Why People of Color Are Misdiagnosed

Getting a plaque psoriasis diagnosis should be a pretty straightforward process. You see a dermatologist, who looks for the telltale scaly patches on your skin. But diagnosis may not be as direct or as easy for people of color. 

People with darker skin are more often misdiagnosed than white people. They also wait longer to get a diagnosis at all. These delays could lead to more severe disease and more complications.

Why Do People of Color Get Misdiagnosed?

Do an online search for psoriasis images, and you’ll see photo after photo of scales on white skin. Those pictures don’t reflect the real demographics of the condition. “Psoriasis does not discriminate. It can affect anyone,” says Adam Friedman, MD, a professor and chair of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, DC.

Dermatologists in training see those same kinds of images in their medical school textbooks. One study found that fewer than 5% of the pictures in dermatology textbooks feature dark skin. 

Without the right training, dermatologists may not know that psoriasis plaques look different on darker skin tones. Many doctors admit they’re less confident diagnosing psoriasis in Black patients than in white patients.

Rina Allawh, MD, is a board-certified dermatologist in the Philadelphia area. She’s seen people with psoriasis after another doctor had misdiagnosed and treated them for ringworm or eczema. Psoriasis on darker skin can also be mistaken for other conditions, such as lupus skin sores and even a syphilis rash.

Friedman says a lack of training is no excuse for missing a psoriasis diagnosis in people of color. “That is so unacceptable. As dermatologists, we should be able to take care of everyone, with all skin tones,” he says.

Access to health care is another barrier to a prompt diagnosis. People of color are less likely to see a dermatologist than white people. Some possible reasons are less awareness of the skin condition, distrust of the medical system, and a lack of health insurance. 

“Patients of color may have issues either obtaining coverage or gaining access to specialty care. This may lead to a delayed diagnosis or more advanced disease when they are eventually seen,” says Janiene Luke, MD, a dermatologist at Loma Linda University Health in California.

The Health Risks of Delayed Psoriasis Diagnosis

When you don’t get a prompt diagnosis, your skin will get worse, but that’s not all. Psoriasis is a body-wide disease. “Every medical condition out there has been linked to psoriasis, because chronic inflammation is bad for everything,” says Friedman.  Unchecked inflammation can make these conditions worse, too.

Another risk if your doctor doesn’t know you have psoriasis is that they might prescribe a treatment that isn’t right for you. For example, beta-blockers to treat high blood pressure could aggravate psoriasis. 

Differences in Psoriasis Treatment for People of Color

Psoriasis treatment is basically the same in people of all skin tones, but there are a few exceptions. 

For example, phototherapy can leave hyperpigmentation, or dark patches on the skin. “This can often be more troublesome to patients than the skin condition itself,” Luke says. Also, people with scalp psoriasis must shampoo often to remove the scales. This can be hard on some hair types. Luke points out that doctors need to understand textured or curly hair so they can offer treatment options that people of color can comfortably use long-term. 

Injected biologic drugs have become an important part of treatment for psoriasis, but Black people are much less likely to be prescribed these medications than white people. “I think some of that has to do with a lot of the ads for biologics not including Black or brown patients,” says Nikki Pritchett, MD, an associate professor in the Department of Dermatology at Howard University College of Medicine in Washington, DC. “So perhaps they’re less familiar with them or maybe they think those treatments don’t work for them.”

Some of Friedman’s patients of color worry about the risks of taking shots and ask for creams instead. He stresses to them that psoriasis is a body-wide disease. To control the inflammation, it needs to be treated from the inside out. 

What Can You Do?

There are things you can do to be sure you get a prompt diagnosis and the right treatment. See a board-certified dermatologist for any skin problems. Make sure they focus on medical dermatology and have experience treating psoriasis. “There are dermatologists who spend a big chunk of their time doing surgery, cosmetics, allergy testing. These people might not be appropriate,” Friedman says.

There are a few websites where you can search for a dermatologist with experience treating skin of color: 

• Skin of Color Society 
• Black Derm Directory
• The National Psoriasis Foundation 
• The American Academy of Dermatology 

It may be hard to find a doctor who looks like you because there are so few dermatologists of color practicing in the United States. But Luke says there’s something even more important: that the person you choose as your care provider is comfortable treating patients of color and willing to honor your beliefs and cultural identity when caring for you.