In this episode of MD Newsline, we sit down with Dr. Meena Singh, a board-certified dermatologist and dermatologic surgeon, to discuss psoriasis—its causes, diagnosis challenges, and the latest advancements in treatment. Dr. Singh provides valuable insights into how psoriasis presents in different skin tones, the role of the gut microbiome, and emerging biologic therapies. She also highlights the importance of early diagnosis, collaborative care between primary physicians and dermatologists, and the potential impact of lifestyle modifications.

Episode Highlights:

Psoriasis Risk Factors & Diagnosis

Psoriasis is a multifactorial condition influenced by genetics, immune markers, and environmental triggers. While genetic predisposition plays a role, studies show that even identical twins do not always share the condition. Researchers have also identified gut microbiome profiles that may contribute to immune dysregulation, further linking intestinal health to psoriasis. The condition affects 2% of the general population, but for individuals of African descent, it has a higher impact on quality of life, likely due to delayed diagnosis and differences in presentation.

Diagnosing psoriasis presents unique challenges, particularly in skin of color, where the condition may not have the typical silvery scale seen in lighter skin tones. Many patients initially try natural remedies before seeking medical attention, which can lead to delays in diagnosis and treatment. The journey from primary care to dermatology is often lengthy, and even when patients do seek care, misdiagnosis remains a concern. Psoriatic arthritis, a common comorbidity, is also frequently underdiagnosed, as many patients do not initially recognize joint pain as a symptom.

Challenges in Diagnosis & Gaps in Care

Severity of psoriasis is graded using the PASI Index, which assesses body surface area affected and symptom intensity. Mild cases are often treated with topical steroids, vitamin D analogs, and newer topical JAK inhibitors, while moderate to severe cases may require biologic therapies targeting specific inflammatory pathways like IL-17, IL-12/23, and JAK inhibitors. Recent advancements have led to highly effective biologic medications, and researchers are now exploring oral small molecules that could provide targeted treatment without injections.

The Future of Psoriasis Treatment

Looking ahead, the future of psoriasis treatment is shifting toward personalized medicine, with research focusing on genetic and cytokine profiling to tailor therapies to individual patients. While there is still no cure, patients can achieve remission for months or even years with the right combination of therapies. In addition to medical treatments, lifestyle modifications such as diet and exercise can play a significant role in reducing inflammation and improving overall health. Collaboration between dermatologists and rheumatologists is crucial in managing both psoriasis and its associated conditions, such as psoriatic arthritis, cardiovascular disease, and inflammatory bowel disease.

As research continues to evolve, new treatment options are on the horizon that may revolutionize psoriasis care. However, psoriasis remains a chronic condition, and ongoing management is essential to maintaining a high quality of life.

Key Takeaway:

Psoriasis in skin of color is often misdiagnosed because it appears more purple or hyperpigmented rather than the classic red plaques with silvery scale, leading to delayed diagnosis and treatment. New biologic therapies, including IL-17 and IL-12/23 inhibitors, have significantly improved outcomes for moderate to severe cases, with promising oral treatments on the horizon. Psoriatic arthritis is a common but underdiagnosed condition, as many patients don't recognize joint pain as a symptom, making early detection by dermatologists crucial.

Resources & Links:

Website: MD Newsline
Newsletter: Subscribe Here

Connect with Dr. Meena Singh: Skin and Hair Center