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3. To help safeguard the skin, the immune system release chemicals that can cause nerves to itch and blood vessels to dilate to prepare the skin for a sudden rush of immune cells
4. When the immune cells arrive at the scene, most work to kill off the pathogens causing the distress, but a few capture some of the invaders and take them back to the heart of the immune system, where other soldier cells are produced in a way to recognize and attack the invading cells on contact
5. Inflammation is the bodys way of opening blood vessels to allow more soldier cells to rush to the battlefield.
While this entire process is completely normal, people with psoriasis tend to overproduce these soldier cells when the body feels threatened. This overabundance of killer immune cells can actually be dangerous to the skin since they begin to attack good cells along with the bad ones.
While it is great to finally understand the impact an improperly working immune system can have on your skin and cause psoriasis more research is needed to pinpoint the exact cause for the over-firing of the cell messages. Mild Psoriasis Pictures
Where Are The Plaques Located On Your Body
Plaques can show up in lots of different places on your body. Some locations cause more problems than others. Plaques on the scalp, for example, can sometimes be more severe than plaques on the rest of the body. Plaques on the face are often associated with a more severe condition overall. Psoriasis in genital areas may be considered more severe because it can affect your sex life.
For a more detailed look at psoriasis severity, you may want to read this article.
How Is Psoriasis Diagnosed
If you think you may have psoriasis, your doctor will perform a variety of examinations to make a diagnosis:
- A physical exam is the quickest and most effective way for a doctor to diagnose psoriasis. Theyll look for the signature psoriasis patches and scaling thats common in plaque psoriasis.
- A scalp check can also be performed on people with darker skin, as scalp psoriasis is common in people of color. Narrowing down the location of the flare-ups is also important for treatment.
- A skin biopsy may be performed if your doctor feels like they need more confirmation for a diagnosis. During a biopsy, a small amount of skin will be removed and sent to the lab for testing. Your doctor can then confirm whether the condition is psoriasis or something else.
Treatment options for psoriasis are generally the same across the board, regardless of skin color, and vary based on the type of psoriasis you have.
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How Common Is Psoriasis In Black People
The chronic skin condition affects eight million Americans, but Black patients account for a much smaller percentage of that number. According to one study, the prevalence of psoriasis in Black patients is 1.3% compared to 2.5% in white patients. But that doesnt necessarily mean dark skin is less prone to it. Its likely not as prevalent because its not as diagnosed, says Dr. Hartman. This begs the question: Why? One theory is that training about psoriasis on Black skin isnt always taught in medical schools. I was fortunate to train in dermatology at Howard University an HBCU we are taught dermatology–not just dermatology in lighter skin tones, says Dr. Kindred. Other institutions are doing the same. However, many are playing catch-up, trying to supplement their curriculum with skin of color.
Bipoc Patient Voices: Living With Psoriasis And Psoriatic Arthritis
By sharing the stories of BIPOC patients living with psoriasis and psoriatic arthritis, were hoping that others will listen to and learn from their disease journey. This conversation is vital for reducing health disparities and improving delays in diagnosis and access to treatment among patients in the BIPOC community. Representation matters in all aspects of life and especially in health care. Learn more.
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Treating Psoriasis On Black Skin
While psoriasis medications can help control outbreaks in many people, Black people are often undertreated. Compared to white people, theyre not only less likely to be treated with biologics , according to a study published in December 2015 in The Journal of Investigative Dermatology, but they sometimes receive only topical medications or no treatment at all, according to the National Psoriasis Foundation.
Black people who have psoriasis were also less familiar with biologics as a treatment option compared to white people, according to a study published in February 2019 in the Journal of Investigative Dermatology, despite the fact these medications are highly effective at treating the skin condition, regardless of a persons pigmentation.
Dr. Hartman points out that undertreatment among Black patients is not due to a lack of concern or care for their health. Disparities such as a lack of access to quality medical care and healthcare insurance in the Black community have been well documented and contribute significantly to Black patients with psoriasis not being treated adequately.
Other research published by Dr. Takeshita has shown that dermatologists are less confident about diagnosing psoriasis in people with darker skin than those with lighter skin.
Contrary to what has been displayed in the media, psoriasis can affect people of any race. And a growing number of providers agree that we need more diverse representation and information for Black people with psoriasis.
What Causes Psoriasis Outbreaks
Psoriasis outbreaks differ from person to person. No one knows exactly what causes flare-ups. Common psoriasis triggers may include:
- Streptococcal or other infection that affects the immune system.
- Certain prescription medications .
- Cold weather, when people have less exposure to sunlight and humidity and more to hot, dry indoor air.
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How To Get A Diagnosis For Psoriasis On Black Skin
The only way to know for sure that you have psoriasis is to go to a dermatologist.
Theyll perform a physical exam, looking for signature signs of psoriasis like lesions, scaling, or flaking skin.
Your doc may also do a skin biopsy, removing a small amount of your skin to test it for psoriasis. This is a good option if a physical exam isnt 100 percent accurate.
Systemic And Biologic Treatments
These treatments work to slow down the growth of skin cells or to reduce inflammation.
Biologic medications block proteins in the immune system that are related to psoriasis, such as:
- tumor necrosis factor-alpha
is continually being done to see how these biologics can help reduce symptoms, and to develop newer medications.
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What To Expect From Your Doctor
Your health care provider is likely to ask you several questions, such as:
- When did you begin having symptoms?
- How often do you have these symptoms?
- Have your symptoms been continuous or occasional?
- Does anything seem to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
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How Psoriasis Is Diagnosed
A GP can often diagnose psoriasis based on the appearance of your skin.
You may be referred to a specialist in diagnosing and treating skin conditions if your doctor is uncertain about your diagnosis, or if your condition is severe.
In rare cases, a small sample of skin called a biopsy will be sent to the laboratory for examination under a microscope.
If your doctor suspects you have psoriatic arthritis, which is sometimes a complication of psoriasis, you may be referred to a doctor who specialises in arthritis .
You may have blood tests to rule out other conditions, such as rheumatoid arthritis, and X-rays of the affected joints may be taken.
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What Are Other Types Of Psoriasis
Plaque psoriasis is the most common type. About 80% to 90% of people with psoriasis have plaque psoriasis.
Other, less common types of psoriasis include:
- Inverse psoriasis appears in skin folds. It may look like thin pink plaques without scale.
- Guttate psoriasis may appear after a sore throat caused by a streptococcal infection. It looks like small, red, drop-shaped scaly spots in children and young adults.
- Pustular psoriasis has small, pus-filled bumps on top of the red patches or plaques.
- Sebopsoriasis typically appears on the face and scalp as red bumps and plaques with greasy yellow scale. This type is a cross between psoriasis and seborrheic dermatitis.
Living With Scalp Psoriasis
Being a Black woman, hair is such a big deal, says Nicole Cech, 26, an artist in Californias East Bay Area. There is a lot of thought about growing and maintaining our hair. Until about 2008, it was hard to even find products for Black hair in mainstream stores.
By the time Nicole began to understand her 4C hair and finally found products that worked, she got hit with a massive psoriasis flareup. In 2020, her hair started coming out in clumps her scalp was inflamed and she had silvery patches that extended down my neck and back. It was really stressful, recalls Nicole. I thought, Oh, man, Im putting all this effort into understanding my hair and growing my hair and now this.
Yet her diagnosis of scalp psoriasis didnt come easy. I was going to a derm who didnt think I had psoriasis because I also had eczema and only two percent of the population has both, says Nicole. She has since found a dermatologist who is Black, who diagnosed her psoriasis and then psoriatic arthritis down the line. That was the beginning of me being able to make adjustments to my hair care routine.
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Rare Types Of Psoriasis Tend To Be More Common In People Of Color
While plaque psoriasis is the most prevalent form of the condition, there are also rare subtypes that appear more frequently in certain racial and ethnic groups, Dr. Robinson says. For example, researchers have found that pustular psoriasiswhich appears as inflamed, scaly, pus-filled bumps4is more common among Asian and Hispanic communities.5
Asian people are also more likely to have erythrodermic psoriasis,5 which covers the body in a red, burn-like rash and can be fatal if its not treated quickly. Whats more, Asian and Black people tend to be more vulnerable to scalp psoriasis, in which plaques pop up around the scalp, hairline, forehead, back of the neck, and on the skin around the ears.6
This is important to know because getting an accurate diagnosis can be complicated if youre dealing with a form of psoriasis thats rarer in white people, according to Dr. Robinson, especially if youre seeing a doctor whos not experienced in treating darker skin.
What Are The Types Of Psoriasis
In children, common types of psoriasis include:
Plaque psoriasis. This is the most common type of psoriasis. It causes plaques and silvery scales, usually on the knees, elbows, lower back, and scalp. They can be itchy and painful and may crack and bleed.
Guttate psoriasis. This type often shows up after an illness, especially strep throat. It causes small red spots, usually on the trunk, arms, and legs. Spots also can appear on the face, scalp, and ears.
Inverse psoriasis. This causes smooth, raw-looking patches of red skin that feel sore. The patches develop in places where skin touches skin, such as the armpits, buttocks, upper eyelids, groin and genitals, or under a woman’s breasts.
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Solutions For Mild Psoriasis
Mild to moderate psoriasis means that the red, scaly patches cover less than 10% of your body. But just because your psoriasis is called “mild” doesn’t mean it’s easy to live with. If the patches are in visible places like your hands or legs, you may be embarrassed to go out without wearing long sleeves and pants. Also, small areas of psoriasis can turn into big problems if they’re itchy or painful.
How Intense Are Your Symptoms
PASI and other scales look at these symptoms:
- How deep is the color of the plaque? On some skin tones, plaques may be gray, dark brown, or purple. On other skin tones, plaques can go from pale pink to a deep, salmon-colored red.
- How hard have the plaques become? Plaques are usually raised. Exactly how thick they are can be an indication of how severe the condition is.
- How much scaling is there? Plaque psoriasis typically involves patches of gray or silvery-white scales. This is because the skin cells receive a signal to produce new skin cells too quickly. They build up and shed. More flaking usually indicates a more severe case.
PASI scores range from 0 to 72. A higher number means a more severe case.
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Signs Of Plaque Psoriasis
Psoriasis usually presents as raised, thick, and scaly skin on your body. These patches, Takeshita said, usually appear on the outside of your elbows, knees, and scalp, as well as on your belly button and buttocks. They are also often symmetrical, she said, so they sometimes appear in the same place on both sides of your body.
Bridges and Takeshita both say to go to the National Psoriasis Foundation’s website for resources if you’re worried that you have plaque psoriasis or have been diagnosed with it.
Meet Your Soulmate Stylist
Because Nicole has psoriatic arthritis, she says, I cant sit for hours on end and manipulate my hair, so she found a stylist who is Black and understands Nicoles scalp condition.
At their initial consultation, Nicole asked questions like Have you worked with a client who has psoriasis before? and Are you ready to be really gentle? She explained that If you see flakes, its probably not dandruff, and if you scrub those too hard, I will bleed.
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How Much Of Your Body Is Involved
Healthcare professionals sometimes use a percentage to talk about how much of your body is affected by a skin condition. The percentage is sometimes called your body surface area involved, or BSA.
- mild psoriasis: covers less than 3 percent of the body
- moderate psoriasis: covers between 3 and about 9 percent of the body
- severe psoriasis: covers 10 percent and more of the body
If you want to estimate that percentage yourself, you can use the size of your hand as a go-by. Most peoples hands are about 1 percent of the overall size of their body. About how many areas the size of your hand are covered by plaques? Health experts sometimes say that a case is severe if more than of your body is affected.
Patches Arent Identical Across Races
Although people of any race, skin type, or skin shade can get psoriasis, it often presents itself differently on light and dark skin:
- On darker skin types, psoriasis may appear violet with grey scales. It may also appear dark brown and be more difficult for providers to diagnose.
- On lighter skin types, psoriasis often appears pink or red with a silvery-white scale.
What Are The Clinical Features Of Psoriasis
Psoriasis usually presents with symmetrically distributed, red, scaly plaques with well-defined edges. The scale is typically silvery white, except in skin folds where the plaques often appear shiny with a moist peeling surface. The most common sites are scalp, elbows, and knees, but any part of the skin can be involved. The plaques are usually very persistent without treatment.
Itch is mostly mild but may be severe in some patients, leading to scratching and lichenification characterised by thickened leathery skin and increased skin markings. Painful skin cracks or fissures may occur.
When psoriatic plaques clear up, they may leave brown or pale marks that can be expected to fade over several months.
Be Your Own Best Advocate
According to a study in the Journal of the American Academy of Dermatology, only 3 percent of dermatologists are people of color, which means you may have to educate your health care professional about how important hair care is for you.
Educate yourself, but also learn to educate others, especially the health care community, says Diane. Make them understand that we cant wash our hair every day that its not only the scalp psoriasis that we have to deal with but our different hair types and styles. People honestly dont know.
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How Is Psoriasis Classified
Certain features of psoriasis can be categorised to help determine appropriate investigations and treatment pathways. Overlap may occur.
- Early age of onset < 35 years vs late age of onset > 50 years
- OMIM Online Mendelian Inheritance in Man
- Chularojanamontri L, Griffiths CE, Chalmers RJ. The Simplified Psoriasis Index : a practical tool for assessing psoriasis. J Invest Dermatol. 2013 133:195662. doi: 10.1038/jid.2013.138. PubMed PMID: 23807685.
- Feldman SR, Fleischer AB Jr, Reboussin DM, et al. The self-administered psoriasis area and severity index is valid and reliable. J Invest Dermatol. 1996 106:1836. doi:10.1111/1523-1747.ep12329912PubMed PMID: 8592072.
- Papp K, Gordon K, Thaçi D, et al. Phase 2 trial of selective tyrosine kinase 2 inhibition in psoriasis. N Engl J Med. 2018 379:131321. doi:10.1056/NEJMoa1806382. PubMed
- Fleming P. Tofacitinib: a new oral Janus kinase inhibitor for psoriasis. Br J Dermatol. 2019 180:1314. doi:10.1111/bjd.17323. PubMed