For one million Canadians living with psoriasis—a skin condition that causes inflamed, scaly flare-ups that can itch, crack, and bleed— it’s a daily reality that can influence how quickly they’re diagnosed and how effectively they’re treated.

This chronic immune-mediated inflammatory skin condition that’s supposed to be “easy to spot” becomes harder to see when it appears on darker skin—those angry red plaques from medical textbooks may show up as violet, grey, or brown.

While medicine has made remarkable advances in treating this inflammatory skin disease, people of colour may still encounter challenges in diagnosis and treatment because the medical system has largely been built around lighter skin tones.

“The appearance of the condition may not be as immediately recognizable due to the colour variations in plaques, inflammation, and pigmentation,” explains Dr. Marissa Joseph, a leading dermatologist and one of the authors of the 2024 Canadian Skin of Colour Consensus paper.

“Visibility of inflammation can be reduced on pigmented skin, which might cause a delay in diagnosis and treatment initiation. In addition, post-inflammatory pigmentation changes—where skin darkens or lightens after inflammation—can also mask underlying psoriasis symptoms entirely.”

When textbooks do not tell the full story

According to Dr. Joseph, only 4-19% of the images in dermatology textbooks represent conditions on darker skin, and just 14.2% of participants in clinical trials for psoriasis treatments are non-white.

“When you don't see yourself in the research, in the imagery, or in your doctor's understanding—it makes you feel invisible,” Dr. Joseph explains.

Beyond clinical challenges, many communities of colour also face cultural stigma around skin conditions. When combined with healthcare providers who may not be fully equipped to diagnose or treat diverse skin tones, this can contribute to gaps in care and feelings of being overlooked.

A consensus for change

That’s why Johnson & Johnson supported the development of a Canadian-first, the Canadian Skin of Colour Consensus Forum, developing consensus statements to establish a new standard of care. In 2024, Canadian dermatologists came together to confront the deep-rooted gaps in psoriasis care for people of colour. Their work resulted in 24 actionable recommendations aimed at transforming care for this underserved population.

The consensus findings are sobering: patients of colour are more likely to be misdiagnosed, less likely to receive advanced therapies, and don’t always encounter culturally competent care. What should be a straightforward diagnosis instead becomes a medical mystery, forcing patients to bounce between specialists as their symptoms worsen.

The Statement’s top priorities are clear:

• Increase representation of people of colour in clinical trials
• Overhaul medical training and textbooks with images and case studies reflecting all skin tones
• Encourage culturally competent care and patient advocacy
• Integrate these recommendations into national clinical guidelines

Tackling these disparities head-on, the group is calling for an end to outdated diagnostic shortcuts—like using race as a proxy for skin type.

They’re also rethinking how severity is measured, moving away from redness-based scales that don’t capture the reality for darker skin, considering hair texture in scalp psoriasis treatments, and addressing pigmentary risks in care plans.

“You can’t just prescribe the same shampoo and expect the same outcome,” says Dr. Joseph. “Scalp psoriasis in a Black patient is a completely different clinical picture.”

By tackling these nuances head-on, the Consensus statements are aiming to set a new standard for culturally competent, individualized care—one that sees every patient for who they are.

The reckoning

For many Canadians with darker skin living with psoriasis, these changes could help ensure their symptoms are recognized and their experiences acknowledged.

“We remain committed to improving care for all patients, ensuring people of all skin tones have access to the best possible treatments,” says Dr. Joseph. “There is hope we can create a better standard of care.”

Still, the Consensus is only a starting point, real change requires medical schools, policymakers, and industry stakeholders to implement these recommendations. Clinical trials must prioritize inclusion. Guidelines must evolve. Every patient—regardless of skin colour—must be seen, believed, and treated with dignity.

The question isn’t whether medicine can adapt to serve all Canadians equally. It’s whether we’ll demand that it does.

Sponsored by Johnson and Johnson