Racial Disparities in Psoriasis Treatment: A Review of Prescription Patterns and Outcomes Across White and Skin of Color Populations

¹Edward Via College of Osteopathic Medicine, Auburn, AL, USA

²Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA

³CUNY School of Medicine, New York, NY, USA

⁴University of Missouri School of Medicine, Columbia, MO, USA

⁵University of California, Riverside School of Medicine, Riverside, CA, USA

⁶Marian University College of Osteopathic Medicine, USA

⁷The Ohio State University College of Medicine, Columbus, OH, USA

⁸Kansas City University College of Medicine, Kansas City, MO, USA

⁹Department of Dermatology, Northwell Health, New Hyde Park, NY, USA

*Corresponding author: Kelly Frasier, DO, MS, Department of Dermatology, Northwell Health, New Hyde Park, NY, USA, Phone: 3105956882, Email: [email protected]

Received Date: January 07, 2025

Publication Date: February 10, 2025

Citation: Hash MG, et al. (2025). Racial Disparities in Psoriasis Treatment: A Review of Prescription Patterns and Outcomes Across White and Skin of Color Populations. Dermis. 5(1):28.

Copyright: Hash MG, et al. © (2025).

ABSTRACT

Psoriasis treatment demonstrates significant racial disparities, with Black patients and other individuals with skin of color experiencing higher disease severity yet receiving less access to advanced therapies compared to White patients. This review examines existing literature on differences in prescription patterns, treatment modalities, and clinical outcomes for psoriasis in White versus Black populations. Focus is placed on biologics, systemic non-biologic therapies, phototherapy, and topical treatments, highlighting inequities in treatment access, clinician decision-making, and infrastructure availability. Black patients are consistently underprescribed advanced therapies, such as IL-17 and IL-23 inhibitors, despite evidence supporting their efficacy in severe plaque-dominant phenotypes. Instead, systemic corticosteroids and methotrexate are disproportionately prescribed, even though they are associated with suboptimal outcomes and higher side-effect profiles. Phototherapy, while effective for darker skin types, is less frequently recommended due to barriers including access and clinician unfamiliarity with tailoring treatment for skin of color. Emerging data suggests that the specialty of the prescribing clinician plays a role in these disparities, with non-dermatologists being less likely to initiate biologic therapies and more likely to prescribe older systemic treatments. Additionally, structural barriers, including limited access to dermatologists and phototherapy centers equipped for darker skin tones, exacerbate inequities. This review identifies key gaps in understanding, including the impact of implicit bias on treatment decisions, differences in adherence and patient-reported outcomes by race, and the role of systemic factors such as insurance coverage and geographic access to care. Strategies to address these disparities include expanding education for non-dermatologist providers, improving infrastructure for phototherapy, and incorporating culturally sensitive approaches into patient education and clinician training.

Keywords: Psoriasis, Racial Disparities, Treatment Modalities, Skin of Color, Biologic Therapies