Psoriasis in 2025: Differences in Appearance and Treatment on Black vs. White Skin

Psoriasis is a chronic autoimmune skin disorder characterized by scaly, itchy, and sometimes painful plaques. Affecting over 125 million individuals worldwide, it varies significantly in its presentation based on skin color, type of psoriasis, and severity of outbreaks.

This guide delves into the distinct manifestations of psoriasis on darker skin tones compared to lighter skin, highlighting diagnosis challenges and effective treatment strategies.

How Does Psoriasis Present on Black Skin?

A U.S. study involving over 12,000 participants indicated psoriasis affects approximately 1.5% of Black individuals versus 3.6% of White individuals. However, underdiagnosis in people of color may skew these figures.

Melanin levels influence psoriasis’s visual symptoms. On lighter skin, plaques are typically red or pink with silvery-white scales, whereas on darker skin, they appear as purple or brown plaques accompanied by gray scales. Variations exist even within dark-skinned populations, making individualized assessment vital.

Additional Symptoms Across Skin Tones

• Dry, cracked skin
• Itchy, burning, or sore plaques
• Thickened, pitted nails
• Joint swelling and pain

Visual Examples of Psoriasis on Black Skin

Common Psoriasis Types in 2024

• Plaque Psoriasis: The most prevalent form, marked by red or purplish patches with distinctive scales, commonly on knees, elbows, and scalp.
• Inverse Psoriasis: Occurs in skin folds like armpits or groin, presenting as smooth, red or purple patches without scales.
• Guttate Psoriasis: Characterized by small, drop-shaped spots, often emerging in childhood.
• Pustular Psoriasis: Features red skin with white pustules, primarily on hands and feet; more frequent among Asian and Hispanic populations.
• Erythrodermic Psoriasis: A rare, severe type causing widespread redness and scaling, requiring urgent medical care.

Frequent Psoriasis Locations on Black Skin

People with darker skin, particularly Black individuals, often develop psoriasis on the scalp and are significantly more prone to palmoplantar psoriasis affecting hands and feet, especially males.

Common Misdiagnoses: What Psoriasis Can Imitate?

• Fungal infections with itchy, scaly rashes
• Lichen planus causing purplish bumps or oral lesions
• Cutaneous lupus presenting as dark rashes on dark skin
• Eczema, which can appear as darkened or ashen patches without scales on darker skin

Diagnosis can be complex, especially for non-dermatologists, emphasizing the need for improved training to recognize psoriasis in diverse skin tones.

If you have concerns about psoriasis, especially as a person of color, advocating for thorough evaluation can ensure accurate diagnosis and timely treatment.

Diagnosing Psoriasis in Darker Skin

Diagnosis involves a physical exam that inspects typical plaques and scaling, including scalp checks. Skin biopsies may be utilized to confirm diagnosis and guide treatment choices.

Effective Psoriasis Treatments for Dark Skin

Topical Therapies

For mild to moderate cases, topical treatments like moisturizers, corticosteroids, retinoids (e.g., tazarotene), and anti-inflammatories help manage symptoms by soothing skin, reducing inflammation, and controlling itching. Medicated shampoos are tailored for scalp psoriasis, with adjustments recognizing different hair care routines in Black populations.

Systemic Medications

Severe psoriasis may require oral or injectable systemic drugs, including biologics. Research in 2023 highlights brodalumab (Siliq) as especially effective for Black patients, with other biologics showing varied efficacy across ethnic groups.

Phototherapy

UVA and UVB light treatments reduce skin inflammation and are often combined with other therapies for enhanced results.

Lifestyle Adjustments

Identifying and avoiding triggers such as stress, skin injury, alcohol, certain foods, medications, and infections can help prevent flare-ups.

Summary

Psoriasis manifests distinctly across skin tones, with darker skin showing purple or brown plaques and gray scales versus red or pink with silvery scales on lighter skin. Awareness of these differences improves diagnostic accuracy and treatment outcomes for people of color worldwide.

Stay informed and consult healthcare professionals experienced in managing psoriasis across diverse populations.

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