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)

Skin Spectrum Weekly is proud to announce the first dermatology conference of its kind. The Indigenous Skin Spectrum Summit is a special session of Skin Spectrum Summit that will be held on March 18 and 20, addressing specific treatment needs of Canada's Indigeous community. Click here to learn more and register.

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.” 

Leave a comment

FROM THE LITERATURE ON PSORIASIS IN SKIN OF COLOUR

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

AT THE INTERSECTION OF SKIN AND SOCIETY

This Week

Something to think about during the week ahead…

Next Week

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.

You are receiving this newsletter because you are a subscriber to The Chronicle of Skin & Allergy or other Chronicle journal, have attended a Skin Spectrum Summit live event or webinar, or have previously requested a subscription to one of our newsletters. If you no longer wish to subscribe to this newsletter, please send an email with the subject line “Unsubscribe Skin Spectrum Weekly” to health@chronicle.org
Skin Spectrum Weekly is published by Chronicle Companies, 701 Ellicott Street, Buffalo, NY 14203. Canada: 555 Burnhamthorpe Road, Suite 306, Toronto, Ont. M9C 2Y3
Mitchell Shannon, Publisher; R. Allan Ryan, Editorial Director; Cory Perla, Managing Editor; John Evans, Dhiren Mahiban, Kylie Rebernik, Jeremy Visser, Editors; Nick Antoniadis, Business Development; Catherine Dusome, Operations Manager, Peggy Ahearn, Consultant
Content is copyright (c) 2020, Chronicle LifeSci America Corp, except as indicated. Interested in contributing to this newsletter or in learning more about Chronicle’s services? Write to us at info@skinspectrum.us