Clearing of psoriasis plaques may not mean the end of treatment for patients with skin of colour

Dr. Andrew Alexis on why it is important for a dermatologist to get the Dx right the first time -- and take into account cultural and aesthetic concerns, as well (800 words, 3.5 min)

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In a presentation on psoriasis in pigmented skin delivered at Skin Spectrum Summit in Montreal, Dr. Andrew F. Alexis asked his audience to keep an open mind while diagnosing the skin disorder and to take into account the patient’s concerns about hyperpigmentation. 

“You need to really look head to toe at the patient and, if it just does not fit, have a low threshold for biopsy,” he said while referring to a patient with sarcoidosis, which he called “one of the great imitators” of psoriasis in darker-skinned patients. 

The quality of life impact of psoriasis can be greater in people with skin of colour, he said, which makes it even more important for a dermatologist to get the diagnosis right the first time and take into account some cultural and aesthetic concerns as well. Dr. Alexis explained why the quality of life may be greatly impaired in patients with skin of colour. 

“It is probably that the associated pigmentary alterations contribute to a greater quality of life impact,” he said.

Some cultural aspects to perceiving the disease may also play a role, he explained. To demonstrate this, he showed an example of a patient whose psoriatic scaling had improved with treatment, along with redness and other symptoms, but who was left with hyperpigmented patches on her legs. 

“In a research study, she might be considered a treatment success, but in real life, she doesn’t think the treatment is even working because functionally she still can’t comfortably expose her skin.” 

He said that clearing up both plaques and pigment alteration can become part of the treatment in darker-skinned patients. This persistent pigment alteration may lead to a much longer treatment period for patients with skin of colour. 

He stated that after clearing psoriasis, he would start working on topical bleaching agents' hyperpigmentation. Dr. Alexis said psoriasis treatment data collections for skin of colour patients are quite limited. 

“When you look at all of the studies, there is one consistent theme: the demographics hover around 90 per cent Caucasians.” 

For this reason, there is less data for patients with skin of colour. Dr. Alexis said he has worked with existing data and has not found any safety or efficacy differences in any psoriasis treatments. 

The takeaway: Regarding his clinical impression of treating hyperpigmentation before it becomes a problem, Dr. Alexis said this: “Early and appropriately aggressive treatment might reduce the impact of the severity and duration of hyperpigmentation.” 

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Successful management of a Black male with psoriasis and dyspigmentation treated with halobetasol propionate 0.01%/tazarotene 0.045% lotion: case report

  • In a case report, Dr. Andrew Alexis, Dr. Seemal Desai, and Dr. Abby Jacobson successfully managed the treatment of a Black male with 50% body surface area psoriasis using a combination of halobetasol propionate and tazarotene lotion. The authors indicated that this combination therapy seems to be promising for patients with skin of colour, who they said are disproportionally affected by postinflammatory dyspigmentation. 

    From "J Drugs Dermatol."

Dermoscopic characterization of guttate psoriasis, pityriasis rosea, and pityriasis lichenoides chronica in dark skin phototypes: An observational study

  • In recent observational study looked at the characteristic colours of skin conditions including guttate psoriasis in patients with dark skin phototypes. They found that for patients with dark skin and guttate psoriasis, the most prominent scale colour was white-gray. 

    From “Dermatologic Therapy”

Psoriasis in patients of colour: Differences in morphology, clinical presentation, and treatment: A review of etiology, prevention, and treatment

  • Patients with skin of colour show “key differences” in psoriasis presentation, according to a recent case report. The researchers said that by recognizing these differences, medical professionals can help patients with skin of colour access better medical attention sooner. 

    From "Cutis"

VIDEO: Telemedicine may be as effective as in-person therapy for psoriasis


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Research has shown that rosacea in people with skin of colour can be easily missed, according to the American Academy of Dermatology. Although there is no lab test to diagnose rosacea, there are several treatment options, according to Dr. Kevin Pehr.

Thank you to our panellists and delegates for making Skin Spectrum Summit 2020 a great success. Conference highlights will soon be posted to the Skin Spectrum website. As always, we welcome your questions and comments on topics in Ethnodermatology.

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