Psoriasis on Black and Brown Skin: What It Looks Like and How It's Treated
How psoriasis looks on darker skin, why it can be missed or under-treated, and what to know about treatment and dark marks.
Part of our psoriasis guide.
Get urgent help first. Call 999 or go to A&E if your skin suddenly becomes red and inflamed over most of your body, or you have widespread pus-filled spots, especially with a fever, chills or feeling very unwell. These can be signs of erythrodermic or generalised pustular psoriasis, which are emergencies. See a GP soon if you have painful, swollen joints. Online treatment isn't suitable in these situations.
Key fact: on brown and black skin, psoriasis plaques often look purple, dark brown or grey rather than red, with thick scale. Because redness is harder to see, psoriasis can be missed or its severity underestimated.
Adults only online, and not in pregnancy or breastfeeding. Access Doctor's online psoriasis service is for adults aged 18 and over, and can't supply treatment if you're pregnant or breastfeeding: your GP or midwife can help. Children with psoriasis should see their GP.
What psoriasis looks like on black and brown skin
Most pictures of psoriasis show pink or red plaques with silvery scale on white skin. On brown and black skin, psoriasis often looks different, which can lead to it being missed, diagnosed late or mistaken for something else.
- Colour: plaques may be purple, dark brown, violet or greyish rather than red. Redness can be hard to see.
- Scale: often thick and grey or white, and may be more noticeable than the colour change.
- Edges: still usually sharply defined.
- Scalp: scalp psoriasis is common and can be confused with dry scalp or seborrhoeic dermatitis.
- After it clears: the skin may stay darker (hyperpigmentation) or lighter (hypopigmentation) for months.
Why severity can be underestimated
Doctors often judge how inflamed psoriasis is by its redness. On darker skin, less visible redness can make psoriasis look milder than it is, so it may be under-treated. Tell your doctor how much it itches, hurts and affects your life, and point out the thickness and scale of the plaques.
Conditions it can be mistaken for
On darker skin, psoriasis can be confused with eczema, lichen planus, fungal infections, seborrhoeic dermatitis and discoid eczema. If treatment isn't working, ask whether the diagnosis should be reviewed. Our guide to psoriasis vs eczema explains the main differences.
Treatment on darker skin
Psoriasis is treated in the same way on all skin tones, following the NICE treatment steps. A few points matter more on darker skin:
- Treat early to reduce the risk of long-lasting dark or light marks after plaques clear.
- Coal tar and dithranol can stain the skin and hair; dithranol in particular can leave temporary brown-purple staining.
- Light therapy can darken the skin temporarily; doses are adjusted to skin type.
- Steroids used for too long on thin skin can cause lightening, so stick to the course length.
- Scalp care: some scalp products and frequent washing can dry out textured hair. Ask about formulations that suit your hair, such as oils, lotions or foams, and see scalp psoriasis treatment.
Dark and light marks after psoriasis
Darker or lighter patches after psoriasis clears are not scars and usually fade over months. Controlling psoriasis is the best way to prevent new marks. Daily sunscreen on exposed areas helps dark marks fade evenly. If marks are troubling you, ask your GP.
Psoriasis on your body, arms or legs?
Our GPhC-registered pharmacist independent prescribers can assess your psoriasis online and, if suitable, prescribe treatment. Adults 18 and over. Dispensed from our UK pharmacy. Approved before 3pm, Monday to Friday? Dispatched the same day, by Royal Mail Tracked 48, Tracked 24 or Special Delivery guaranteed by 1pm next working day: you choose.
Start Psoriasis Consultation →How our online service supplies psoriasis treatment: adults 18 and over, not for the face, genitals or skin folds. Enstilar, Dovobet and other psoriasis-only treatments need psoriasis already diagnosed by a GP or dermatologist. Enstilar and Dovobet: one pack per order, supplied as a course of up to 4 weeks, on no more than 30% of the body. Betnovate and Elocon: up to 3 × 30g or 1 × 100g, for a 4-week course followed by a 4-week break. Dermovate only if you have been prescribed it before. Widespread psoriasis, joint pain or psoriasis that hasn't responded to treatment is referred to your GP.
UK safety and reporting side effects
Prescription psoriasis treatments are only supplied after a GPhC-registered pharmacist independent prescriber reviews your consultation, including where your psoriasis is, how much skin it covers and what you have used before. Always read the patient information leaflet. Since 2024, UK steroid packs show their strength on the front (mild, moderate, strong or very strong). The MHRA advises using topical steroids for the shortest time needed, and to tell a healthcare professional if your skin flares badly after you stop a steroid you have used for a long time, which can be a topical steroid withdrawal reaction.
If you think you've had a side effect, tell your pharmacist or doctor. You can also report it to the MHRA through the Yellow Card scheme.
Psoriasis treatments from Access Doctor
Following an online consultation, our prescribers can supply the treatments below where suitable, as part of our psoriasis treatment service.
Vitamin D + potent steroid · Rx
Enstilar Foam
Calcipotriol with betamethasone in a spray foam, once a day for up to 4 weeks. For diagnosed plaque psoriasis.
View product →Potent steroid · Rx
Betnovate Ointment
The greasier form, better for thick, dry or scaly plaques.
View product →Potent steroid · Rx
Elocon Cream
Mometasone 0.1%, applied once a day.
View product →Vitamin D + potent steroid · Rx
Dovobet Gel
Calcipotriol with betamethasone, for the scalp and for mild to moderate plaque psoriasis on the body.
View product →Frequently Asked Questions
What does psoriasis look like on black skin?
Plaques are often purple, dark brown, violet or greyish rather than red, with thick grey or white scale and sharp edges. After they clear, the skin may stay darker or lighter for a while.
Is psoriasis less common on black skin?
It's reported less often in people with black skin, but part of the reason may be that it's missed or misdiagnosed, because most medical pictures show white skin.
Will psoriasis leave dark marks?
It often leaves darker or lighter patches as it clears, especially on brown and black skin. These usually fade over months. Treating psoriasis early and using sunscreen on exposed skin helps.
Is psoriasis treated differently on darker skin?
The same treatments are used on all skin tones. On darker skin, it matters more to treat early, to know that coal tar and dithranol can stain, and to choose scalp products that suit your hair.
Can psoriasis on black skin be mistaken for eczema?
Yes. On darker skin psoriasis can be confused with eczema, lichen planus, fungal infections and seborrhoeic dermatitis. If treatment isn't working, ask for the diagnosis to be reviewed.
References
- British Association of Dermatologists. Psoriasis: an overview (patient information leaflet), August 2023. skinhealthinfo.org.uk
- NICE Clinical Knowledge Summaries. Psoriasis. cks.nice.org.uk
- NHS. Psoriasis. nhs.uk
- NICE. Psoriasis: assessment and management (CG153). nice.org.uk
Medical disclaimer: This article is for information only and isn’t medical advice. Prescription psoriasis treatments need a clinical consultation before they can be supplied. If your skin is red all over, you have widespread pus spots, a fever or you feel unwell, seek medical advice the same day. In a medical emergency, call 999.