Psoriasis affects people of all races and ethnicities, but those with skin of color (SoC) may face unique challenges, including barriers to health care access, obstacles to diagnosis, and difficulties surrounding treatment. Data recently presented at Maui Derm Hawaii 2025 can help inform treatment considerations for patients with psoriasis and SoC.

Following these presentations, featured expert Jason Ezra Hawkes, MD, MS, FAAD, was interviewed by Conference Reporter Associate Editor-in-Chief Rick Davis. Clinical perspectives from Dr Hawkes on these findings are presented here.

In the last few years, the topic of psoriasis in patients with SoC has come to the forefront. We are seeing the emergence of dedicated programs in the research, advocacy, and clinical trial spaces to address some of the unique challenges and barriers that patients with psoriasis and SoC face. These clinical challenges include lower or limited disease awareness, unique clinical presentations, delays in diagnosis and treatment, inferior treatment offerings, and worse treatment outcomes. Some of these challenges can be explained by the difficulty assessing psoriasis in SoC, but we also know that patients with SoC are more likely to be offered inadequate treatments more often than White patients with psoriasis.

The Psoriasis Area and Severity Index (PASI) has to be performed carefully in patients with SoC because, typically, erythema is often present in such individuals even though it cannot easily be seen. Other unique aspects of psoriasis in SoC include dyschromia or postinflammatory hypopigmentation and hyperpigmentation, which can be quite bothersome or distressing to our patients with psoriasis. Further, some additional information may be necessary to help alleviate patient concerns about dyspigmentation or misunderstandings about the safety of systemic and biologic treatments in SoC populations.

Data from cohort A of the VISIBLE study were presented at the recent Maui Derm Hawaii 2025 meeting. Andrew Alexis, MD, MPH, and colleagues evaluated response to treatment with guselkumab and treatment safety in patients with moderate to severe plaque psoriasis across all skin tones. I like to see these types of research efforts, where clinical trial programs are intentionally trying to improve diversity and specifically design studies around groups of patients who have historically been excluded or underrepresented in clinical trials. It is great for patients to see treatment responses in individuals whom they can self-identify with and in skin that looks like their own, and we now have data showing treatment responses and safety in this subset of the general population that we can now reference with our patients.

Victoria Barbosa, MD, et al presented data at Maui Derm Hawaii 2025 on some of the racial and ethnic disparities among patients with psoriasis and SoC. This study highlighted just how prevalent some of the gaps in psoriasis management are, and it is important for providers to recognize the potential systemic limitations and inequities in the health care system. An awareness of these ethnic disparities may be even more important for trainees and practitioners working in areas with limited diversity or during interactions with patients with psoriasis who identify as having SoC.

Finally, at Maui Derm Hawaii 2025, we also saw data from studies of medications with different mechanisms of action being studied in patients with SoC, such as inhibition of IL-17A with ixekizumab. A real-world study by Chesahna Kindred, MD, MBA, FAAD, and colleagues examined whether patients with psoriasis and different Fitzpatrick skin types had a differential response in their skin, nails, and/or scalp when treated with ixekizumab. Importantly, researchers found that targeted therapy with ixekizumab worked well across all skin types. This is important because it reinforces that we do not need to offer different treatment options to patients with darker skin types. Instead, we are able to offer patients with SoC reassurance that they can achieve a similar treatment response as their White counterparts with similar disease characteristics.

The call to action among advocacy groups, the health care system, and providers is to acknowledge that inequities exist and to inspire efforts to proactively work to mitigate the negative consequences of these disparities on this patient population. We must be cognizant of these inequities as we treat patients with SoC and try to eliminate them so that these individuals can benefit from the same offerings that White patients have historically had for their psoriasis.