Psoriasis in African-Americans: A Caregivers’ Survey
April 2012 | Volume 11 | Issue 4 | Journal Article | 478 | Copyright © April 2012
Amy J. McMichael MD,aVasanop Vachiramon MD,a,bDaniela Araucaria Guzmán-Sánchez MD,aFabian Camacho MS MAc
aDepartment of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC bDivision of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand cDepartment of Public Health Sciences, Milton S. Hershey Medical Center, Hershey, PA
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
