Psoriasis in Black People: Symptoms and Management Options

Psoriasis is one common skin condition that you've probably heard of before.

Psoriasis symptoms include thick, scaly patches of skin and an itchy or burning sensation, which can lead to poorer quality sleep at night.

Around 2-3% of the world's population is estimated to have psoriasis [1].

Previously, research suggests that this skin condition may be less common in people with darker skin than those with lighter skin.

However, more recent findings point toward a higher prevalence than initially reported. That's because psoriasis tends to be under-reported and underdiagnosed in black people [2].

But why is this the case?

One possible reason is that psoriasis may be harder to recognize on darker skin. Thus, people with darker skin tones are less likely to seek and receive a diagnosis or treatment for their symptoms.

In this article, we'll explore how psoriasis lesions may appear differently on darker skin. We'll also discuss common psoriasis triggers, compare its symptoms to those of similar skin conditions, and dive deeper into different treatment options.

Table of Contents: 

• What Does Psoriasis Look Like on Dark Skin?
• Understanding the Different Types of Psoriasis in Black People
• What Causes Psoriasis Symptoms?
• Differentiating Psoriasis From Other Skin Conditions
• Psoriasis vs. Eczema
• Psoriasis vs. Seborrheic Dermatitis
• Scalp Psoriasis on Black Skin
• How to Relieve Psoriasis Affecting Darker Skin
• What if I Have Eczema Instead?
• The Calming Seborrheic Serum

What Does Psoriasis Look Like on Dark Skin?

Before we unpack the differences based on skin tones, let's first explore the general symptoms of psoriasis.

Psoriasis can lead to the following symptoms: [3]

• Patches of raised skin with silvery-white scales

• Red and inflamed skin

• Flakiness in affected skin areas

• Itching or burning

• Skin dryness

• Cracked and pitted nails

Psoriasis tends to affect the knees, scalp, elbows, palms, soles of the feet, and trunk.

It can also lead to joint pain, which is known as psoriatic arthritis. Psoriasis is the greatest risk factor for developing psoriatic arthritis, which can cause inflammation, swelling, and pain in the joints.

On dark brown or black skin, you may notice these differences in symptoms of psoriasis: [2]

• Skin discoloration, which includes the hyperpigmentation (darkening) and hypopigmentation (lightening) of the skin

• Less obvious redness or inflammation, which may instead appear more purplish than red

• Thicker plaques affecting a larger area of the skin

A doctor or dermatologist can provide advice if you're unsure about the cause of your symptoms.

It's always best to get the condition attended to early, as research suggests that psoriasis can affect your mental health. Some mental health conditions that psoriasis is strongly related to include depression and anxiety [3].

Understanding the Different Types of Psoriasis in Black People

Each type of psoriasis has different symptoms and treatment options. It's important to pinpoint exactly which type of psoriasis is causing your symptoms so that you can get the most effective treatment.

According to the National Psoriasis Foundation, the different types of psoriasis include:

• Pustular psoriasis: One characteristic symptom of pustular psoriasis is the appearance of whitish or yellowish, pus-filled, and painful bumps. This type of psoriasis can either be localized and appear on a specific area of the skin or can be widespread and affect a large area of the body [4].

• Plaque psoriasis: This is the most common type of psoriasis. It leads to dry, scaly, and raised areas of the skin that can also be itchy or painful.

• Guttate psoriasis: This is a skin condition where small, round, and red spots appear on the body. These scaly patches look like raindrops scattered around the affected area.

• Inverse psoriasis: Inverse psoriasis causes rashes in areas where the skin rubs against itself. Examples include your armpits, groin, under the breasts, and other skin folds.

• Erythrodermic Psoriasis: This is a rarer kind of psoriasis that can cause red, scaly rashes to appear all over the body. It can lead to dehydration and disrupt the body's ability to control temperature, which could become life-threatening.

The type of psoriasis and its severity will determine what treatment is required.

What Causes Psoriasis Symptoms?

Psoriasis is a skin condition caused by an overactive immune system. Your immune cells begin to attack healthy skin cells, which causes your body to produce skin cells quicker than normal [4].

These extra skin cells then build up on the surface of your skin, leading to flaky, inflamed, and itchy psoriasis plaques.

Research suggests that psoriasis is likely to run in families, with a heritability of 60-90% [4]. This means that if you have a close family member with the condition, you also run a higher risk of developing it yourself.

Differentiating Psoriasis From Other Skin Conditions

Psoriasis can sometimes be tricky to tell apart from other common skin conditions, especially in people with dark skin tones. Let's explore the differences between psoriasis and other skin conditions with similar symptoms.

Psoriasis vs. Eczema

There are different types of eczema, but the most common is atopic dermatitis. This form of eczema can cause itchy, flaky, scaly, and dry skin. It can also cause purplish patches and hyper- and hypopigmentation of the skin for people with darker skin tones. Though psoriasis and eczema share some similar symptoms, there are ways to differentiate the two.

Firstly, the plaques caused by psoriasis tend to be thicker and more raised than the patches caused by eczema. Atopic eczema is more likely to cause intense itchiness. While psoriasis may also be itchy, it's often described as more of a stinging or burning sensation.

Apart from that, they also appear in different parts of the body. Eczema more often affects the inner bends of the body, like the inner elbow or inner knee. It can also appear on the face and hands. On the other hand, psoriasis tends to show up on the outer bends of the elbow and knees, as well as the scalp, face, palms, and soles.

Psoriasis vs. Seborrheic Dermatitis

Seborrheic dermatitis causes the formation of itchy, scaly, and inflamed patches. It commonly affects the scalp but can also be seen in areas of the body with a high density of sebaceous glands, which include the face or back. Seborrheic dermatitis can also lead to hyperpigmentation on black or brown skin.

Psoriasis typically leads to thicker plaques that extend further beyond the hairline compared to seborrheic dermatitis. While seborrheic dermatitis can affect different parts of the body, it is most often seen on the scalp and face. Meanwhile, if you have scalp psoriasis, you will likely find psoriasis symptoms in other areas, such as the outer bends of your elbows and knees. You might also notice cracked and pitted nails or joint pain.

Now that you can recognize the differences between psoriasis and other common skin conditions, you can better decide what step to take next to manage the most likely cause of your symptoms.

Scalp Psoriasis on Black Skin

Research suggests psoriasis can be made worse by a fungus called Malassezia [5]. This fungus typically resides on your skin without causing much trouble. This fungus feeds on the natural oils your skin glands release, known as sebum.

According to research, a change in the population of various Malassezia species can aggravate symptoms. The fungus releases enzymes known as lipases that break down the sebum and oils on your skin. These enzymes can break down and disrupt your skin's natural barrier [6]. Malassezia also produces a protein known as interleukin, which plays a prominent role in the inflammation and immune response in psoriasis [7].

This is why many people are experiencing relief from their scalp psoriasis with the Calming Seborrheic Serum and MCT Scalp Moisturizer.

The Calming Seborrheic Serum uses a three-step process to soothe scalp psoriasis symptoms. It contains ingredients that target Malassezia's natural barrier, known as the biofilm. At the same time, the serum's antifungal agents help clear away the fungus, while other soothing and hydrating ingredients nourish the skin.

The MCT Scalp Moisturizer also contains antifungal agents that help target Malassezia. It keeps your scalp and skin well-hydrated and moisturized, preventing your skin from overproducing sebum. This sebum serves as food and fuel for the fungus, so controlling its production can help soothe psoriasis symptoms.

How to Relieve Psoriasis Affecting Darker Skin 

Psoriasis cannot be cured. However, its symptoms can be managed with medications, natural remedies, and lifestyle changes.

Psoriasis affecting darker skin is treated similarly to psoriasis affecting lighter skin. No matter your skin color, these are options that you can consider to improve your symptoms.

Medications

Psoriasis medications include ointments, creams, oral medications, and injections. In less severe cases, your doctor may recommend topical creams containing corticosteroids [4].

However, if you have more severe symptoms, you may be given corticosteroid injections, retinoid pills, or light therapy [4].

Research shows that African Americans may have more brittle and fragile hair with less tensile strength. So, if psoriasis affects the scalp area, extra care must be given when picking a suitable treatment. For instance, a daily medicated shampoo may not be suitable, as it can further dry out the hair and increase breakage. Instead, a weekly medicated shampoo combined with a daily corticosteroid cream might be a better management option as it may be less likely to affect hair texture [4].

Natural Remedies

Some natural remedies for psoriasis include the following:

• Aloe vera: Aloe vera creams or gels can be applied to the affected areas. This is said to help reduce inflammation and scaling as well as increase the hydration of the skin.

• Apple cider vinegar: You can dilute apple cider with water and apply it to help calm the itch and burning sensation. However, be careful not to apply it to broken skin or open wounds.

• Salt bath: Bathing in Epsom salt mixed with warm water can help soothe itchiness and inflammation and reduce the scales on your skin. After bathing, be sure to moisturize your skin to prevent it from drying out.

• Tea tree oil: Known for its antifungal, antibacterial, and anti-inflammatory properties, tea tree oil is a common remedy for various skin conditions, including psoriasis. Be careful not to use undiluted tea tree oil on your skin, as this can increase the risk of skin burns and irritation. You'll have to first dilute it with water or a carrier oil before applying it to your skin.

• Colloidal oatmeal: You can bathe in colloidal oatmeal or use it as a wet dressing on the affected areas of your skin. You might find that it helps to reduce itch and inflammation.

Before using any of these natural remedies on your skin, it's important to perform a skin patch test. You'll apply a smaller amount of product to your skin and leave it on for a couple of hours to a day to see if it leads to signs of an allergy or skin irritation.

Lifestyle Changes

There are certain lifestyle changes that you can start making today to improve your symptoms.

These include:

• Eating a healthier diet

• Including exercise in your routine

• Reducing your alcohol intake

• Quitting smoking

• Maintaining a healthy weight

• Practicing self-care and stress management techniques

Of course, these lifestyle changes aren't the easiest to implement and maintain for the long haul. You can start by picking one or two of the above and finding ways to incorporate related good habits into your day-to-day.

What if I Have Eczema Instead? 

Treatment for psoriasis and eczema can share similarities, but it depends on the type of eczema you're experiencing.

If you have atopic dermatitis, moisturizers and anti-itch creams can help combat symptoms. However, if you have seborrheic dermatitis, antifungal medications or natural remedies with antifungal properties will be your best bet.

The Calming Seborrheic Serum offers another solution to relieving seborrheic dermatitis symptoms. It uses the same three-step process to clear away Malassezia and soothe itching, inflammation, and flakiness of the skin.

The Calming Seborrheic Serum

This dermatologist-recommended formulation is suitable for scalp psoriasis and seborrheic dermatitis. It can help target the fungus responsible for causing or worsening symptoms. The best part is that the serum does not contain parabens, sulfates, fragrances, or hard-to-pronounce chemicals.

The Calming Seborrheic Serum can also soothe psoriasis as it helps combat the Malassezia fungus while nourishing and hydrating the skin.