Psoriasis

Dr Catherine Fernando

IYASU Healthcare

East Lothian's Private GP Service

Explains what you should know about psoriasis in all skin types. 

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Psoriasis is a long-term condition where the immune system becomes overactive and causes patches of thick, dry, scaly skin. It affects people of all races, but it can look different and be harder to diagnose in people with darker skin tones. This sometimes leads to delays in getting the right treatment and support.

Here are 10 things that people with skin of colour should know about psoriasis.

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1. Psoriasis is Often Missed in People with Darker Skin

Psoriasis is diagnosed more often in White people, but this doesn’t mean others don’t get it. Instead, it is more likely to be underdiagnosed because:

• it can look different on darker skin

• not everyone has equal access to healthcare

• medical training often shows skin conditions only on lighter skin

• patient information may not reflect diverse skin tones

If you feel something is wrong with your skin, it’s important to seek advice—even if you’ve been told “people like you don’t get psoriasis.”

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2. Psoriasis Can Look Different on Darker Skin

The most common type of psoriasis causes raised, scaly patches called plaques. On darker skin, these patches may look:

• brown, purple, or dark red

• thicker and more scaly

• less red than on lighter skin

Some people may also experience:

• more itching

• scalp involvement (especially common in Black and Asian patients)

• lighter or darker marks left behind after the rash settles

Natural skin colour in body folds (like the armpits or groin) may hide psoriasis, making it harder to spot.

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3. Other Skin Conditions Can Look Similar

Psoriasis may be confused with:

• eczema

• seborrhoeic dermatitis (a flaky scalp condition)

• lichen planus

• lupus

• sarcoidosis

In darker skin, these conditions can look especially alike. Sometimes a skin biopsy is needed to confirm the diagnosis.

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4. People With Skin of Colour May Face Healthcare Barriers

Some people delay seeking help because of:

• stigma or embarrassment

• cultural beliefs (e.g., “Black people can’t get psoriasis”)

• distrust of medical services

• cost, time off work, or lack of insurance (in some countries)

These challenges can affect both diagnosis and treatment. No one should feel dismissed—your symptoms deserve attention.

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5. Medical Training Has Not Always Included Darker Skin

Doctors have historically learned about skin conditions using pictures of mainly White skin, which makes diagnosis in darker skin harder.

Positive changes are happening, including:

• more educational resources featuring diverse skin tones

• new training programmes focused on skin of colour

But there is still more work to do, so speaking up about your concerns is important.

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6. Patient Information Needs to Be Easier to Understand

Resources about psoriasis in darker skin are improving, but:

• many websites are written at a very high reading level

• information may not feel relevant or inclusive

Reliable places to learn more include:

• the National Psoriasis Foundation’s Skin of Color resources

• the Skin of Colour Society’s patient information

Your healthcare team can also provide leaflets that are easier to understand.

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7. Cultural Practices Can Affect the Skin

Some traditional or cultural skin and hair practices can irritate the skin and trigger psoriasis patches, including:

• cupping

• coining / gua sha

• moxibustion

• threading, shaving, or waxing

• certain hairstyles that pull on the scalp

These can cause skin trauma, which may lead to new psoriasis patches (called the Koebner phenomenon).

However, some practices can help—for example, many Black individuals use moisturisers regularly to prevent dryness, which also benefits psoriasis.

Always let your doctor know about any products or remedies you use. Some herbal treatments may interfere with medicines.

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8. Psoriasis Can Strongly Affect Emotional Wellbeing

Psoriasis affects more than the skin—it can impact:

• confidence and self-esteem

• social and work life

• anxiety and depression

People with skin of colour may be especially affected because:

• changes in skin colour (light or dark patches) can be upsetting and long-lasting

• stress may trigger flares more often in some ethnic groups

If psoriasis affects your mental health, speak to your GP—support is available.

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9. Research Often Does Not Include People With Darker Skin

Most clinical trials for psoriasis have mostly White participants. This means:

• treatments are not always tested on darker skin

• some scoring systems underestimate severity (especially those based on redness)

More inclusive research is needed so that treatments work well for everyone.

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10. Treatment May Need to Be Individualised

Scalp psoriasis can be harder to treat in people with textured hair or specific styling practices. Your doctor should consider:

• how often you wash your hair

• chemical treatments (relaxers, dyes)

• braids, weaves, or head coverings

Phototherapy (light treatment) can help, but:

• higher doses may be needed

• darker skin may experience temporary darkening

Systemic treatments (tablets or injections) may be started earlier to prevent long-term skin colour changes and improve quality of life. Unfortunately, people with skin of colour are less likely to receive these treatments, but they should be offered when appropriate.

 

In Summary

Psoriasis affects people of all skin tones, but in darker skin it may:

• look different

• be harder to diagnose

• cause more emotional impact

• lead to delays in treatment

If you suspect psoriasis:

• seek medical advice early

• ask for a referral to dermatology if needed

• discuss how your culture and lifestyle affect your skin

• speak up if you feel unheard—your concerns are valid

 

Everyone deserves access to accurate diagnosis, supportive care, and effective treatment. If you are struggling with psoriasis, make an appointment to see Dr Catherine Fernando at IYASU Healthcare.