I'm a Woman of Color With Psoriasis, but That Diagnosis Wasn't Easy to Get

According to the National Psoriasis Foundation, around 125 million people have psoriasis — that's two to three percent of the population — including me. Psoriasis is an autoimmune disorder whereby the immune system is overactive and produces new skin cells at an abnormally rapid rate. New skin cells typically take about a month to form and shed, but for those with psoriasis, new cell development can happen in as little as three days and the shedding process doesn't take place. This results in thick, scaly patches of skin that can itch and burn, as well as crack, bleed, and peel. The cause of psoriasis isn't clear, and there is no known cure — just techniques and medications to manage the symptoms.

My psoriasis started in 2017 when I was 20 years old in college; it began with a small patch on the top of my left foot. This isn't a common area for psoriasis, which usually develops around the elbows, knees, and scalp. It started off as itchy skin, which I would scratch in my sleep, causing it to become sore and inflamed. This cycle continued and slowly spread over eight years, and I have yet to find a solution for it. Luckily, it has remained on my feet, though it does now affect both of them and my ankles. I go through phases where new patches pop up anywhere from my elbows and knees to the back of my neck, under my eyes, and even in my belly button.

One of the most frustrating parts of my psoriasis journey (beyond the condition itself) was the lack of understanding within the medical community. I was misdiagnosed multiple times over five years before I received a psoriasis diagnosis in 2022. I think one of the main reasons is that psoriasis, along with many other skin conditions, is taught to medical students on white skin, where the symptoms look completely different. My psoriasis patches do not have any redness and look completely different than most pictures I've seen online. This meant for years, I was given treatments for eczema, dermatitis, and various other conditions before it was finally identified as an autoimmune disorder.

There are many things that supposedly help with psoriasis, and so many people believe they have the answer because it worked for a friend of a friend. For several years, I struggled to wear anything that showed my feet in public because it would inevitably lead to questions and end with me being recommended a dairy-free diet, a juice cleanse, or an "all-natural" cream from an overseas homeopath, or given the sage advice that it was probably my cat that had caused it. I was embarrassed by how it looked, of my footwear choices, of the fact that I was newly married and was scratching at my feet in my sleep.

At its very worst last year, both my feet were covered in thick, scaly skin, which would constantly bleed and itch. I remember one particular weekend when I went into the city with my husband and ended up having to head home because I'd bled through my socks. We then spent the next few days indoors; I wasn't even able to walk a few minutes to the local supermarket or wear any kind of shoes without being in pain. It's tricky having an autoimmune skin disorder when you work in the beauty industry and are constantly testing and trialing products — you end up convinced that something or other will be the answer you're seeking, and the disappointment can be shattering when nothing works.

Finally, in December 2023, I connected with a brilliant dermatologist, Aadarsh Shah of the Holborn Clinic, an expert in the field who has brown skin like mine. He was a tremendous help and refreshingly honest, sharing the limited options I had for my psoriasis. Immunosuppressants (methotrexate or cyclosporine) would help slow down my overactive immune system but leave me susceptible to infections and viruses. They would also need to be factored into any family planning, as they can lead to birth defects. The other option was to live with it and use steroid treatments to calm particular flare-ups, whilst leaving enough of a gap to avoid TSW (topical steroid withdrawal). I opted for the latter, knowing my immune system was already not very strong. Having a doctor who was able to fully understand psoriasis on skin that looked like mine was empowering. He acknowledged that due to the melanin in my skin, the scarring and pigmentation I had from healed psoriasis plaques would likely remain on my skin for years. This isn't something any other doctor or dermatologist had mentioned.

With Dr. Shah's guidance, I was able to bring the heavy inflammation on my feet down. While I have had a few bouts of TSW, which has resulted in new inflammation in previously unaffected areas, I was able to get my psoriasis back to a place that had little impact on my day-to-day life. Although it was the use of the steroid Diprosalic that helped the most, I do now try to take care of my skin without relying on steroids. If I am able to keep the area consistently hydrated, I find it itches less and is overall less aggravated. I also know that it is best to stick to ceramide-rich formulas with little to no fragrance in the inflamed areas.

We don't have a cure for psoriasis yet, so like many others I still suffer with it, and I'm concerned for what the future looks like — especially with the symptoms I am showing of early-onset psoriatic arthritis. The body positivity movement has meant there is pressure to feel confident in my skin, and I don't think I'm quite there yet — I still hesitate before wearing sandals, I still crop my feet out of pictures, and I still struggle when I see a new patch, which can lead to feelings of shame. However, I also know that when I see others with psoriasis, I feel a sense of belonging and applaud them for not hiding it. That isn't my choice, but I'm learning to accept that about myself and be more understanding that choosing to cover up my skin is just as much my decision as choosing to show it.

Sidra Imtiaz is a freelance British Pakistani Muslim beauty writer and PR expert based in London, but often in the US. She has written for Refinery29, Glamour, InStyle, Bustle, Who What Wear, and PS.