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Psoriasis and Ethnicity: Is Race a Risk Factor?

Posted on May 26, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Eli Sachse, RN

The risk for developing psoriasis is associated with many factors, including genetics and environmental conditions. People of some races and ethnicities are more likely than others to develop psoriasis or experience more severe symptoms than others.

However, the reasons for this are unclear. Since race and ethnicity can influence health in many ways, details of the connection between race and ethnicity and risk for psoriasis are not fully clear.

Which Races and Ethnicities Are Most at Risk?

American studies find white people are diagnosed most frequently with psoriasis. Black people and people of Hispanic origin appear to have the next-highest risk. A Chinese study suggests that Asians appear to be less affected by psoriasis compared to people with European heritage.

Are People of Color Underdiagnosed?

Studies about prevalence and risk in different races are complicated by many factors. It is important to note that there has been a common misconception in the U.S. that people of color do not experience psoriasis. There are many factors that may have contributed to this. One doctor notes that clinicians are more often taught about how to identify psoriasis lesions on white skin (red patches with silvery scales) rather than on darker skin (violet, or darker brown patches). This may lead to psoriasis being underdiagnosed in people with darker skin types.

Researchers also note that barriers to accessing care may also lead to underdiagnosis of psoriasis in Americans of color. These barriers include the fact that Black and Asian people are less likely to seek medical care for their psoriasis. Additionally, Black Americans are less likely to have access to health insurance and primary health care. Researchers suggest these disparities may hinder researchers’ ability to draw conclusions about the true incidence and prevalence of psoriasis among people of color.

Genetics, Race, and Risk for Psoriasis

Traditionally, it has been assumed that diseases that appear linked to race and ethnicity also share a genetic link. However, research increasingly proves that there is no genetic basis for race. Genetic risk for psoriasis becomes more complicated when considered in the light of race.

For example, a variation of the gene HLA-Cw6 appears strongly associated with risk of psoriasis. Globally, this gene appears more frequently among people of African heritage (15.09 percent) when compared with people of European heritage (9.62 percent). However, this does not match up with American studies that show white people being more affected by psoriasis than Black people.

It is important to note that the majority of genetic research regarding psoriasis has involved primarily participants of European or Asian descent. More diversity in research is needed in order to confirm any links between race, ethnicity, and genetic risk for psoriasis.

Race, Psoriasis Severity, and Treatment

The severity of psoriasis symptoms appears to vary between different racial and ethnic groups. Black Americans report more extensive symptoms, including more severe scalp psoriasis, than white people according to one study from 2017. A study from 2011 found Asian Americans to have the most extensive disease involvement, measured by percentage of body surface area (BSA) affected. Next severely affected were people of Hispanic origin, then Black people. White people reported the least percentage of body surface affected.

An important factor may be that Black and Asian Americans are less likely to see a doctor about their psoriasis. In fact, white and Hispanic people report attending twice as many doctor appointments regarding their psoriasis when compared with Black and Asan people. The reasons for these disparities are not yet well understood.

Treatment delays or under-treatment can exacerbate symptoms of any condition. People without access to specialist care and effective treatment could potentially experience more disease severity over time.

Diversifying Research and Dermatology

More research is needed in order to understand why people of color experience more severe psoriasis symptoms than white people, and to explore links between genetics, race, and disease.

A review of diversity in the participants of clinical trials for dermatology found that only 38.1 percent of dermatology clinical trials conducted between 2010 and 2015 included at least 20 percent of ethnically or racially diverse participants. Among these, studies on psoriasis were found to be the least diverse.

A 2020 study examined the fields of interest of medical residents training for a career in dermatology. Only 7.5 percent expressed a specific interest in treating skin of color. The same year, dermatology was found to be the second-least diverse specialty, with relatively few doctors of color. Several professional dermatology organizations have announced initiatives, including scholarships and mentorship programs, to increase diversity in the dermatology field.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 104,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Have questions about how race and ethnicity affect psoriasis? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Psoriasis in Skin of Color: Insights Into the Epidemiology, Clinical Presentation, Genetics, Quality-of-Life Impact, and Treatment of Psoriasis in Non-White Racial/Ethnic Groups — American Journal of Clinical Dermatology
  2. Social Determinants of Health — U.S. Department of Health and Human Services: Office of Disease Prevention and Health Promotion
  3. Ethnicity Affects the Presenting Severity of Psoriasis — Journal of the American Academy of Dermatology
  4. Epidemiology and Treatment of Psoriasis: A Chinese Perspective — Psoriasis: Targets and Therapy
  5. Disparities in Psoriasis Care Among Racial-Ethnic Minority Groups — The Dermatologist
  6. Psoriasis in Skin of Color: Epidemiology, Genetics, Clinical Presentation, and Treatment Nuances — The Journal of Clinical and Aesthetic Dermatology
  7. Racial Minorities Less Likely To See a Doctor for Psoriasis — Penn Medicine
  8. Healthcare Access and Quality — U.S. Department of Health and Human Services
  9. Treatment Disparities Among the Black Population and Their Influence on the Equitable Management of Chronic Pain — Health Equity
  10. Race and Genetics Versus ‘Race’ in Genetics: A Systematic Review of the Use of African Ancestry in Genetic Studies — Evolution, Medicine, & Public Health
  11. A Retrospective Study To Investigate Racial and Ethnic Variations in the Treatment of Psoriasis With Etanercept — Journal of Drugs in Dermatology (JDD)
  12. Inclusion of Racial and Ethnic Minorities in Genetic Research: Advance the Spirit by Changing the Rules? — The Journal of Law, Medicine & Ethics
  13. Assessment of Changes in Diversity in Dermatology Clinical Trials Between 2010-2015 and 2015-2020: A Systematic Review — JAMA Dermatology
  14. Why Dermatology Is the Second Least Diverse Specialty in Medicine: How Did We Get Here? — Clinics in Dermatology
All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Eli Sachse, RN is a registered nurse living in California. He has written about health topics for Sonoma Medicine and Microcosm Publishing. Learn more about him here.

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