INTRODUCTION
Psoriasis is a chronic inflammatory disorder involving the skin and joints. Although psoriasis is more prevalent in populations of European ancestry, recent data show substantial rates of psoriasis in populations with skin of color.1,2 According to data from the 2011-2014 National Health and Nutrition Examination Surveys (NHANES), a national data repository representative of the adult population in the United States, 3.6% of Caucasian, 1.5% of African American, and 1.9% of Hispanic adults between the ages of 20 and 59 years were affected by psoriasis; which is relatively unchanged from the 2009-2010 NHANES data.1 The prevalence of psoriasis in darker phototypes may be higher than estimated figures suggest given that non-white patients are more likely to have undiagnosed psoriasis.3
Classically, plaque psoriasis lesions are described as erythematous plaques with sharp borders and micaceous scale. However, psoriasis in skin of color may have morphological and clinical variations including thicker and scalier plaques, greater body surface area involvement, less conspicuous erythema, and increased risk of post-inflammatory pigment changes.4-6 Erythema is often obscured in skin of color, and can appear hyperchromic or violaceous.5,7 Furthermore, even after resolution of lesions, patients with darker skin types often have dyspigmentation that can be at least as bothersome as the original psoriatic lesions.7,8 Notably, psoriasis in skin of color has been associated with greater psychological impact and worse quality of life (QOL), demonstrated by higher Dermatology Life Quality Index (DLQI) scores in Black and Hispanic populations.6,7,9,10
Despite differences in the presentation and sequelae of psoriasis between diverse ethnic groups, there is a paucity of data on the use of topical medications in patients with darker phototypes.11,12 Phase II and III clinical trials with combined calcipotriene and betamethasone dipropionate (Cal/BD) 0.005%/0.064% aerosol foam showed efficacy in the treatment of mild, moderate, and severe plaque psoriasis and improved QOL with once daily use for 4 weeks.13-15 In the phase III PSO-ABLE study comparing Cal/BD aerosol foam with Cal/BD gel, 37.8% of 180 aerosol foam-treated patients achieved treatment success at week 4 according to the Physician's Global
Classically, plaque psoriasis lesions are described as erythematous plaques with sharp borders and micaceous scale. However, psoriasis in skin of color may have morphological and clinical variations including thicker and scalier plaques, greater body surface area involvement, less conspicuous erythema, and increased risk of post-inflammatory pigment changes.4-6 Erythema is often obscured in skin of color, and can appear hyperchromic or violaceous.5,7 Furthermore, even after resolution of lesions, patients with darker skin types often have dyspigmentation that can be at least as bothersome as the original psoriatic lesions.7,8 Notably, psoriasis in skin of color has been associated with greater psychological impact and worse quality of life (QOL), demonstrated by higher Dermatology Life Quality Index (DLQI) scores in Black and Hispanic populations.6,7,9,10
Despite differences in the presentation and sequelae of psoriasis between diverse ethnic groups, there is a paucity of data on the use of topical medications in patients with darker phototypes.11,12 Phase II and III clinical trials with combined calcipotriene and betamethasone dipropionate (Cal/BD) 0.005%/0.064% aerosol foam showed efficacy in the treatment of mild, moderate, and severe plaque psoriasis and improved QOL with once daily use for 4 weeks.13-15 In the phase III PSO-ABLE study comparing Cal/BD aerosol foam with Cal/BD gel, 37.8% of 180 aerosol foam-treated patients achieved treatment success at week 4 according to the Physician's Global
