Evolving Concepts in Psoriasis: Special Considerations for Patients With Skin of Color, Skin Barrier Dysfunction, and the Role of Adjunctive Skin Care
October 2022 | Volume 21 | Issue 10 | 1054 | Copyright © October 2022
Published online September 30, 2022
Andrew F. Alexis MD MPH FAADa, Heather Woolery-Lloyd MD FAADb, Anneke Andriessen PhDc, John Koo d, Amy J. McMichael e, George Han MD PhD FAADf
aProfessor of Clinical Dermatology, Weill Cornell Medical College, New York, NY
bDirector, Skin of Color Division Dr Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami, Miller School of Medicine Miami, FL
cRadboud UMC Nijmegen, Andriessen Consultants, Malden, NL
dProfessor of Dermatology at the UCSF School of Medicine and as Co-Director of the UCSF Psoriasis and Skin Treatment Center in San Francisco, CA
eProfessor, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
fAssociate Professor, Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
Abstract
Background: Despite considerable advances in our understanding of the pathogenesis and treatment of psoriasis, data pertaining to racial/ethnic variations, effects on barrier function, and the potential role of adjunctive skin care are relatively limited. Knowledge gaps in the clinical presentation, quality-of-life impact, and approach to treating psoriasis in patients with skin color contribute to disparities in care. In addition, small studies suggest that using skincare products can reduce psoriasis symptoms, improve barrier function, and result in higher patient satisfaction, yet patients with psoriasis may underuse skincare products. This manuscript seeks to offer insights into these knowledge gaps and their potential treatment implications.
Methods: A structured literature search followed by a panel discussion and an online review process explored best clinical practices in treating psoriasis patients with skin of color and providing expert guidance for skincare use, including gentle cleansers and moisturizers.
Results: Racial/ethnic differences in genetic factors, clinical presentation, and disease burden in psoriasis have been reported. Underrecognition of these differences contributes to racial/ethnic health disparities for psoriasis patients in the US. Several studies have shown a greater quality-of-life impact with psoriasis among patients with skin of color. Although the published data are limited, some studies have identified differences in skin barrier properties and suggest a role for adjunctive skin care in the management of psoriasis.
Conclusion: Further study is needed to understand racial/ethnic population variations in psoriasis and develop strategies to reduce disparities in care. Addressing alterations in skin barrier function observed in psoriasis may help to improve treatment outcomes and patient satisfaction.
J Drugs Dermatol. 2022;21(10):1054-1060. doi:10.36849/JDD.7090
INTRODUCTION
Psoriasis is a chronic, immune-mediated, multisystemic skin disease with an estimated prevalence rate of over 2% of the US population.1 Although the exact pathophysiology is not fully understood, a combination of genetic, environmental, and immunologic factors is thought to be involved.2 Psoriatic lesions are characterized by inflammation, epidermal hyperproliferation, abnormal keratinocyte differentiation, and skin barrier dysfunction.3 Psoriasis can severely impact a patient's quality of life (QoL), with variations reported in different ethnic/racial populations.1,2,4-6
Genetic differences between racial/ethnic populations have also been described.4,5 In patients with skin of color (SOC), nuances in psoriasis morphology and clinical presentation can include varied hues of erythema (which may be less conspicuous compared to lighter phototypes) and associated postinflammatory pigment alteration in higher skin phototypes.5
In comparison to other inflammatory skin conditions like acne, rosacea, and atopic dermatitis, the role of skin care in psoriasis is less frequently addressed. Skin care is rarely mentioned in published guidelines and algorithms to treat psoriasis.7-9
