A Black woman with psoriasis says her condition was misdiagnosed because her doctor wasn't trained to spot the disease on dark skin

Dr. Junko Takeshita said Black patients with psoriasis who are misdiagnosed may miss out on effective treatments that can improve their symptoms.

• On WebMD's "Health Discovered" podcast, a Black woman said she's had psoriasis since she was 7.
• She said she was misdiagnosed in her 20s because her doctor couldn't identify psoriasis on her skin.
• A 2015 study suggested Black Medicare patients were less likely to get a treatment than White patients.

On the August 25 episode of WebMD's "Health Discovered" podcast, a guest said she'd had psoriasis since she was 7.

In her 20s, Alisha Bridges said she went to see a doctor for treatment and was told she likely didn't have the disease because it didn't present the way it commonly does on light skin. Bridges said Black people are visually underrepresented in educational materials provided to doctors, which makes diagnosing the condition on dark skin harder. After her own misdiagnosis, Bridges is now on a mission to bring awareness to psoriasis and other chronic illnesses.

A 2015 study of about 799,000 Medicare psoriasis claims found that Black recipients were less likely to receive a standard treatment, called biologics, for moderate to severe psoriasis than their White counterparts. Biologic treatments are medications usually taken through injection that target parts of the immune system and block proteins and cells that can cause psoriasis. The lead researcher on the study, Dr. Junko Takeshita, an assistant professor of dermatology at the University of Pennsylvania, said on the podcast that misdiagnoses could prevent Black psoriasis patients from receiving effective treatment. 

Takeshita said greater representation of darker-skinned people with psoriasis in media and in education may help people identify the disease and get treatment faster.

Bridges said her psoriasis was misdiagnosed in her 20s, which delayed effective treatment

Psoriasis is a chronic autoimmune skin disease in which the body's immune system attacks healthy skin cells, causing the rapid production of new skin cells. Plaque psoriasis is the most common form of the disease, in which dead skin cells create raised patches of itchy skin called plaques, according to Mayo Clinic. These patches can vary in color, depending on the person's skin color. A panel of experts on a 2019 National Psoriasis Foundation podcast episode for World Psoriasis Day estimated 2 to 3% of people in the world had psoriasis.

Bridges has had itchy, dry patches on her body since she was 7, but when she got chicken pox as a kid, the patches spread to 90% of her body, she said. While she was diagnosed with psoriasis shortly thereafter, she said her insurance limited her to treatments like phototherapy and occlusion — a treatment where the patient is covered in a topical steroid and plastic suit for an extended period. The dry skin still never went away, she said. 

In her mid-20s, Bridges said she went to a Black doctor looking for cultural sensitivity and hoping to try some different treatments for her psoriasis.

"I was like, 'OK, she's Black. She's going to get it, right?' And so she looked at my skin and was like, 'Eh, I don't think it's psoriasis because it does not look the way that we've been taught to think it's supposed to be presented,'" Bridges said on the podcast.

Given the ineffectiveness of her previous treatments, the doctor diagnosed Bridges with an autoimmune condition called lichen planus, she said, which can appear as purple lesions on the skin, according to Healthline.

Bridges said psoriasis on darker skin could show up as purple, dark red, and pink patches, not red, which is how the disease may present on people with lighter skin. She said she finally met Dr. Jamie Weisman at a National Psoriasis Foundation event, who has worked with diverse patients with psoriasis. Bridges said Weisman was able to prescribe her biologics, which has helped clear almost 100% of her skin, she said.

Dermatologists are less likely to diagnose and treat Black people with psoriasis, study suggests

Takeshita said on the podcast that her team's research based on Medicare patients with psoriasis found that Black patients were 70% less likely to receive biologic treatments than their White counterparts.

She said bias in treatment could be due to a number of factors, including lower rates of diagnoses among Black patients, racial disparities in insurance coverage, and a lack of representation of people of color with psoriasis. Black people may not even know they can get plaque psoriasis, she said, because ads for medication mainly feature white people.

In addition to education, she said people of color with psoriasis needed to be represented more in media.

Signs of plaque psoriasis

Psoriasis usually presents as raised, thick, and scaly skin on your body. These patches, Takeshita said, usually appear on the outside of your elbows, knees, and scalp, as well as on your belly button and buttocks. They are also often symmetrical, she said, so they sometimes appear in the same place on both sides of your body.

Bridges and Takeshita both say to go to the National Psoriasis Foundation's website for resources if you're worried that you have plaque psoriasis or have been diagnosed with it.