Transcript
Announcer:
Welcome to DermConsult on ReachMD. On this episode, Dr. Seemal Desai will discuss how we can recognize psoriasis in skin of color. He’s the Past President of the American Academy of Dermatology, a Clinical Associate Professor in the Department of Dermatology at the University of Texas Southwestern Medical Center, and the Founder and Medical Director of Innovative Dermatology. Let’s hear from Dr. Desai now.
Dr. Desai:
I think psoriasis in skin of color is increasingly complex and very interesting. Psoriasis in skin of color represents a presentation of a common skin disease, an inflammatory skin disease, but also can present with nuances.
First and foremost, the erythema or redness that we typically see in psoriasis in patients with skin of color oftentimes presents more with a purplish, grayish, or even brownish hue. And so catching that inflammation in its early stages is really important.
I also think psoriasis in skin of color is something that oftentimes we see at a later stage of diagnosis in our darker skin type patients because for many patients, they may think it's just simply dry, scaly, and flaky skin. They may not even know that there is something called psoriasis that can affect all skin tones.
And I think the other thing to think about is that psoriasis can affect all skin tones equally. And so regardless of racial ethnic background, you can certainly see patients who have psoriasis.
Psoriasis in skin of color can present in lots of different ways. First and foremost, we look for patterns, colors, and textures. I oftentimes in my darker skin tone patients see that the clues may not be the classic silvery scale that we're used to seeing on the elbows and knees in lighter skin tones with associated redness and thickening. Instead, what you may see is sometimes even more of a thicker texture without scale. So sometimes it can even look lichenified and even papular in certain areas. There have been reports in the literature of a variant of psoriasis called follicular psoriasis that can present with more of a follicular presentation, meaning more of a presentation where you see more little scaly bumps in hair follicles on the extremities, the arms and legs.
We oftentimes also see lots of post-inflammatory hyperpigmentation or dyschromia in patients with psoriasis in skin of color. And why is that important? It's important because a lot of these patients oftentimes present more for the pigmentation rather than for the actual psoriasis itself. And then it's an important part of our job to really go through and talk about the importance of that.
One of the things that we want to remember is that the severity of psoriasis in skin of color as well as a non-darker skin type population should not be viewed in a silo. And what I mean by that is that we want to make sure that patients understand that regardless of skin tone and skin type, you can still have psoriasis, and you could still have sequelae of psoriasis, psoriatic arthritis, more inflammatory metabolic disease, more skin irritation, and more psychological burden and psychosocial impact. So all of these things can play a role for our patients who have psoriasis in skin of color.
I think what we do need, however, is more data. We need more prevalence data, more outcomes data, and more randomized double-blinded placebo-controlled trials in patients in skin of color. And I'm proud to mention that we were part of the VISIBLE study, which looked at guselkumab in skin of color. And the interesting thing about that is that this was the first time we were able to have dedicated data on a biologic in skin of color. So I think we're just on the first precipice of knowing where to move forward in this disease state.
Announcer:
That was Dr. Seemal Desai explaining how psoriasis presents in skin of color. To access this and other episodes in our series, visit DermConsult on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
