Scalp psoriasis in Afro-textured hair
Diagnosis and management can be challenging, and cultural practices must be considered (1,200 words, 6 minutes)
Patients with Afro-textured hair or with darker skin have a greater prevalence of scalp psoriasis, said Dr. Yvette Miller-Monthrope during a presentation at the 8th annual Skin Spectrum Summit. This form of psoriasis also tends to be more severe in these patients, she said.
Dr. Miller-Monthrope is a dermatologist in practice in Toronto and an Assistant Professor at the Department of Medicine, University of Toronto.
Scalp psoriasis is also often misdiagnosed in this population, she said, noting she had managed a patient who had been misdiagnosed for 20 years as having a fungal infection or seborrheic dermatitis instead of psoriasis. She added that psoriasis has also been mistaken for hypertrophic lichen planus in this population.
Follicular psoriasis, while rare, is more common in patients with Black or Brown skin, Dr. Miller-Monthrope said. It can easily be mistaken for atopic dermatitis.
Physicians should ask about and watch for pinpoint bleeding on the scalp where psoriatic plaques may have been removed, Dr. Miller-Monthrope advised.
She noted that it is a cultural practice among many patients with Afro-textured hair to scrape their scalp to remove plaques. However, Dr. Miller-Monthrope said this practice creates an area of irritation and psoriasis may return to the area or worsen.
Dr. Miller-Monthrope said that patients with Afro-textured hair often wash their hair less frequently. Instructing a patient with scalp psoriasis to wash their hair daily with a medicated shampoo could lead to increased dryness and breakage or just noncompliance with treatment. Because of haircare practices and styles, an oil-based therapy may be preferable to patients over therapies that use an alcohol or liquid base, she said.
Bottom line: There is a higher incidence of scalp psoriasis in patients of colour, and rarer variants, such as follicular psoriasis, are more common. Misdiagnosis may delay treatment, and cultural scalp and hair care practices should be considered when advising patients.
From the literature on psoriasis in skin of colour
Efficacy, convenience, and safety of calcipotriene-betamethasone dipropionate cream in skin of colour patients with plaque psoriasis
Researchers conducted a post hoc analysis of phase III clinical trial data to assess the efficacy, convenience, and safety of a calcipotriene/betamethasone dipropionate (CAL/BDP) cream versus CAL/BDP topical solution and vehicle cream in people with Fitzpatrick skin types IV to VI. The data came from a study with 784 participants, 280 (35.7%) of whom had Fitzpatrick skin types IV to VI.
The investigators found that patients treated with CAL/BDP cream had greater disease improvement, treatment convenience scores, and overall satisfaction than those treated with CAL/BDP topical solution in the subgroup with skin types IV to VI and the total study population.
Similar adverse event rates were also between the subgroup with skin types IV to VI and the total study population for all treatment arms. The authors write that the findings of this sub-analysis support the efficacy and safety of CAL/BDP cream in treating plaque psoriasis in patients with skin of colour.
Differential patient travel distance and time to psoriasis clinical trial sites
Considering the disparities in racial representation in psoriasis clinical trials, researchers sought to characterize travel distance and time to reach a psoriasis clinical trial site as a potential barrier to trial participation for multiple demographic and geographic variables.
The investigators used the geographic information system software ArcGIS to determine travel distance and time from every census tract population centre in the United States to the nearest psoriasis clinical trial site. They then linked travel estimates to demographic characteristics in each census tract based on the 2020 American Community Survey.
They found the average distance and time travelled to reach a psoriasis clinical trial site nationally were 45.6 miles and 51.8 min, respectively. Urban and Northeast residents had significantly lower travel distances and time than their counterparts in other regions. Travel burden was substantially more significant among Native American and Black populations, individuals without a college education and Veterans Affairs beneficiaries relative to their peers.
Racial disparities in primary therapy for newly diagnosed psoriasis patients
The objectives of this study were to compare the initial prescription treatments received by different racial groups at Weill Cornell Medicine in New York and examine trends over time.
Researchers collected annual numbers of patients with psoriasis between Jan. 1, 2005, and Dec. 31, 2019. They recorded the initially prescribed treatment (phototherapy, biologics, apremilast, immunosuppressants) and patient demographics. Race was determined by patient self-identification.
Overall, 4,976 White, 478 Asian, and 400 Black newly diagnosed patients received psoriasis treatment over the study period. For initial treatments, patients were prescribed topicals (5,166, 88.2%), immunosuppressants (269, 4.6%), phototherapy (174, 3.0%), biologics (159, 2.7%), or apremilast (59, 1.0%).
When looking at trends, the investigators found that regarding initial treatment, phototherapy usage for psoriasis has decreased across racial groups. Compared to other racial groups, phototherapy and systemic treatments are prescribed more often to Black patients as initial treatment.
Presentations of cutaneous disease in various skin pigmentations: Plaque psoriasis
This article includes images of psoriasis vulgaris in various Fitzpatrick skin types. The authors describe presentations of psoriasis in different skin types and body regions.
Also covered in the article are the demographics of patients with psoriasis in the U.S. and differential diagnoses.
VIDEO: Skin of colour and psoriasis | Andrew Alexis, MD, New York, International Psoriasis Council
At the intersection of skin and society
This year the Skin Spectrum Summit conference* is pleased to announce the launch of the Canadian Skin of Colour & Diversity Scholarship program, supported by Pfizer Canada.
In our shared goal of empowering dermatologists to enhance Canadian healthcare and knowledge, a committee of independent dermatologists will invite applications from dermatology residents nationwide. The aim is to propose novel projects addressing care gaps in skin diseases in underrepresented populations. This includes individuals with deeper skin tones, Indigenous people, and other racialized groups in Canada.
Selected recipients will receive scholarship funds to support the development and implementation of their initiative.
This scholarship aims to create an equitable dermatology environment. It welcomes applications that focus on improving dermatological care for underrepresented populations, including Canadians with deeper skin tones, Indigenous people and other racialized groups.
The application period opens today, July 17, 2023, and ends on Sept. 5, 2023.
More details on the application, review, and selection processes are available at this link:
https://skinofcolourscholarship.com/
This week
July 17 is National Tattoo Day in the U.S.
July 18 is Nelson Mandela International Day
July 18 is Black Leaders Awareness Day
Something to think about in the week ahead…
Charles Eames, U.S. designer, 1907 to 1978
Next week
In an episode of the What’s Health Got To Do With It? podcast, dermatologists Dr. Andrew F. Alexis, president of the Skin of Color Society, and Dr. Valerie Harvey, director of the Hampton Roads Center for Dermatology in Virginia and a former president of the Skin of Color Society, detail the factors that increase the risk of skin cancer in people with darker skin tones.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper print providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
A review of advances in cosmetic dermatology with Drs. Monica Li (Vancouver), Jessica Asgarpour (Toronto), Jason Rivers (Vancouver), and Andrei Metelitsa (Calgary).
Drs. Andrei Metelitsa (Calgary), Charles Lynde (Markham, Ont.) and Irina Turchin (Halifax) discuss new treatments for plaque psoriasis.
An essay from Dr. Shakira Brathwaite (Toronto) submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Brathwaite wrote on the need for health systems to “see colour” and recognize the differences in needs and challenges dermatology patients with different skin types experience.
Plus regular features, including the popular column “Vender on Psoriasis” by Hamilton, Ont. dermatologist Dr. Ron Vender
Read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary* subscription or to receive a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.
Season two of the Shear Listening Pleasure podcast with Dr. Neil Shear has launched. Listen to the eighth episode here, where Dr. Shear speaks with dermatologist Dr. Sonja Molin (Kingston, Ont.) about allergology, patch testing, and the growth of Queen’s University’s dermatology division.
And if you’re looking for a web destination for all things derm, please visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.