure to regular, short bursts of sunlight can help improve psoriasis, but a sunburn can trigger flares — and Black skin is no less susceptible to burns than light skin.
When you’re outside on sunny days, stay out of direct sunlight, and apply an unscented sunscreen frequently, even on psoriasis lesions. Cover up as much as you comfortably can with lightweight, breathable clothing, and wear a brimmed hat and sunglasses to protect your face and scalp.
5. Understand your treatment options.
For the most part, Black skin responds to most psoriasis treatments in the same way white skin does. One possible exception is phototherapy, as the light used to treat psoriasis can worsen dyspigmentation — darkening (hyperpigmentation) or lightening (hypopigmentation) of patches of skin — caused by flare-ups. Ask your dermatologist about this risk if they recommend phototherapy for you.
Note too that scalp psoriasis is more common in Black people. However, treating the scalp often involves frequent use of medicated shampoo plus medication applied directly to the scalp, which may be drying to African-American hair, causing it to break easily and be difficult to style. Talk to your dermatologist about other options if shampooing this frequently isn’t a good match with your hair care routine.
6. Diminish the appearance of lesions safely.
In general, it’s not advisable to use makeup to cover active psoriasis lesions, but it may be safe to use a bleaching cream to help lighten hyperpigmentation of fully healed lesions. Don’t do this without talking to your dermatologist first. And remember: The more consistent you are with regular treatment and the sooner you deal with a flare, the less likely it is to leave behind discoloration.
7. Take care of your mental and emotional health.
Because it’s such a visible condition, psoriasis sometimes triggers social stigmas that, studies show, can be especially painful for Black people. Hartman suggests these steps for dealing with the emotional toll of living with psoriasis.
- Find a dermatologist with experience treating Black skin and be up front with them if your mental or emotional health is suffering because of your psoriasis.
- Be honest with yourself and those closest to you if your psoriasis makes it hard for you to do certain things. Ask for help when you need it.
- Move your body regularly. Exercise has been shown to be an instant mood booster and help with depression.
- Find ways to manage stress, such as taking up a hobby, reading, doing yoga, or meditating.
- Focus on what’s important to you and gives your life meaning and purpose.
- Learn as much as you can about psoriasis. The better you understand it, the easier it will be for you to feel that you, not your condition, are in control of your skin, your body, and your overall health and well-being.
