Psoriasis on skin of color typically appears as dark patches with gray scales. These patches may be brown, purple, or darker than the surrounding skin.

Psoriasis lesions tend to be thick and crusty and often form on the scalp, elbows, knees, and back.

In this article, learn about psoriasis on skin of color, including its appearance and symptoms, and how to treat it.

Psoriasis is a common condition affecting more than 7.5 million people in the United States.

It affects approximately 1.5% of Black individuals compared with 3.6% of white people.

The United Kingdom’s National Health Service (NHS) notes that a person may develop psoriasis at any age, but there are two common peaks of onset, ages 20 to 30 and 50 to 60. It is a long-term condition. While there is no cure, many treatment options are available to help manage the symptoms.

Below are pictures of different psoriasis presentations.

Psoriasis presents as thickened areas of skin, sometimes with an overlying scaly crust that may look shiny or silver. These lesions are sometimes itchy. If a person scratches them, they will bleed and scab over.

In people of color, psoriasis can look violet or purple. The individual may also notice areas of darker, thicker skin. In both cases, the lesions can appear scaly. Lesions can develop anywhere on the body, including the scalp.

As psoriasis heals, it can leave areas of discoloration, which can take 3 to 12 months to disappear, according to the American Academy of Dermatology (AAD).

Psoriasis tends to follow a relapsing-remitting pattern, meaning that people will experience a period of few or no symptoms and a flare-up of more severe symptoms.

There are several different types of psoriasis, which can vary in their appearance. These are:

Chronic plaque psoriasis

The AAD notes that chronic plaque psoriasis is the most common form of the condition. It causes clearly defined lesions on the elbows, knees, and scalp.

Guttate psoriasis

Guttate psoriasis is more common in children or young people recovering from an infection, such as strep throat.

It causes small bumps that can cover the entire body.

Nail psoriasis

Some people with psoriasis only have symptoms on their nails. Nail psoriasis looks like tiny pinpricks on the fingernails or toenails. The AAD notes that symptoms of nail psoriasis also include:

  • nail pits, or small dents
  • changes in the color of the nails
  • thickening or crumbling of the nail
  • nails separating from the skin beneath
  • blood under the nail

Inverse psoriasis

Inverse psoriasis appears on folds where the skin touches another part of the skin. It commonly occurs in the armpits, the buttocks, the groin, and the folds underneath the breasts. The lesions may be purple or darker than the surrounding skin.

A dermatologist will perform a physical examination and ask questions about the lesions to diagnose psoriasis. They will probably also ask about any family history of psoriasis or related conditions, such as arthritis.

Psoriasis on dark skin tones can be challenging to diagnose because it may resemble other skin disorders that are more common in people of color.

In some cases, the doctor may also take a skin biopsy so that they can rule out other conditions.

The treatment options for psoriasis are essentially the same regardless of skin tone, although some carry special considerations for people with dark skin.

Standard psoriasis treatments include:

Creams and ointments

Creams and ointments are the first treatment option for most people with psoriasis.

Prescription creams and ointments for psoriasis include:

According to the AAD, topical corticosteroids are the primary treatment for psoriasis. However, using corticosteroids long term, or not as directly prescribed, carries a risk of adverse side effects such as scarring or changes in skin color.

Topical treatments such as synthetic vitamin D creams carry less risk of side effects, so they can be more suitable for long-term treatment.

The AAD notes that some over-the-counter creams and ointments may help reduce psoriasis symptoms such as swelling or itching. These include products containing salicylic acid and coal tar.

Oral and injectable medications

If creams and ointments do not work, a doctor may prescribe oral or injectable medications. These drugs are called systemic medications, and they may be pills, liquids, or injections.

Systemic medications include:

The National Psoriasis Foundation notes that a doctor may prescribe biologic drugs for moderate to severe psoriasis. People usually receive these drugs, which target specific parts of the immune system, as an injection or infusion.

Examples of biologic drugs include:

Phototherapy

Phototherapy is also called light therapy. This treatment involves regularly exposing the skin to ultraviolet light under medical supervision.

Standing in a lightbox two or three times a week can cause the skin to tan or darken. The AAD warns that this may make dark spots on dark skin tones more noticeable.

There is currently no cure for psoriasis. Anything that irritates the skin can cause the condition to flare up. The AAD offers the following advice to help avoid flare-ups wherever possible:

  • avoid skin injuries, such as nicks, cuts, and bug bites
  • protect the skin from sunburn
  • use a cold compress and moisturize regularly to alleviate the itching associated with psoriasis
  • avoid scratching itchy skin

Learning how to recognize the triggers that lead to flare-ups can also be helpful. Triggers differ among individuals but can include:

  • stress
  • bug bites
  • summer heat
  • cold winter weather

Some people with psoriasis develop lesions on their scalp, so doctors may also recommend frequent shampooing with a medicated shampoo.

Psoriasis is a common skin condition that affects fewer Black individuals than white people in the United States.

In people of color, psoriasis may look darker than the surrounding skin or appear purple. In both cases, it tends to have a scaly overlay. Psoriasis lesions can appear anywhere on the body, including the scalp.

Anyone with symptoms of psoriasis should speak with a doctor about diagnosis and appropriate treatment options.