A Elbow and forearm with erythematous, well-demarcated, pink plaques with mild micaceous scale in a 42-year-old White woman.
B Elbow and forearm with violaceous, well-demarcated plaques with micaceous scale and hyperpigmented patches around the active plaques in a 58-year-old Black man.
Epidemiology Psoriasis prevalence in the United States has been estimated at 3.7%.1-3 If broken down by race or ethnicity, the prevalence of psoriasis varies: 2.5% to 3.7% in White adults1-4; 1.3% to 2% in Black adults1-4; 1.6% in Hispanics/ other adults1-3; 1% in children overall; 0.29% in White children1,5; and 0.06% in Black children.1,5
Key clinical features in people with darker skin tones include:
plaques that may appear more violaceous in color instead of pink or erythematous
higher body surface area of involvement4 and thicker, more scaly plaques6
increased likelihood of postinflammatory hyperpigmentation (PIH).
Worth noting Although individuals of all skin tones may experience the psychosocial impact of psoriasis, quality-of-life measures have been found to be worse in those with skin of color (SOC) compared to White patients.1,4 This may be due to the lingering PIH and hypopigmentation that occurs even after inflammatory plaques are treated. Of course, lack of access to care contributes to greater disease burden and more devastating psychological impact.
Health disparity highlight Psoriasis may be underreported and underdiagnosed in individuals with SOC, as factors contributing to health care disparities may play a role, such as access to health care in general,1,7 and access to clinicians proficient in diagnosing cutaneous diseases in SOC may be delayed.8
Biologic medications are used less often in Black patients than in White patients, despite biologic medications being very efficacious for treatment of psoriasis.1,9,10
References
Kaufman BP, Alexis AF. Psoriasis in skin of color: insights into the epidemiology, clinical presentation, genetics, quality-of-life impact, and treatment of psoriasis in non-white racial/ethnic groups. Am J Clin Dermatol. 2018;19:405-423.
Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70:512-516.
Helmick CG, Lee-Han H, Hirsch SC, et al. Prevalence of psoriasis among adults in the U.S.: 2003-2006 and 2009-2010 National Health and Nutrition Examination Surveys. Am J Prev Med. 2014;47:37-45.
Gelfand JM, Stern RS, Nijsten T, et al. The prevalence of psoriasis in African Americans: results from a population-based study. J Am Acad Dermatol. 2005;52:23-26.
Wu JJ, Black MH, Smith N, et al. Low prevalence of psoriasis among children and adolescents in a large multiethnic cohort in southern California. J Am Acad Dermatol. 2011;65:957-964.
Davis SA, Narahari S, Feldman SR, et al. Top dermatologic conditions in patients of color: an analysis of nationally representative data. J Drugs Dermatol. 2012;11:466-473.
Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014;7:16-24.
Mundluru SN, Ramalingam ND, Tran HN. Addressing internal medicine residents’ discomfort with basic dermatology in persons of color in the primary care clinic. Am J Med Qual. 2019;34:513-513.
Kerr GS, Qaiyumi S, Richards J, et al. Psoriasis and psoriatic arthritis in African-American patients—the need to measure disease burden. Clin Rheumatol. 2015;34:1753-1759.
Takeshita J, Gelfand JM, Li P, et al. Psoriasis in the US Medicare population: prevalence, treatment, and factors associated with biologic use. J Invest Dermatol. 2015;135:2955-2963.
A Elbow and forearm with erythematous, well-demarcated, pink plaques with mild micaceous scale in a 42-year-old White woman.
B Elbow and forearm with violaceous, well-demarcated plaques with micaceous scale and hyperpigmented patches around the active plaques in a 58-year-old Black man.
Epidemiology Psoriasis prevalence in the United States has been estimated at 3.7%.1-3 If broken down by race or ethnicity, the prevalence of psoriasis varies: 2.5% to 3.7% in White adults1-4; 1.3% to 2% in Black adults1-4; 1.6% in Hispanics/ other adults1-3; 1% in children overall; 0.29% in White children1,5; and 0.06% in Black children.1,5
Key clinical features in people with darker skin tones include:
plaques that may appear more violaceous in color instead of pink or erythematous
higher body surface area of involvement4 and thicker, more scaly plaques6
increased likelihood of postinflammatory hyperpigmentation (PIH).
Worth noting Although individuals of all skin tones may experience the psychosocial impact of psoriasis, quality-of-life measures have been found to be worse in those with skin of color (SOC) compared to White patients.1,4 This may be due to the lingering PIH and hypopigmentation that occurs even after inflammatory plaques are treated. Of course, lack of access to care contributes to greater disease burden and more devastating psychological impact.
Health disparity highlight Psoriasis may be underreported and underdiagnosed in individuals with SOC, as factors contributing to health care disparities may play a role, such as access to health care in general,1,7 and access to clinicians proficient in diagnosing cutaneous diseases in SOC may be delayed.8
Biologic medications are used less often in Black patients than in White patients, despite biologic medications being very efficacious for treatment of psoriasis.1,9,10
Photographs courtesy of Richard P. Usatine, MD.
The Comparison
A Elbow and forearm with erythematous, well-demarcated, pink plaques with mild micaceous scale in a 42-year-old White woman.
B Elbow and forearm with violaceous, well-demarcated plaques with micaceous scale and hyperpigmented patches around the active plaques in a 58-year-old Black man.
Epidemiology Psoriasis prevalence in the United States has been estimated at 3.7%.1-3 If broken down by race or ethnicity, the prevalence of psoriasis varies: 2.5% to 3.7% in White adults1-4; 1.3% to 2% in Black adults1-4; 1.6% in Hispanics/ other adults1-3; 1% in children overall; 0.29% in White children1,5; and 0.06% in Black children.1,5
Key clinical features in people with darker skin tones include:
plaques that may appear more violaceous in color instead of pink or erythematous
higher body surface area of involvement4 and thicker, more scaly plaques6
increased likelihood of postinflammatory hyperpigmentation (PIH).
Worth noting Although individuals of all skin tones may experience the psychosocial impact of psoriasis, quality-of-life measures have been found to be worse in those with skin of color (SOC) compared to White patients.1,4 This may be due to the lingering PIH and hypopigmentation that occurs even after inflammatory plaques are treated. Of course, lack of access to care contributes to greater disease burden and more devastating psychological impact.
Health disparity highlight Psoriasis may be underreported and underdiagnosed in individuals with SOC, as factors contributing to health care disparities may play a role, such as access to health care in general,1,7 and access to clinicians proficient in diagnosing cutaneous diseases in SOC may be delayed.8
Biologic medications are used less often in Black patients than in White patients, despite biologic medications being very efficacious for treatment of psoriasis.1,9,10
References
Kaufman BP, Alexis AF. Psoriasis in skin of color: insights into the epidemiology, clinical presentation, genetics, quality-of-life impact, and treatment of psoriasis in non-white racial/ethnic groups. Am J Clin Dermatol. 2018;19:405-423.
Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70:512-516.
Helmick CG, Lee-Han H, Hirsch SC, et al. Prevalence of psoriasis among adults in the U.S.: 2003-2006 and 2009-2010 National Health and Nutrition Examination Surveys. Am J Prev Med. 2014;47:37-45.
Gelfand JM, Stern RS, Nijsten T, et al. The prevalence of psoriasis in African Americans: results from a population-based study. J Am Acad Dermatol. 2005;52:23-26.
Wu JJ, Black MH, Smith N, et al. Low prevalence of psoriasis among children and adolescents in a large multiethnic cohort in southern California. J Am Acad Dermatol. 2011;65:957-964.
Davis SA, Narahari S, Feldman SR, et al. Top dermatologic conditions in patients of color: an analysis of nationally representative data. J Drugs Dermatol. 2012;11:466-473.
Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014;7:16-24.
Mundluru SN, Ramalingam ND, Tran HN. Addressing internal medicine residents’ discomfort with basic dermatology in persons of color in the primary care clinic. Am J Med Qual. 2019;34:513-513.
Kerr GS, Qaiyumi S, Richards J, et al. Psoriasis and psoriatic arthritis in African-American patients—the need to measure disease burden. Clin Rheumatol. 2015;34:1753-1759.
Takeshita J, Gelfand JM, Li P, et al. Psoriasis in the US Medicare population: prevalence, treatment, and factors associated with biologic use. J Invest Dermatol. 2015;135:2955-2963.
References
Kaufman BP, Alexis AF. Psoriasis in skin of color: insights into the epidemiology, clinical presentation, genetics, quality-of-life impact, and treatment of psoriasis in non-white racial/ethnic groups. Am J Clin Dermatol. 2018;19:405-423.
Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70:512-516.
Helmick CG, Lee-Han H, Hirsch SC, et al. Prevalence of psoriasis among adults in the U.S.: 2003-2006 and 2009-2010 National Health and Nutrition Examination Surveys. Am J Prev Med. 2014;47:37-45.
Gelfand JM, Stern RS, Nijsten T, et al. The prevalence of psoriasis in African Americans: results from a population-based study. J Am Acad Dermatol. 2005;52:23-26.
Wu JJ, Black MH, Smith N, et al. Low prevalence of psoriasis among children and adolescents in a large multiethnic cohort in southern California. J Am Acad Dermatol. 2011;65:957-964.
Davis SA, Narahari S, Feldman SR, et al. Top dermatologic conditions in patients of color: an analysis of nationally representative data. J Drugs Dermatol. 2012;11:466-473.
Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014;7:16-24.
Mundluru SN, Ramalingam ND, Tran HN. Addressing internal medicine residents’ discomfort with basic dermatology in persons of color in the primary care clinic. Am J Med Qual. 2019;34:513-513.
Kerr GS, Qaiyumi S, Richards J, et al. Psoriasis and psoriatic arthritis in African-American patients—the need to measure disease burden. Clin Rheumatol. 2015;34:1753-1759.
Takeshita J, Gelfand JM, Li P, et al. Psoriasis in the US Medicare population: prevalence, treatment, and factors associated with biologic use. J Invest Dermatol. 2015;135:2955-2963.
A Pink scaling plaques and erythematous erosions in the antecubital fossae of a 6-year-old White boy.
B Violaceous, hyperpigmented, nummular plaques on the back and extensor surface of the right arm of a 16-month-old Black girl.
C Atopic dermatitis and follicular prominence/accentuation on the neck of a young Black girl.
Epidemiology
People of African descent have the highest atopic dermatitis prevalence and severity.
Key clinical features in people with darker skin tones include:
follicular prominence
papular morphology
prurigo nodules
hyperpigmented, violaceous-brown or gray plaques instead of erythematous plaques
lichenification
treatment resistant.1,2
Worth noting
Postinflammatory hyperpigmentation and postinflammatory hypopigmentation may be more distressing to the patient/family than the atopic dermatitis itself.
Health disparity highlight
In the United States, patients with skin of color are more likely to be hospitalized with severe atopic dermatitis, have more substantial out-of-pocket costs, be underinsured, and have an increased number of missed days of work. Limited access to outpatient health care plays a role in exacerbating this health disparity.3,4
References
1. McKenzie C, Silverberg JI. The prevalence and persistence of atopic dermatitis in urban United States children. Ann Allergy Asthma Immunol. 2019;123:173-178.e1. doi:10.1016/j.anai.2019.05.014
2. Kim Y, Bloomberg M, Rifas-Shiman SL, et al. Racial/ethnic differences in incidence and persistence of childhood atopic dermatitis. J Invest Dermatol. 2019;139:827-834. doi:10.1016/j.jid.2018.10.029
3. Narla S, Hsu DY, Thyssen JP, et al. Predictors of hospitalization, length of stay, and costs of care among adult and pediatric inpatients with atopic dermatitis in the United States. Dermatitis. 2018;29:22-31. doi:10.1097/DER.0000000000000323
4. Silverberg JI. Health care utilization, patient costs, and access to care in US adults with eczema. JAMA Dermatol. 2015;151:743-752. doi:10.1001/jamadermatol.2014.5432
A Pink scaling plaques and erythematous erosions in the antecubital fossae of a 6-year-old White boy.
B Violaceous, hyperpigmented, nummular plaques on the back and extensor surface of the right arm of a 16-month-old Black girl.
C Atopic dermatitis and follicular prominence/accentuation on the neck of a young Black girl.
Epidemiology
People of African descent have the highest atopic dermatitis prevalence and severity.
Key clinical features in people with darker skin tones include:
follicular prominence
papular morphology
prurigo nodules
hyperpigmented, violaceous-brown or gray plaques instead of erythematous plaques
lichenification
treatment resistant.1,2
Worth noting
Postinflammatory hyperpigmentation and postinflammatory hypopigmentation may be more distressing to the patient/family than the atopic dermatitis itself.
Health disparity highlight
In the United States, patients with skin of color are more likely to be hospitalized with severe atopic dermatitis, have more substantial out-of-pocket costs, be underinsured, and have an increased number of missed days of work. Limited access to outpatient health care plays a role in exacerbating this health disparity.3,4
THE COMPARISON
A Pink scaling plaques and erythematous erosions in the antecubital fossae of a 6-year-old White boy.
B Violaceous, hyperpigmented, nummular plaques on the back and extensor surface of the right arm of a 16-month-old Black girl.
C Atopic dermatitis and follicular prominence/accentuation on the neck of a young Black girl.
Epidemiology
People of African descent have the highest atopic dermatitis prevalence and severity.
Key clinical features in people with darker skin tones include:
follicular prominence
papular morphology
prurigo nodules
hyperpigmented, violaceous-brown or gray plaques instead of erythematous plaques
lichenification
treatment resistant.1,2
Worth noting
Postinflammatory hyperpigmentation and postinflammatory hypopigmentation may be more distressing to the patient/family than the atopic dermatitis itself.
Health disparity highlight
In the United States, patients with skin of color are more likely to be hospitalized with severe atopic dermatitis, have more substantial out-of-pocket costs, be underinsured, and have an increased number of missed days of work. Limited access to outpatient health care plays a role in exacerbating this health disparity.3,4
References
1. McKenzie C, Silverberg JI. The prevalence and persistence of atopic dermatitis in urban United States children. Ann Allergy Asthma Immunol. 2019;123:173-178.e1. doi:10.1016/j.anai.2019.05.014
2. Kim Y, Bloomberg M, Rifas-Shiman SL, et al. Racial/ethnic differences in incidence and persistence of childhood atopic dermatitis. J Invest Dermatol. 2019;139:827-834. doi:10.1016/j.jid.2018.10.029
3. Narla S, Hsu DY, Thyssen JP, et al. Predictors of hospitalization, length of stay, and costs of care among adult and pediatric inpatients with atopic dermatitis in the United States. Dermatitis. 2018;29:22-31. doi:10.1097/DER.0000000000000323
4. Silverberg JI. Health care utilization, patient costs, and access to care in US adults with eczema. JAMA Dermatol. 2015;151:743-752. doi:10.1001/jamadermatol.2014.5432
References
1. McKenzie C, Silverberg JI. The prevalence and persistence of atopic dermatitis in urban United States children. Ann Allergy Asthma Immunol. 2019;123:173-178.e1. doi:10.1016/j.anai.2019.05.014
2. Kim Y, Bloomberg M, Rifas-Shiman SL, et al. Racial/ethnic differences in incidence and persistence of childhood atopic dermatitis. J Invest Dermatol. 2019;139:827-834. doi:10.1016/j.jid.2018.10.029
3. Narla S, Hsu DY, Thyssen JP, et al. Predictors of hospitalization, length of stay, and costs of care among adult and pediatric inpatients with atopic dermatitis in the United States. Dermatitis. 2018;29:22-31. doi:10.1097/DER.0000000000000323
4. Silverberg JI. Health care utilization, patient costs, and access to care in US adults with eczema. JAMA Dermatol. 2015;151:743-752. doi:10.1001/jamadermatol.2014.5432
A Pink scaling plaques and erythematous erosions in the antecubital fossae of a 6-year-old White boy.
B Violaceous, hyperpigmented, nummular plaques on the back and extensor surface of the right arm of a 16-month-old Black girl.
C Atopic dermatitis and follicular prominence/accentuation on the neck of a young Black girl.
Epidemiology
People of African descent have the highest atopic dermatitis prevalence and severity.
Key clinical features in people with darker skin tones include:
follicular prominence
papular morphology
prurigo nodules
hyperpigmented, violaceous-brown or gray plaques instead of erythematous plaques
lichenification
treatment resistant.1,2
Worth noting Postinflammatory hyperpigmentation and postinflammatory hypopigmentation may be more distressing to the patient/family than the atopic dermatitis itself.
Health disparity highlight In the United States, patients with skin of color are more likely to be hospitalized with severe atopic dermatitis, have more substantial out-ofpocket costs, be underinsured, and have an increased number of missed days of work. Limited access to outpatient health care plays a role in exacerbating this health disparity.3,4
References
McKenzie C, Silverberg JI. The prevalence and persistence of atopic dermatitis in urban United States children. Ann Allergy Asthma Immunol. 2019;123:173-178.e1. doi:10.1016 /j.anai.2019.05.014
Kim Y, Bloomberg M, Rifas-Shiman SL, et al. Racial/ethnic differences in incidence and persistence of childhood atopic dermatitis. J Invest Dermatol. 2019;139:827-834. doi:10.1016 /j.jid.2018.10.029
Narla S, Hsu DY, Thyssen JP, et al. Predictors of hospitalization, length of stay, and costs of care among adult and pediatric inpatients with atopic dermatitis in the United States. Dermatitis. 2018;29:22-31. doi:10.1097/DER.0000000000000323
Silverberg JI. Health care utilization, patient costs, and access to care in US adults with eczema. JAMA Dermatol. 2015;151:743-752. doi:10.1001/jamadermatol.2014.5432
Dr. Candrice R. Heath is from Temple University Hospital Philadelphia, Pennsylvania. Dr. Richard P. Usatine is from the University of Texas Health at San Antonio.
Dr. Candrice R. Heath is from Temple University Hospital Philadelphia, Pennsylvania. Dr. Richard P. Usatine is from the University of Texas Health at San Antonio.
The authors report no conflict of interest.
Author and Disclosure Information
Dr. Candrice R. Heath is from Temple University Hospital Philadelphia, Pennsylvania. Dr. Richard P. Usatine is from the University of Texas Health at San Antonio.
A Pink scaling plaques and erythematous erosions in the antecubital fossae of a 6-year-old White boy.
B Violaceous, hyperpigmented, nummular plaques on the back and extensor surface of the right arm of a 16-month-old Black girl.
C Atopic dermatitis and follicular prominence/accentuation on the neck of a young Black girl.
Epidemiology
People of African descent have the highest atopic dermatitis prevalence and severity.
Key clinical features in people with darker skin tones include:
follicular prominence
papular morphology
prurigo nodules
hyperpigmented, violaceous-brown or gray plaques instead of erythematous plaques
lichenification
treatment resistant.1,2
Worth noting Postinflammatory hyperpigmentation and postinflammatory hypopigmentation may be more distressing to the patient/family than the atopic dermatitis itself.
Health disparity highlight In the United States, patients with skin of color are more likely to be hospitalized with severe atopic dermatitis, have more substantial out-ofpocket costs, be underinsured, and have an increased number of missed days of work. Limited access to outpatient health care plays a role in exacerbating this health disparity.3,4
Photographs courtesy of Richard P. Usatine, MD.
The Comparison
A Pink scaling plaques and erythematous erosions in the antecubital fossae of a 6-year-old White boy.
B Violaceous, hyperpigmented, nummular plaques on the back and extensor surface of the right arm of a 16-month-old Black girl.
C Atopic dermatitis and follicular prominence/accentuation on the neck of a young Black girl.
Epidemiology
People of African descent have the highest atopic dermatitis prevalence and severity.
Key clinical features in people with darker skin tones include:
follicular prominence
papular morphology
prurigo nodules
hyperpigmented, violaceous-brown or gray plaques instead of erythematous plaques
lichenification
treatment resistant.1,2
Worth noting Postinflammatory hyperpigmentation and postinflammatory hypopigmentation may be more distressing to the patient/family than the atopic dermatitis itself.
Health disparity highlight In the United States, patients with skin of color are more likely to be hospitalized with severe atopic dermatitis, have more substantial out-ofpocket costs, be underinsured, and have an increased number of missed days of work. Limited access to outpatient health care plays a role in exacerbating this health disparity.3,4
References
McKenzie C, Silverberg JI. The prevalence and persistence of atopic dermatitis in urban United States children. Ann Allergy Asthma Immunol. 2019;123:173-178.e1. doi:10.1016 /j.anai.2019.05.014
Kim Y, Bloomberg M, Rifas-Shiman SL, et al. Racial/ethnic differences in incidence and persistence of childhood atopic dermatitis. J Invest Dermatol. 2019;139:827-834. doi:10.1016 /j.jid.2018.10.029
Narla S, Hsu DY, Thyssen JP, et al. Predictors of hospitalization, length of stay, and costs of care among adult and pediatric inpatients with atopic dermatitis in the United States. Dermatitis. 2018;29:22-31. doi:10.1097/DER.0000000000000323
Silverberg JI. Health care utilization, patient costs, and access to care in US adults with eczema. JAMA Dermatol. 2015;151:743-752. doi:10.1001/jamadermatol.2014.5432
References
McKenzie C, Silverberg JI. The prevalence and persistence of atopic dermatitis in urban United States children. Ann Allergy Asthma Immunol. 2019;123:173-178.e1. doi:10.1016 /j.anai.2019.05.014
Kim Y, Bloomberg M, Rifas-Shiman SL, et al. Racial/ethnic differences in incidence and persistence of childhood atopic dermatitis. J Invest Dermatol. 2019;139:827-834. doi:10.1016 /j.jid.2018.10.029
Narla S, Hsu DY, Thyssen JP, et al. Predictors of hospitalization, length of stay, and costs of care among adult and pediatric inpatients with atopic dermatitis in the United States. Dermatitis. 2018;29:22-31. doi:10.1097/DER.0000000000000323
Silverberg JI. Health care utilization, patient costs, and access to care in US adults with eczema. JAMA Dermatol. 2015;151:743-752. doi:10.1001/jamadermatol.2014.5432
