Psoriasis within the US Hispanic Population: What Can Be Done to Diversify Clinical Data?

Mona Shahriari

With September marking Hispanic Heritage month in the United States, Dermatology Times’ spoke with several leaders in the field to understand the level of diversity, research, and data associated with specific dermatological conditions within the US Hispanic population.

Mona Shahriari, MD, FAAD, an assistant clinical professor of dermatology at Yale University and the associate director of clinical trials at Central Connecticut Dermatology (CCD) Research, shared her insights into psoriatic disease within the US Hispanic population.

Q&A

Dermatology Times: How prevalent is psoriasis among the Hispanic population in the US compared to other ethnic groups?

Mona Shahriari: The prevalence of psoriasis is about 1.9% in the Hispanic population of the US. However, this number may be under-reported owing to underdiagnosis, selection bias, and lower utilization of the health care system in the Hispanic population in comparison to their Caucasian counterparts.

DT: What are the common clinical manifestations of psoriasis seen in Hispanic patients? Are there any unique presentations compared to other populations?

Shahriari: The clinical presentation of plaque psoriasis can vary based on a patients' skin tone. For example, in lighter skin, the plaques of psoriasis can appear red or pink, however, in Hispanic patients with melanin rich skin, these plaques can be dark brown, violet, or even gray which can lead to challenges in diagnosing psoriasis in Hispanic patients. Moreover, studies show that Hispanic patients are more likely to have scalp involvement as part of their overall psoriasis picture in comparison to their Caucasian counterparts. And in those patients that have textured or tightly coiled hair, psoriasis of the scalp can be particularly challenging to treat.

DT: What are the most used treatment modalities for psoriasis in Hispanic patients, and are there any cultural considerations influencing treatment choices?

Shahriari: The most common treatments are topical therapies. Studies show that Hispanic patients are less likely to receive a systemic agent, including a biologic for their plaque psoriasis. This is partly due to underestimation of disease severity on melanin rich skin, mistrust in the healthcare system, health literacy and even access barriers. Cultural factors also play a role. In Hispanic culture, many times patients think their disease is caused by an internal imbalance and may seek the help of a healer and try herbal medicine before agreeing to a systemic medication prescribed by an allopathic clinician. Cultural sensitivity is a key part of the treatment regimen to ensure trust between the clinician and patient forms and guides treatment decisions.

DT: How effective are current psoriasis awareness and education campaigns in reaching the Hispanic community?

Shahriari: We have made significant strides in including Hispanic patients in advertising and social media campaigns to improve psoriasis awareness and education in these populations. However, there is still an under-representation of images of plaque psoriasis in Hispanic patients which is an unmet need that we are actively trying to address. And there are still significant knowledge gaps about psoriasis in our Hispanic patients that large educational campaigns are trying to address. Clearly, there is still work to be done to ensure all patients feel knowledgeable about their skin disease and feel empowered to ask their clinician about treatment options for their psoriasis.

DT: How does the lack of research into psoriatic disease in Hispanic patients impact the development of effective treatment protocols?

Shahriari: The under-representation of Hispanic patients in our clinical trials leaves us with limited data on the safety and efficacy of our FDA approved therapeutics for psoriasis in this population. This can make it more challenging to educate patients on what they can expect from a systemic therapy and whether their response will be similar or dissimilar to what we see in our current clinical trials for various therapeutics. The lack of concrete data can make it more challenging for a Hispanic patient to agree to trying a novel biologic for psoriasis versus a topical which has fewer risks but may not be efficacious enough to control the psoriasis.

DT: What future research directions are needed to better understand and address psoriasis within the US Hispanic population?

Shahriari: We need clinical trials that capture the racial and ethnic diversity of the US population that we see in everyday clinical practice. This is the only way that we can take the results of a clinical trial and apply it to our real-world patients in clinical practice. These studies can give us information on the safety and efficacy of various therapies in patients, across skin tones and racial/ethnic backgrounds, but they can also make us aware of the unique challenges that various populations face when it comes to navigating their psoriasis diagnosis and treatment journey which can impact their ability to get the care they need and deserve.

DT: How can dermatologists, researchers, and community groups advocate for more research focused on psoriatic disease in the US Hispanic population?

Shahriari: So far, efforts of clinicians and researchers have led to the FDA mandated diversity requirements in clinical trial design that is meant to improve representation of all groups, including Hispanics, in dermatology clinical trials. Moreover, advocating for NEW clinical trial sites and NEW investigators can improve the diversity in clinical trials. The National Psoriasis Foundation has many patient and clinician focused resources and can be a great resource with a lot of reach to help further guide clinicians, researchers and community groups in advocacy efforts.

DT: What are the potential consequences of not addressing the research gap in treating psoriatic disease among Hispanic patients, both in terms of patient outcomes and healthcare equity?

Shahriari: Hispanic patients with plaque psoriasis face unique challenges when it comes to navigating their diagnosis and treatment journey. By continuing to have research gaps in the treatment of psoriatic disease, we are standing in the way of high-quality equitable care for all patients, including Hispanic patients. These gaps can lead to delays in diagnosis of psoriasis and delays in starting appropriate systemic therapy which can ultimately result in negative health outcomes for these patients. And one thing is clear, everyone deserves to have access to an inclusive health care system that recognizes them for their own unique self with a customized approach to treatment, which is why the research gap needs to be prioritized.