Amy McMichael, MD: Transforming Psoriasis Care for Skin of Color

In 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, highlights significant advances in understanding and treating psoriasis in patients with skin of color. Historically, data on these patients has been incomplete, and clinical trials have often underrepresented them. However, recent efforts, such as the VISIBLE trial, have focused specifically on this population, providing groundbreaking insights.

McMichael notes that patients with skin of color were previously thought to have more extensive and thicker lesions, particularly on the scalp. The trial not only confirmed some of these assumptions but also provided concrete data, showing that these patients respond well to systemic biologics—an outcome that was previously assumed but not well-supported by research.

One major takeaway from the VISIBLE trial was its success in recruiting patients with skin of color more efficiently than expected, a challenge that many pharmaceutical companies have struggled with. By collaborating with clinicians who regularly treat these patients, the trial exceeded recruitment goals ahead of schedule. This demonstrated that with the right approach, it is possible to run inclusive trials and gather much-needed data on diverse populations.

In terms of treatment outcomes, the trial was a success. For patients with scalp psoriasis, a particularly difficult area to treat, 85% achieved significant improvement by week 48. This is noteworthy, as scalp psoriasis is notoriously challenging to manage, especially with traditional treatments like creams and ointments that are messy and hard to apply. Guselkumab can offer a much-needed alternative. Similarly, patients with body psoriasis also saw impressive results, with over 70% achieving clear or minimal disease, and nearly 77% showing significant improvement.

McMichael emphasizes the importance of these findings, particularly for educating future dermatologists, and hopes that these results will encourage more pharmaceutical companies to include diverse populations in their clinical trials.