Amy McMichael, MD, on Psoriasis in Skin of Color: Challenges and Innovations

In the first part of an interview with The Educated Patient, Amy McMichael, MD, FAAD, professor of Dermatology and chair of the Department of Dermatology at Wake Forest School of Medicine and VISIBLE Steering Committee member, discusses the unique presentation of plaque and scalp psoriasis in individuals with skin of color, explaining that traditional signs like redness (erythema) are often—but not always—less visible in darker skin tones.

Instead, these patients often present with more hypertrophic (thicker) lesions, extensive involvement of the scalp and body and post-inflammatory hyperpigmentation after treatment, which can be disfiguring. These symptoms can make diagnosing psoriasis in skin of color more challenging, especially for dermatologists who are not trained to recognize variations in presentation.

McMichael emphasizes the need for more dermatologists in underrepresented minority communities, noting that areas predominantly populated by people of color often lack adequate access to specialized care. This lack of access, combined with insufficient training in dermatology residencies, can easily lead to delays in diagnosis and treatment.

She highlights the importance of clinical trials, including the groundbreaking VISIBILE trial that evaluated guselkumab treatment for patients with skin of color diagnosed with psoriasis, which shows promise for improving both symptoms and quality of life. The inclusion of diverse populations in these trials helps to build trust between patients and providers by providing evidence-based data that supports effective treatment outcomes.

McMichael encourages patients to seek dermatologists who focus on medical dermatology—as opposed to cosmetic dermatology—and to utilize resources, such as the National Psoriasis Foundation, for guidance. She also calls for better education of primary care physicians, who play a key role in referring patients for specialized systemic treatment rather than relying solely on topical therapies. McMichael remains hopeful that these advancements in research and outreach will change the future of psoriasis care for people of color.