Psoriasis in skin of color: clinical presentation, diagnostic challenges, and therapeutic considerations

Psoriasis in individuals with Skin of Color (SOC) shows distinctive clinical features and particularities that require careful consideration for accurate recognition and care. Erythema is often less apparent, and plaques may appear violaceous or dark brown. These features, together with limited discussion of these nuances in textbooks and articles, contribute to delayed diagnosis, greater reliance on skin biopsy, and reduced diagnostic accuracy. Although overall prevalence may be lower than in White populations, SOC patients frequently present with greater body-surface involvement, thicker scale, and a disproportionate impact on quality of life. Early, effective control is critical not only to limit systemic comorbidities and quality of life impairment but also to prevent post-inflammatory dyspigmentation, which can persist for years after clinical resolution and substantially affect psychosocial well-being. Despite major advances in psoriasis research, important gaps remain regarding genetic drivers, immunopathogenesis, and the comparative effectiveness and safety of therapies across diverse populations, gaps compounded by the persistent underrepresentation of SOC in clinical trials. This review synthesizes current evidence on epidemiology, clinical presentation, diagnostic pitfalls, pigmentary sequelae, psychosocial dimensions, and therapeutic options so as to support equitable, patient-centred outcomes for SOC patients living with psoriasis.