“I don’t look like you”: The problem of diagnosing psoriasis in people of color
Written on October 7, 2015 by Diane Talbert
I am an African-American woman in her fifties with very dark skin who in addition to battling psoriatic arthritis since my forties, has battled…
Plaques Psoriasis—the scaly skin that itches and flakes—all of her life
Erythrodermic Psoriasis—the best way to describe this is that my whole body goes on fire—several times in my life
Guttate Psoriasis—spots that covered my entire body—at one point in my life
What’s been especially challenging in my lifelong struggle with psoriasis has been the general lack of information as well as a medical community lacking in knowledge when it comes to psoriasis in people of color.
When I was a teenager I used to go to the library and try and find pictures of someone who looked like me. I spent countless hours searching for just one photo. After months and months of searching and coming up with nothing, I believed I was alone in this world and there was no one like me with psoriasis.
I did find some photos of Caucasian people with psoriasis, but their psoriasis never looked like mine—nowhere close. My psoriasis was always very dark and thick. They had red or pink patches of thickened skin that were covered with whitish scales, just like the articles that described what psoriasis looked like. This was not me.
In the town where I was raised, we didn’t have a physician who knew anything about psoriasis. At the age of five, I was taken to the nearest town that had a dermatologist. When I started going to this doctor, a Caucasian male, he actually looked directly at my skin and said he knew I had psoriasis by my white silvery scales.
As a child of color, this was extremely confusing because, guess what: I didn’t have white silvery scales on me!
Then over the next 40 years, I went to many doctors.
One doctor would tell me he knew I had psoriasis because it was on the back of my elbows and on the front of my knees. This was odd and very funny to me since I had psoriasis over 70% to 80% of my whole body, my whole life, not just my elbows and knees.
Not only did every doctor I went to tell me a different story—they put me on a different treatment. I remember seeing a doctor who gave me a tube of cream. Now, remember, for most of my life, 70% to 80% of my body has been covered with this disease, and putting creams on me made me a wet, greasy mess—not a great look for someone who worked in the corporate world. What’s more, the tube only lasted for two days.
I saw a doctor in my early 20’s who started me on an ultraviolet light treatment. It started working pretty well for my psoriasis. My dermatologist decided that he needed to keep me in the box longer because the light needed to penetrate my dark skin—his exact words.
Well that back fired: I was burned over my entire body. I had to take a week off from work and go to a burn specialist.
Needless to say, I never went back to that doctor, but I never openly questioned authority either; I just wasn’t raised that way.
When I was in my 40’s, someone told me my skin was different from people who are not like me. They said I needed a doctor who knew about black skin. I believed this; mostly because I was always covered in psoriasis that never got better and my psoriatic arthritis started to kick in really bad at that time. Also, there were not many doctors of color when I was growing up, and definitely not many knowledgeable about psoriasis and psoriatic arthritis.
So I set out to find a doctor of color who specialized in psoriasis; I found one. While in the care of this doctor I developed the worst case of psoriasis ever, erythodermic psoriasis which is a rare and serious condition that makes most the skin surface and the body inflamed and you have intense shedding. I had severe itching and pain. I went to this doctor in tears and horrible pain. I actually thought I was going to die. I looked like something out of an alien movie.
The dermatologist looked at me and said, “I don’t know what to do for you.”
Well, right then and there, I knew the color of my doctor didn’t matter!!
That day I made up my mind to search out and find a good doctor who specialized in psoriasis. I did my research and found three in my area. I made appointments with them the following week.
The first dermatologist I went to took my hand and said, yep, you have psoriasis. He wrote me a prescription for cream. Remember, I am still 90% covered at this time and in the worst pain ever. I never went back.
The second dermatologist spent over 35 minutes with me. He examined my skin, nails, scalp and did blood work. He asked if any of my family members had psoriasis. He asked what had been happening in my life. He asked if I was under any stress, had a recent illness, and what kind of medication I was on. There was no need to see a third doctor; I was in love with him that first day. No one ever took that much time to actually find out about me.
He is Caucasian and the best doctor ever. His name is Dr. Ronald Prussick out of Rockville, Maryland. I have been with him for 11 years and have never looked back.
This is what I learned: When it comes to finding a good doctor, color should never come into play.
But how can you find a good doctor?
You need to have a good understanding of psoriasis before your appointment. Make sure you have a list of questions to ask such as what causes psoriasis, how do you diagnose it, what can trigger flare-ups, what are the risks of my medications, and can you treat it?
You need to educate yourself. Right now I know just as much about my psoriasis (and psoriatic arthritis) as my doctor does. And never be afraid to question authority. I wasn’t raised that way but I’ve learned to speak up for myself and others with psoriasis and psoriatic arthritis.
The color of your doctor doesn’t matter, but my personal opinion is that if you are a person of color that you should consider getting a biopsy if the doctor doesn’t know for sure what you have. Back in the day when dermatologists thought that people of color didn’t get psoriasis, getting a biopsy was the only way to prove it. However, we have so many knowledgeable dermatologists today that they might just be able to examine your skin and tell if you have psoriasis.
Indeed, finding a good dermatologist is the key. Just getting the proper treatment has its benefits. When I finally found the right doctor and proper treatment, I became 90% clear and felt 100% better. Getting the proper treatment changed my life.
Unfortunately, awareness for psoriasis (and psoriatic arthritis) is low in the African American community and other minorities. My goal is to help find more research and bring more awareness to this disease so that we can get the proper treatment that is needed.
Over the years I have been an active advocate for psoriasis and psoriatic arthritis, and I am now Executive Director of the nonprofit Psoriasis Network Support. To visit the website: www.psoriasisnetwork.org