Psoriasis in skin-of-colour patients: New Canadian consensus report released
Delphi process produces consensus on terminology, clinical management optimization for guiding treatment in patients with skin of colour (Issue #238,1,600 words, 8 minutes)
A group of 16 Canadian dermatologists have developed a Delphi consensus defining skin of colour (SOC) terminology and addressing the need to optimize the clinical management of psoriasis in patients with SOC. The group hopes their consensus will provide valuable guidance to the dermatology community treating these patients.
The process and consensus are detailed in an open-access paper published in the Journal of the American Academy of Dermatology International (April 2025; 19:12-20).
The team, led by Dr. Geeta Yadav (Toronto), also included Drs. Yvette Miller-Monthrope (Toronto), Jaggi Rao (Edmonton), David Adam (Ajax, Ont.), Rachel Asiniwasis (Regina), Parbeer Grewal (Edmonton), Christina Han (Vancouver), Marissa Joseph (Toronto), Richard Langley (Halifax), Charles Lynde (Markham, Ont.), Andrei Metelitsa (Calgary), Loukia Mitsos (Montreal), Boluwaji Ogunyemi (St. John’s, NL), Kerri Purdy (Halifax), and Maxwell Sauder (Toronto).
The team used a modified Delphi methodology. Four core faculty members drove the study's content, and 12 additional panel members consulted to vote and provide consensus on the content produced by the core faculty. The panel revised and voted on the final consensus statements at the last meeting.
The exercise resulted in 11 consensus statements on SOC terminology and five primary and four secondary statements on clinical presentation, differential diagnosis, and treatment guidelines based on evidence and expert opinion. Four additional consensus statements on current assessment tools and access to care were developed based solely on expert opinion.
Their final consensus statements on clinical presentation, differential diagnosis, and guiding principles of treatment are:
1. Special considerations are needed when assessing psoriasis in patients with skin of colour, as the clinical presentation may be different from that of White skin.
2. The scalp is a challenging site to treat. Hair texture, care patterns, hair washing frequency, head coverings, and patient preferences should be considered when developing a management plan to treat scalp psoriasis.
3. Pigmentary alteration disproportionately impacts patients with skin of colour and may negatively affect quality of life.
4. Pigmentary alteration should be considered in the management of psoriasis:
A) Consideration should be given when prescribing topical therapies in patients with skin of colour as these therapies may contribute to pigmentary alteration.
B) Phototherapy in individuals with skin of colour may temporarily darken the skin, which may not be acceptable for some patients.
C) Early initiation of systemic therapies should be considered, when appropriate, in patients with skin of colour to minimize the sequelae of disease-related pigmentary alteration.
D) Proper education, counselling, additional studies, and treatment guidelines are needed to prevent and manage dyspigmentation.
5. There is limited evidence that the efficacy of systemic therapies varies in different populations, including skin of colour. More research is required.
Bottom line: A new consensus statement developed by a team of Canadian dermatologists defines key SOC terminology and may support optimizing the clinical management of psoriasis in patients with SOC. The consensus developers hope their work will provide valuable guidance to the dermatology community treating these patients.
From the literature on psoriasis in skin of colour
Racial disparities in length of hospitalization and systemic medication utilization in patients with psoriasis
Researchers examined the impact of race on hospitalization duration and systemic medication prescription patterns in patients with psoriasis in the United States in 2020. They used the 2020 Healthcare Cost and Utilization (HCUP) National Inpatient Sample (NIS) database, including inpatient admissions older than 17 with an ICD-10-coded psoriasis diagnosis.
The investigators compared patient demographics and hospital characteristics between “non-White” and “White” patients, with White patients as the reference group. Using logistic regression models, they evaluated the primary outcome, systemic medication prescription, producing an odds ratio and corresponding 95% confidence interval (CI). Their secondary outcome was the length of stay. In total, the researchers included 1,802,720 patients with psoriasis in this study.
Hispanic, Asian or Pacific Islander, and Native American patients with psoriasis had significantly lower odds of systemic medication prescription than White patients with psoriasis. The authors found all non-white racial identities had significantly longer estimated lengths of stay compared to White patients with psoriasis. Disparities in the medication of choice for psoriasis treatment can lead to increased inpatient burden with longer lengths of stay for non-White patients.
Celebrating diversity: Unveiling the characteristics of nail psoriasis and nail lichen planus in 30 patients with skin of colour
This paper describes the ungual manifestations of nail psoriasis (NPso) and nail lichen planus (NLP) in 30 patients with skin of colour (SOC). Each patient’s diagnosis was primarily based on clinical examination. When there was diagnostic uncertainty, physicians performed a nail matrix biopsy to obtain conclusive histologic evidence.
Among the participants were 24 patients with NPso, who had a median Fitzpatrick phototype of 4.77, and six patients with NLP and a median Fitzpatrick phototype of 5. Regarding the 24 patients with NPso, 10 presented with trachyonychia, nine displayed nail pitting, eight showed onycholysis, and 12 had subungual hyperkeratosis. In comparison, splinter hemorrhages were visible in two patients, and activation melanonychia was discernible on the nail plates of eight patients. Of the six patients diagnosed with NLP, all had post-inflammatory pigmentation on the proximal nail, with three patients exhibiting trachyonychia and three others having longitudinal fissures; subungual hyperkeratosis was found in five patients, while three patients displayed activated melanonychia.
The authors conclude that people with SoC exhibit a peculiar clinical presentation of both NPso and NLP, and a better understanding is essential to providing timely and effective care.
A descriptive, post-hoc analysis of efficacy and safety of risankizumab in diverse racial and ethnic patient populations with moderate-to-severe psoriasis
Researchers assessed the efficacy and safety of risankizumab in patients with moderate-to-severe plaque psoriasis by race and ethnicity in the open-label extension LIMMitless study.
The patients received continuous treatment with 150 mg risankizumab through their initial trial and the open-label extension. They self-identified their race and ethnicity. Researchers assessed efficacy using the Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI) and reported safety by events per 100 patient-years.
Investigators included 897 patients in their analysis (race: 662 White, 196 Asian, 25 Black or African American, 14 Other; ethnicity: 98 Hispanic or Latino, 799 non-Hispanic or Latino).
Compared to the baseline, patients had a mean percent reduction in PASI between 94.6% (Asian) and 99.3% (Black or African American). They reported mean percent improvements in DLQI ranging from 87.1% (Asian and Black or African American) to 93.7% (Hispanic or Latino) at week 100.
“While the data presented here comprise a small retrospective descriptive analysis and cannot detect statistical differences, efficacy of risankizumab for the treatment of moderate-to-severe plaque psoriasis appears similar across the racial and ethnic groups studied and no new safety signals were detected,” the authors conclude.
VIDEO: Unmet needs for people of colour with psoriasis and new guidance for diversity within clinical trials
In a webinar from the Psoriasis and Psoriatic Arthritis Hub’s Clinical Trial Club, Paolo Gisondi, MD, a dermatologist at the University Hospital of Verona, discusses the unmet needs of people of colour with psoriatic disease. Dr. Gisondi also spoke about multiple methods to increase diversity in clinical research that could be implemented to improve health equity.
At the intersection of skin and society
Child welfare advocates in Ontario are stressing the need for more education about Black hair care and access to the necessary products, reports CBC News.
That advocacy comes as the province's children's aid societies struggle to find foster parents from diverse cultural backgrounds. This shortage has a particular impact on Black children, who are overrepresented in the provincial child welfare system.
Culturally-relevant knowledge is crucial to care for Black children, said Roger Dilworth, director of children and youth care at Toronto’s Catholic Children Aid Society (CCAS). Black children represent roughly 40% of foster kids managed by the CCAS.
“Black hair care is very important for young people because it is tied to their self-cultural identity, self-esteem and even a sense of belonging to the Black community, and that is important,” Dilworth told CBC Toronto.
However, Dilworth said many Black children end up in the care of white families who may live in rural areas due to a shortage of Black foster parents—regions where there may not be suitable access to products for Black hair care.
The news outlet also interviewed Susanne Curry, a former foster mother, who moved from the island of Grenada to Ontario’s Blue Mountain region with her adopted daughter Hope.
“My biggest concern, especially in the Blue Mountain area, was who was going to help me with my daughter's hair?” said Curry. She said she had these concerns despite living in the Caribbean for 20 years, and learned some details about caring for Black hair from women who worked at the daycare she owned in the region.
“It can be very challenging as a white person because we're not born and raised working with Black hair,” she said. “Once you understand that Black hair—it's not just hair—it carries history and culture and pride, then you just learn to have patience and care.”
Natural Kids Movement, a non-profit created by Takiyah Wedderburn, is working to provide education, tools, and care products to foster families that are taking care of Black children. The organization offers workshops and care baskets.
“There was a lot of anxiety and stress around styling the child's hair on a daily or weekly basis,” Wedderburn told the CBC. She noted that Black hair products may be more expensive, potentially straining family budgets.
She said in some instances, families have resorted to cutting off their foster child's hair, which can be traumatizing.
Wedderburn said that the Natural Kids Movement educational programs can help Black youth gain the confidence necessary to thrive once they leave the foster system.
This week
March 19 is National Certified Nurses Day in the U.S.
March 21 is the first day of the Week of Solidarity Against Racism and Racial Discrimination
March 22 is National Health Care Rights Day in the U.S.
Something to think about in the week ahead . . .
—Roger Babson (1875-1967), U.S. economist and founder of Babson and Webber Colleges
Next week
A new narrative review highlights genetic features and clinical features of acral melanoma as well as the need for targeted interventions to address racial and ethnic disparities in outcomes.
Just three weeks away: Register now for Indigenous Skin Spectrum Global Summit
Less than three weeks remain until the first Indigenous Skin Spectrum Global Summit, which will be held in Montreal on April 5, 2025.
The summit will allow attendees to learn more about the unique dermatologic challenges facing Indigenous, rural, and circumpolar populations worldwide. Experts worldwide will provide insights on how physicians can support equitable health for these populations.
Summit chair Dr. Rachel Asiniwasis (Regina) leads a world-renowned faculty for this historic meeting.
Two confirmed presentations for the meeting include:
Montreal-based Dr. Ivan Litvinov’s discussion will explore clinical presentations in Indigenous Peoples and when to consider testing for HTLV-1-associated dermatitis. Dr. Litvinov is the Director and Chair of the Division of Dermatology for the Faculty of Medicine and Health Sciences at McGill University.
Dr. Megan MacGillivray will present case examples of pigmented basal cell carcinoma and the importance of dermoscopy in detecting this cancer.
In Barrie, Ont., Dr. MacGillivray’s practice strongly focuses on Indigenous Health, including travelling to First Nations communities and offering teledermatology. She is the lead physician for the Skin Cancer Biopsy Clinic at the Royal Victoria Regional Hospital.
More details on the Global Summit are at this link.
If you enjoy Skin Spectrum Weekly, why not check out the Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Drs. Ilya Shoimer (Calgary), Michael Stevens (Bedford, NS.), and Mark Lupin (Victoria, BC) discuss the current strategies for managing actinic keratoses, including identifying the risk of progression to squamous cell carcinoma.
Dr. Irina Turchin (Fredericton, NB) describes findings from recent research on the safety and efficacy of topical roflumilast 0.3% in treating psoriasis.
Drs. Yuka Asai (Kingston, Ont.), Benjamin Barankin (Toronto), Fiona Lovegrove (London, Ont.), and Sam Hanna (Toronto) review some of the significant dermatologic treatment approvals of 2024.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender.
You can read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary subscription or to request a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.