Diagnosing Psoriasis in patients of color can be tricky. We sat down with Dr. Hope Mitchell to learn more about Psoriasis–how it’s diagnosed, progression, treatments and more.
A native of Brooklyn, New York, Dr. Mitchell attended the University of Rochester and graduated with a Bachelor of Arts in Biology. She obtained her doctorate of medicine from The Medical College of Ohio (MCO). She also completed an internship in Internal Medicine and a Pathology Fellowship while at MCO and a residency in Dermatology at Henry Ford Hospital in Detroit, Michigan. Dr. Mitchell is certified by the American Board of Dermatology and is a fellow of the American Academy of Dermatology.
Dr. Mitchell is an Ohio and Michigan board-certified dermatologist and the founder & CEO of Mitchell Dermatology. With over 25 years of experience in the medical field, she is an accomplished, highly qualified dermatologist and entrepreneur. As the director of operations of Mitchell Dermatology Center of Northwest Ohio and Commerce Medical Partners, she manages the Perrysburg location and the company’s satellite locations in Fremont and Fostoria, Ohio.
MDNewsline: How does psoriasis present on darker skin? How is this different from its presentation on lighter skin?
Dr. Hope Mitchell: Although skin disease can affect anyone, it may not affect African Americans the same way as it would Caucasian patients. In fact, some conditions can affect patients of color more severely. Skin rashes such as psoriasis may have high-grade inflammation or redness mixed with discoloration or hyperpigmentation in patients of color. The condition presents with red, gray-brown dry areas that tend to leave dark patches which in turn may take a long time to clear. For many, it is the hyperpigmentation that is of greater concern than the rash. In patients with lighter skin tones, psoriasis presents with red areas that are less likely to leave long-lasting residual markings.
MDNewsline: How does psoriasis progress?
Dr. Hope Mitchell: Psoriatic arthritis tends to develop five to twelve years after psoriasis starts. Approximately three in ten people with psoriasis may eventually get psoriatic arthritis (PsA); however, people with PsA don’t always have psoriasis first. Arthritis precedes psoriasis in 15-20% of people. Advancement of the skin condition to involve greater body surface area along with joint stiffness and pain, drive many patients into the doctor’s office to seek treatment. Many people assume they have ‘arthritis’ but don’t correlate it with psoriasis.
MDNewsline: What are some common misconceptions by HCPs about psoriasis that need to be addressed?
Dr. Hope Mitchell: A common misconception is that there are no safe treatments for advanced cases of psoriasis and that steroids are the only treatment option. Although steroids had been the mainstay of treatment, we know there can be significant thinning of the skin with long term use, bone thinning, and possibly even endocrine abnormalities.
Another misconception is that psoriasis is just a rash, dry skin, a cosmetic issue, or only affects Caucasian people. Some may believe it’s contagious and others don’t know it is a serious condition that has associated comorbidities such as type 2 diabetes, lymphoma, cardiovascular disease (including stroke), and inflammatory bowel disease. Depression is also twice as common among people with psoriasis.
Common misconceptions surrounding psoriasis can result in stigmas and psychological burdens for those living with this condition. Psoriasis is more than a skin disease. For many, the scaly plaques on the skin can make one feel embarrassed, anxious, and depressed.
MDNewsline: Why is psoriasis often misdiagnosed as and how can HCPs avoid making some of these misdiagnoses?
Dr. Hope Mitchell: Sometimes a diagnosis of psoriasis can be challenging for dermatologists to make, especially in patients of color, and hence the grouping of skin conditions that look like psoriasis into a diagnosis of psoriasiform dermatitis may be used.
Although Psoriasis is the most common autoimmune condition in the United States its diagnosis is not always straightforward. It may be confused with eczema in some cases. Taking a detailed history and paying close attention to the areas involved in the physical examination is important.
Looking for other clues like nail and joint involvement may also be helpful in making a diagnosis of psoriasis. Psoriasis often involves the elbows and knees while eczema involves the insides of the arms and knees. When history and physical examination don’t provide enough information, a biopsy should always be considered because there are new treatment options geared at targeting specific pathways in the immune process of psoriasis.
MDNewsline: What are the most recent breakthrough therapies for psoriasis?
Dr. Hope Mitchell: Biologics are a class of medications that can quiet the immune system and curtail the condition. They are injectable medications that target specific parts of the immune system. The biologics used to treat psoriasis block a specific immune cell called a T cell or they block specific proteins in the immune system like interleukins 12, 23, or tumor necrosis factor-alpha (TNF-alpha) which play a major role in developing psoriasis and psoriatic arthritis.
MDNewsline: What are you looking forward to in the field?
Dr. Hope Mitchell: I am looking forward to seeing the disparity gap closed and continued education of the public and medical professionals as we debunk a lot of myths that may stigmatize people with this condition. While it is not contagious, it is a serious condition and requires medical attention right away. Many people are not aware of the new biologic treatment options and if they have heard of them, they may believe they are harmful or toxic or simply that they are not a candidate for these innovative and safe medications.
I look forward to patients advocating one hundred percent for themselves. That by advocating, they get all of their questions answered at medical appointments and that they not be afraid to seek a second opinion if necessary.
Remember when diagnosed with a chronic skin condition, it is always a good idea to check in yearly with a board-certified dermatologist for new treatment options. Part of the accountability check-up is always making sure you stay up to date on your medical condition so that you can take advantage of new treatments for chronic medical conditions, like psoriasis.
Follow Dr. Hope Mitchell on Instagram at @drhopemitchell