Proceedings of the Fifth SKIN SPECTRUM SUMMIT

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Clearing of psoriasis plaques may not mean the
end of treatment for patients with skin of colour
Dr. Andrew F. Alexis
In a presentation on psoriasis in pigmented
skin delivered at Skin Spectrum Summit in
Montreal, Dr. Andrew F. Alexis asked his audience
to keep an open mind while diagnosing
the skin disorder and to take into account the
patient’s concerns about hyperpigmentation.
“You need to really look head to toe at the patient
and, if it just does not fit, have a low threshold
for biopsy,” he said while referring to a patient with
sarcoidosis, which he called “one of the great imitators”
of psoriasis in darker-skinned patients.
The quality of life impact of psoriasis can be
greater in people with skin of colour, he said, which
makes it even more important for a dermatologist to
get the diagnosis right the first time and to take into
account some cultural and aesthetic concerns as
well.
Dr. Alexis explained why the quality of life is impacted
more so in people with skin of colour.
“It is probably that the associated pigmentary alterations
contribute to a greater quality of life impact,”
he said.
Some cultural aspects to perceiving the disease
may also play a role, he explained.
To demonstrate this, he showed an example of
a patient whose psoriatic scaling had improved with
treatment, along with redness and other symptoms,
but who was left with hyperpigmented patches on
her legs.
“In a research study, she might be considered a
treatment success, but in real life, she doesn’t think
the treatment is even working because functionally
she still can’t comfortably expose her skin.”
Clearing up both plaques and pigment alteration
can become part of the treatment in darkerskinned
patients, he said. This persistent pigment
alteration may lead to a much longer treatment period
for patients with skin of colour.
He stated that after clearing the psoriasis, he will
start working on the hyperpigmentation with topical
bleaching agents.
When it comes to data on the treatment of psoriasis
in skin of colour, Dr. Alexis said they are quite
limited.
“When you look at all of the studies, there is one
consistent theme: the demographics hover around
90 per cent Caucasians.”
For this reason, there are fewer data for patients
with skin of colour.
Dr. Alexis said has worked with the data that do
exist and has not found any safety or efficacy differences
in any of the treatments for psoriasis.
Regarding his clinical impression of treating hyperpigmentation
before it becomes a problem, Dr.
Alexis said this: “Early and appropriately aggressive
treatment might reduce the impact of the severity
and duration of hyperpigmentation.”
Signs of psoriasis
Dr. Jaggi Rao
28 • Proceedings of 2019 SKIN SPECTRUM SUMMIT
changes may indicate
psoriatic arthritis
“Nail
as nails are an extension
of the skin itself,” said Dr.
Jaggi Rao in a presentation at Skin
Spectrum Summit in Vancouver.
Dr. Rao described psoriasis as
an immune-mediated chronic inflammatory
skin condition that impairs
the physical and emotional aspects
of an individual’s life. He states
that “nothing is destroying or attacking
the skin; it has to do with the influence
of the immune system to
create the reaction we see.” Dr. Rao
lists the five main types of psoriasis
as psoriasis vulgaris, guttate psoriasis,
pustular psoriasis, inverse psoriasis
and erythrodermic psoriasis.
Psoriasis vulgaris is the most common
as it is seen in 80 to 90% of all
psoriasis cases. Guttate psoriasis is
caused by the presence of group A
streptococcus. Pustular psoriasis,
identified through the studded pustules
commonly found on palms and
soles, and erythrodermic psoriasis,
which involves blood vessel dilation
(which can change thermal regulation),
are both types that require
emergency urgent care.
Psoriatic arthritis can be identified
through the change in appearance
of the nails. Dr. Rao explained
that nails “do not have blood vessels
but have keratin and different forms
of skin cells.” Some changes that
occur can be pits and grooves,
white-yellow discolouration, separation
of the nail from the nail bed, a
thickened plate, scales of the nail
bed, splinter hemorrhages, pustules