Derm Topics

My Approach to Recognizing, Diagnosing and Treating Psoriasis in Diverse Skin Tones

Next Steps in Derm, in partnership with Skin of Color Update, interviewed Dr. Amy McMichael, professor and chair of the department of dermatology at Wake Forest University School of Medicine, about her approach to recognizing, diagnosing and treating psoriasis in diverse skin tones. Watch as Dr. McMichael shares why psoriasis workups in patients with skin of color should be different. Don’t prolong your patients’ suffering! She shares why early and aggressive treatment is key. Also, Dr. McMichael outlines what characteristics should lead you to biopsy in order to rule out an alternate diagnosis.

Further Reading

If you want to read more about psoriasis in patients with skin of color, check out the following articles published in the Journal of Drugs in Dermatology:

Efficacy and Safety of Calcipotriene/Betamethasone Dipropionate Foam in the Treatment of Psoriasis in Skin of Color


Background: There is a paucity of data on usage of topical medications in patients with darker phototypes. This single-center, randomized, double-blinded, vehicle-controlled clinical study investigated the efficacy of a combination calcipotriene/betamethasone dipropionate (Cal/BD) aerosol foam 0.005%/0.064% in the treatment of psoriasis vulgaris in Fitzpatrick skin types IV to VI.
Methods: 25 adult subjects were randomized 4:1 to Cal/BD foam or foam vehicle once daily for 4 weeks followed by 4 weeks of open label treatment. From week 4 to week 8, subjects randomized to Cal/BD foam once daily switched to Cal/BD foam twice weekly for 4 weeks, while those randomized to vehicle applied Cal/BD foam once daily.
Results: At week 4, 4/19 (21%) of Cal/BD foam patients achieved clear/almost clear Investigator Global Assessment (IGA) status with ≥2 grade improvement compared with 0/5 (0%) of vehicle patients (P=0.54). 12/19 (63%) of Cal/BD foam patients achieved a 50% reduction in Psoriasis Area and Severity Index (PASI 50) at week 4, compared with 0/5 (0%) of vehicle patients (P=0.04). Mean changes in melanin index at week 4 indicate a trend toward increased pigmentation in Cal/BD foam patients and decreased pigmentation in foam vehicle patients (P=0.30). All adverse events were mild and deemed unrelated to treatment by the investigators.
Limitations: The sample size was small and underpowered to detect statistically significant changes in most endpoints.
Conclusion: Cal/BD foam was safe and well tolerated in plaque psoriasis patients with skin of color. Larger studies involving skin of color populations with psoriasis are warranted. Pigmentary changes (hyper- and hypopigmentation) in lesional skin were observed.

Evolving Concepts in Psoriasis: Special Considerations for Patients With Skin of Color, Skin Barrier Dysfunction, and the Role of Adjunctive Skin Care


Background: Despite considerable advances in our understanding of the pathogenesis and treatment of psoriasis, data pertaining to racial/ethnic variations, effects on barrier function, and the potential role of adjunctive skin care are relatively limited. Knowledge gaps in the clinical presentation, quality-of-life impact, and approach to treating psoriasis in patients with skin color contribute to disparities in care. In addition, small studies suggest that using skincare products can reduce psoriasis symptoms, improve barrier function, and result in higher patient satisfaction, yet patients with psoriasis may underuse skincare products. This manuscript seeks to offer insights into these knowledge gaps and their potential treatment implications.
Methods: A structured literature search followed by a panel discussion and an online review process explored best clinical practices in treating psoriasis patients with skin of color and providing expert guidance for skincare use, including gentle cleansers and moisturizers.
Results: Racial/ethnic differences in genetic factors, clinical presentation, and disease burden in psoriasis have been reported. Underrecognition of these differences contributes to racial/ethnic health disparities for psoriasis patients in the US. Several studies have shown a greater quality-of-life impact with psoriasis among patients with skin of color. Although the published data are limited, some studies have identified differences in skin barrier properties and suggest a role for adjunctive skin care in the management of psoriasis.
Conclusion: Further study is needed to understand racial/ethnic population variations in psoriasis and develop strategies to reduce disparities in care. Addressing alterations in skin barrier function observed in psoriasis may help to improve treatment outcomes and patient satisfaction.

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