The Utility of Topical Treatment in Skin of Color

EP: 1.Challenges With Topical Psoriasis Treatments and the Need for Simpler Options

EP: 2.Why Treating Scalp Psoriasis With Topicals Remains a Challenge

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EP: 3.The Utility of Topical Treatment in Skin of Color

Diagnosing and managing psoriasis in patients with skin of color poses unique clinical challenges. One major issue is the variation in how erythema presents. Although classically trained clinicians often look for pink or salmon-colored plaques, psoriasis in richly pigmented skin may appear violaceous, gray, or reddish-brown, making it harder to identify. The classic silvery scale may also be less visible, and pigmentation changes—either from the disease itself or from treatment—can further obscure diagnosis. These challenges can lead to delayed recognition and more advanced disease by the time patients receive proper care.

Hair texture, cultural grooming practices, and common use of oils or emollients among patients with skin of color can also obscure clinical findings or interfere with vehicle efficacy. For example, alcohol-based solutions may be drying and irritating, particularly in Afro-textured hair or on damaged scalp skin. Moreover, providers may feel uncertain diagnosing overlapping conditions such as sebopsoriasis or atopic dermatitis in these populations. In such cases, a topical treatment with broad efficacy across multiple inflammatory conditions becomes especially valuable, offering an effective option when the precise diagnosis is still being refined.

Importantly, although patients with skin of color often present with more severe disease, they are statistically less likely to be offered systemic therapies. This gap may be due to health literacy barriers, mistrust of the medical system, or limited clinical trial data on systemic treatments in these populations. For these reasons, topicals are often a more acceptable and accessible first-line option. A safe, effective, and cosmetically elegant topical agent can empower both patients and providers to manage disease earlier and more confidently, offering a practical and culturally sensitive solution while minimizing systemic risk.