Psoriasis on Black and Brown Skin Tones (With Images)

Psoriasis is a skin condition caused by your immune system. It affects more than 8 million people in the U.S. People of all races and ethnicities can get psoriasis. But it doesn’t look the same in everyone. 

Psoriasis can affect the skin of Black people and other people of color differently, making it harder to get the right diagnosis. One reason for this is that skin conditions affecting Black people are underrepresented in medical textbooks and public resources. 

If you want to learn more about psoriasis on Black skin and darker skin tones, you’re in the right spot. Let’s take an in-depth look at how psoriasis affects Black people, including signs to look for and what to consider when getting treated. 

Signs of psoriasis on Black skin and other brown skin tones

In white people, psoriasis usually forms red patches on the skin that are covered in a thick, white scale. But in Black people, psoriasis can look quite different. This can make it more challenging to diagnose, especially for clinicians who don’t have much experience working with darker skin tones.

Some signs of psoriasis in people with darker skin tones include: 

• Raised skin patches that can be purple, brown, or gray

• Skin scales that are silver or gray rather than white

• Scaly patches in the scalp that can look like dandruff

• Healed psoriasis that leaves behind flat patches of darkened or lightened skin

Keep in mind that psoriasis may affect just a small portion of skin, like the elbows and knees. But it may be more widespread.

Images of psoriasis on Black skin and other brown skin tones?

Psoriasis in Black and brown people with darker skin tones can look different depending on its type and location. Here are some descriptions of this common rash in darker skin types, as well as some images to help you see the features. 

Plaque psoriasis 

Plaque psoriasis is the most common type of psoriasis. It can affect any part of the body. It causes thick skin patches that show up as violet or brown with overlying gray or white scales. After it heals, psoriasis can leave dark patches that can take months to fade. This is called post-inflammatory hyperpigmentation.

Plaque psoriasis on darker skin tone with post-inflammatory hyperpigmentation.

Plaque psoriasis on brown skin tone.

Guttate psoriasis

Guttate psoriasis is a type of psoriasis more common on the arms, legs, and torso. In darker skin tones, the patches are small and round on your skin, and they can look violet or brown in color — usually with white or gray scales.

Guttate psoriasis on darker skin tone.

Guttate psoriasis on brown skin tone.

Inverse psoriasis 

Inverse psoriasis usually affects skin folds — like the armpits, genitals, and buttocks, as well as underneath the breasts. In darker skin tones, patches of psoriasis look shiny violet or brown. Typically, inverse psoriasis isn’t very scaly.

Inverse psoriasis on darker skin tone.

Inverse psoriasis on darker skin tone.

Pustular psoriasis 

Pustular psoriasis forms small, white-filled bumps called pustules. They may be surrounded by red or violet patches that can be scaly. Pustules can be on large areas of skin or on certain parts of the body (like the hands and feet).

Pustular psoriasis on darker skin tone.

Pustular psoriasis on brown skin tone.

Nail psoriasis

Psoriasis can cause many changes in the nails. These are the same, no matter your underlying skin color. Common changes you may notice are tiny pits in the nail, nail thickening, discoloration, and short or misshapen nails. One nail may be affected — or many. And while nail psoriasis is more common in the hands, it can affect the feet too. 

Here’s what nail psoriasis can look like in darker skin tones.

Psoriasis causes many tiny pits in the fingernail.

Psoriasis can also cause nails to become short, misshapen, and discolored.

How does psoriasis affect Black people with darker skin tones?

All types of psoriasis can affect all people — no matter their skin color. Psoriasis does seem to be less common in Black people than in white people. But this may be because psoriasis isn’t diagnosed so readily in Black people. So, more people with darker skin tones may have psoriasis without knowing it.

When it comes to complications of psoriasis, Black people seem less likely to have psoriatic arthritis. But Black people are more likely to experience complications more severely when they do occur. This includes physical as well as emotional complications of living with psoriasis. 

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Here are some of the reasons why Black people experience psoriasis differently than white people: 

• It can take three times longer for Black people to get a diagnosis of psoriasis.

• Black people are four times more likely to need a skin biopsy to get diagnosed.

• Psoriasis is often more severe at the time of diagnosis on darker skin because it takes longer to diagnose.

• Black people with psoriasis are more likely to have skin symptoms in the hands and feet, which can interfere with many day-to-day functions.

And the difference in experience doesn’t end with diagnosis. Black people are also less likely to be represented in the clinical trials that study new psoriasis medications. This means there isn’t as much information about what works best for treating psoriasis in Black people. And this can make it difficult to find a treatment that works.

Treatment for psoriasis on Black skin and other brown skin tones

For the most part, psoriasis treatment is the same for all skin tones. The treatment you start will depend on: 

• How severe your psoriasis is

• Whether or not you also have psoriasis affecting your joints (psoriatic arthritis)

• Your personal preferences

For mild psoriasis, you may just need medicated creams, lotions, or ointments that you apply to the skin. Some examples include:

• Topical steroids (like clobetasol or hydrocortisone)

• Vitamin D analogues (like calcipotriene)

• Calcineurin inhibitors (like pimecrolimus and tacrolimus)

• Tazarotene (a type of retinoid) 

For more severe psoriasis (or if you have psoriatic arthritis), you may need stronger medication that works throughout your body. Some options include:

• Pills that suppress or alter your immune system (like methotrexate, cyclosporine, and Otezla)

• Biologics (like Humira and Cosentyx)

• Acitretin (a retinoid pill)

• Phototherapy (ultraviolet light treatment applied to your skin in a controlled setting)

Management of psoriasis triggers

Many things can trigger psoriasis and make it worse. These vary from person to person, but some common ones include:

• Medications, like beta blockers and nonsteroidal anti-inflammatory drugs (NSAIDs)

• Certain foods, like alcohol and sugar 

• Stress

• Infections, like strep throat and seasonal flu

• Cold weather

• Hormonal changes, like during menstruation and menopause

The best way to manage psoriasis triggers is to know what they are and avoid them as much as possible. Keeping a diary can help you figure out your specific triggers. 

When to see a healthcare professional about psoriasis

If you have a skin rash and you think it could be psoriasis, see your dermatologist or another skin care health professional. You may need to find someone with experience in treating skin of color — and the Skin of Color Society can help. It has a searchable database, so you can find an experienced clinician near you.

And, if you have psoriasis that isn’t getting better with treatment, then that’s another sign you need professional help. You may need to try a new strategy or a different combination of treatments.

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Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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Images used with permission from VisualDx (www.visualdx.com).