In these textbooks, the disease is often said to cause red or pink patches with a silvery scale—but this description really only applies to white skin.
One of the primary features of psoriasis is a finding called “erythema”—a sign of inflammation in the skin. “The root of the word is actually from the Greek for ‘red,’ but erythema can manifest in different ways,” explains Dr. Landriscina.
In white skin, erythema is typically pink to red—often referred to as salmon pink. However, erythema can manifest differently in more melanin-rich skin tones. “Overlapping the erythema of psoriasis with the brown color of melanin can lead to other colors, such as purple,” Dr. Landriscina tells SELF. “Also, inflammation can lead to increased or decreased pigment production in the affected area, resulting in dark or light spots in skin of color.”
All of this means that it can be even more difficult for people of color to receive an accurate diagnosis of psoriasis, which can make this arduous process even more costly and discouraging.
“Dermatology is all about pattern recognition, so unless you train and practice in an area with a diverse patient cohort you will not be familiar with identifying subtle signs of disease on patients with darker skin tones,” Dr. Psomadakis adds.
“My plaques have never been red,” Bridges says. “My flares are dark brown to purple. Due to this misinformation in texts, many doctors who are unfamiliar with darker skin have been more likely to speculate that I didn’t have psoriasis, and that it was perhaps another disease.”
“Trial and error” is a phrase familiar to many psoriasis patients.
Carina Linnane, 25, knows all about trial and error. “First, it was moisturizer and coal tar treatment for my scalp, but that didn’t help much,” she tells SELF. Then she tried light therapy, but she stopped when her doctor had concerns about the risks of prolonged ultraviolet (UV) light exposure.
Linnane was then put on a course of topical steroids “until they stopped working,” then various other types of steroids until she decided—last year, at the age of 25—to focus on lifestyle changes. “I eliminated a lot of foods (mainly dairy and gluten) and six weeks later my arms were [mostly] clear of psoriasis. I still have some patches on my legs, but it’s improving.”
Dr. Psomadakis doesn’t entirely agree that psoriasis treatment is all trial and error. “There are scientifically-backed ingredients and treatments that are effective in the majority of people,” she says. But she agrees that finding what works can be a confusing process, because the disease is influenced and exacerbated by many external triggers.
Searching for the right treatment for your psoriasis may indeed require trying several different treatments, with varying levels of success, but the upside of treating psoriasis is that this wide range of treatments exists in the first place, says Dr. Landriscina, noting that there are dozens of FDA-approved medications for psoriasis.
Bridges currently manages her psoriasis symptoms with a combination of a biologic and topicals. “Never in a million years would I have thought I would achieve clear skin,” she says.
Many factors can affect whether a particular psoriasis treatment works for someone. These include how much of the body is affected, whether certain “special sites”—such as the scalp or genitals—are affected, and whether or not the patient has psoriatic arthritis, Dr. Landriscina says. Each patient’s overall health also plays a role, he adds, so having a care team that you see regularly is crucial.
Dr. Klein agrees. “It’s about careful management that is both reactive and proactive and often involves working with a patient’s medical team should they have other health conditions connected to the psoriasis,” she says. “The National Psoriasis Foundation estimates that up to 30 percent of people with psoriasis develop psoriatic arthritis. Due to increased inflammation, psoriasis patients are at greater risk of developing cardiovascular disease, and therefore optimizing cardiovascular health is of utmost importance. Psoriasis patients are also at greater risk of developing depression and other health conditions.”