Psoriasis in People With Skin of Color: An Evidence-Based Update

Abstract

Variations in epidemiology, pathophysiology, genetics, clinical presentation, management, quality of life (QoL) impact, and access to care and research exist globally across the spectrum of individuals with psoriasis. This article aims to provide an evidence-based update on the characteristics of psoriasis in individuals with skin of color (SOC), a population in which psoriasis data have historically been limited. A literature search was conducted from January 2018 until August 2023 in Pubmed/MEDLINE/Cochrane Library and identified studies with I-III level of evidence using Oxford Centre for Evidence-Based Medicine recommendations. Multiple factors (including biological and non-biological) contribute to differences in clinical features and therapeutic nuances in patient populations with SOC. The prevalence of plaque psoriasis is lower in people with SOC but tends to be more severe. People with SOC are less likely to receive biologic treatment. Although the QoL impact of psoriasis is worse in populations with SOC than in White populations, more research is needed to elucidate variations in presentation and impact across diverse populations. An important limitation of this study is that ethnicity, race, and SOC have not been defined universally or used consistently in the literature. Available evidence provides limited information on populations with SOC outside North America, which limits generalizability across global populations. Furthering our understanding of psoriasis in individuals with SOC is crucial to improving patient care outcomes for diverse patient populations worldwide.

Keywords: disparities; epidemiology; ethnicity; genetics; psoriasis; quality of life; race; skin of color; treatment.

FIGURE 1

PRISMA diagram showing databases, search terms, and number of articles identified and included in this review.

FIGURE 2

Different clinical presentations of psoriasis in skin of color. Psoriasis lesions are characterized by a purple or lilac (more often gray on darker skin) hue (A–D), thick plaques (D), and extensive scaling with hyper‐ and hypopigmentation (C). Images courtesy of Mahira El Sayed, Ain Shams University, Cairo, Egypt, and Nejib Doss, Hospital Militaire Tunis, Tunis, Tunisia.