predominantly White populations.16 The association of PSORS4 with psoriasis has also been demonstrated in Singaporean Chinese, although it is unknown whether this association is present in other ethnic populations.17
Statement 3
Post-inflammatory pigment alteration is a common associated feature of psoriasis in patients with skin of color.
An important sequela of psoriasis in patients with SOC is a postinflammatory pigmentary alteration that can appear while a psoriasis lesion is resolving and persist after psoriatic lesions have cleared (Figure 1).5 Postinflammatory pigmentary alterations in patients with SOC are not captured by measurements of psoriasis severity and may contribute to a greater negative impact on QoL.4 Hyper- or hypopigmented patches resulting from postinflammatory pigmentary alterations can take 12 months or more to resolve and become a source of considerable distress for the patient.5 Furthermore, erythema can be mistaken for postinflammatory hyperpigmentation in richly pigmented skin, which may cause undertreatment during active inflammation. Phototherapy-associated burns can also cause postinflammatory hyperpigmentation during treatment.
Statement 4
The desired treatment endpoint in patients with skin of color is the reduction of erythema/scaling/elevation of plaques and the clearance of the pigmentary sequelae.
The PASI score is a validated scoring system commonly used in clinical trials to measure psoriasis severity. It takes into account BSA involvement, erythema, induration, and scaling.2,4 Using PASI to measure psoriasis severity in patients with SOC may present challenges. The assessment of erythema in patients with SOC is nuanced, with areas appearing as dark brown, violaceous, or hyperchromic versus pink or red as seen in patients with lighter complexions (Figure 2).5 The PASI score does not consider postinflammatory pigmentary sequelae,
