Psoriasis in African-Americans: A Caregivers’ Survey

April 2012 | Volume 11 | Issue 4 | 478 | Copyright © April 2012


Abstract
Background: Psoriasis is a common skin disease in Caucasians but less common in African-Americans.Aims: Our aim is to evaluate caregiver opinions regarding the clinical presentations and treatment of psoriasis in African-Americans compared to Caucasians.Patients/Methods: A survey was sent to 29 dermatologists who are opinion leaders in the field of psoriasis. The survey included a number of questions regarding the characteristics of the patients seen in their practice.Results: A total of 29 surveys were completed and returned. All of the dermatologists use the extent of disease as a criterion to determine the severity of the disease. Other criteria include scale, thickness, erythema, associated general symptoms, and dyspigmentation. About 66% of the respondents reported the different manifestations of disease, such as more dyspigmentation, thicker plaques, and less erythema in African-Americans. The most common first-line treatments for mild to moderate disease were highpotency topical steroids (68%) followed by topical vitamin D analogues (41%). For moderate to severe disease, the most commonly used first-line treatments were high-potency topical steroids (54%) and phototherapy (46%).Conclusions: The clinical manifestations of psoriasis in African-Americans are not exactly the same as in Caucasians. Physicians should be aware of the difference in clinical manifestations in African-Americans. Further research and large-scale studies are necessary to elucidate the differences in the clinical presentation, natural course of the disease, and the criteria used for the evaluation of severity among ethnic groups.J Drugs Dermatol. 2012;11(4):478-482.

INTRODUCTION

Psoriasis is a common chronic inflammatory skin disease characterized by well-demarcated erythematous plaques with silvery scale that can be localized or widespread. According to the result from a population-based study by Gelfand et al,1the estimated prevalence of psoriasis in the United States is 2.5% in Caucasian patients and 1.3% in African-American patients. Genetic, environmental, and dietary factors have also been implicated as cause for clinical differences.2Regarding the clinical features of psoriasis in dark-skin population, some studies suggest there are no differences3 while others propose greater pigmentary disturbance, reduced redness, or a different clinical course.4,5This disparity is likely, at least in part, due to difficulty in perception of erythema in skin of color.4
The impact of psoriasis on health-related quality of life is comparable to that seen in cancer, arthritis, hypertension, heart disease, diabetes, and depression.6 Despite many emerging treatment options for psoriasis, there are a number of patients indicating substantial dissatisfaction with their treatment.7 Treatment may also be further hampered by limited access and utilization of dermatologic care by African-Americans.8Recognizing the lack of information on the clinical presentations of psoriasis in African-American population, we conducted a survey on dermatologists to evaluate their opinions regarding the clinical presentations and treatment of psoriasis in African-Americans compared to Caucasians.

MATERIALS AND METHODS

This cross-sectional survey study was conducted with the approval of the Wake Forest University School of Medicine institutional review board.

Subject

We performed a survey study among 29 dermatologists who are opinion leaders in the field of psoriasis. They are all practicing in the United States.

Survey instrument

A written survey was sent to dermatologists containing 15 questions regarding the characteristics of the patients with psoriasis seen in their practice. The survey requested information regarding

Keywords: Psoriasis, Skin of Color
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