Oct
Dermatologist Frank Wang, MD, says there are some things he wishes he had learned earlier about treating different patients.
Psoriasis, a chronic skin condition affecting approximately 7.5 million people in the United States, is a perplexing and often misunderstood ailment. It occurs when the body accelerates the production of new skin cells, causing them to replace old ones at an unusually rapid rate, within days instead of weeks. This accelerated cell turnover results in the formation of thick, scaly, and intensely itchy patches of skin, particularly in the most common form of psoriasis, known as plaque psoriasis.
However, despite its prevalence, psoriasis remains underdiagnosed and inadequately addressed in the medical field. One significant contributing factor to this issue, as highlighted by Dr. Frank Wang, an associate professor of dermatology at the University of Michigan, is the limited exposure and education on dermatology during medical school. Medical students typically receive only a brief window of instruction in dermatology, often lasting a mere few days, before they must select their specialization. For those who do pursue dermatology as a specialty, it requires an additional three years of residency training beyond medical school. In contrast, many physicians who choose other specialties receive their entire dermatology education in that limited timeframe during medical school.
This compressed timeline presents a significant challenge when it comes to comprehensively understanding the manifestations of skin conditions, including psoriasis, across diverse skin types. It leaves little room to explore the nuanced ways in which psoriasis can present itself in patients with different ethnic backgrounds, skin tones, and skin characteristics.
Dr. Wang, who later specialized in dermatology and obtained the extended training required, admits that he wishes he had learned more about managing psoriasis in diverse patient populations during his medical school years. This includes individuals with darker skin tones, older patients, and those with drier skin. Here, he provides insights into the knowledge gaps and considerations that could have enriched his medical education:
Q: How much time do you have in medical school to learn about how psoriasis shows up in patients with different skin tones?
Dr. Wang: In general, there’s very limited amounts of time for dermatology exposure, training, and education in medical schools. When I was in medical school, I had three to five days of dermatology education. For the average medical student at the University of Michigan, they get around five to six days of formal dermatology training. You can imagine with that limited amount of time, there’s even more limited time for education in the presentations of disorders in skin of color.
Q: What do you wish you had learned in medical school about the presentation or treatment of psoriasis in patients with different skin tones?
Dr. Wang: I personally was not exposed to much dermatology in medical school, let alone dermatology in patients with skin of color. Some of the things I now know that I wish I had known before was that how psoriasis looks is different in darker skin tones than lighter skin tones. The redness and inflammation can be harder to detect in darker skin, whereas it may appear bright red in lighter skin. Psoriasis may have a dull red or even a darkish brown color to it in darker skin.
Q: What do you wish you had known about the impact on quality of life on patients with psoriasis who have darker skin tones?
Dr. Wang: Psoriasis in general impacts quality of life. But particularly for people with darker skin, it can leave behind a darker or lighter area. That kind of discoloration can last a really long time—months, even years. That’s very upsetting to many patients with darker skin, and it really impacts their quality of life. Those are just some of the clinical features that I wish I knew more about before.
Q: What do you wish you had known about finding the right psoriasis treatment for people of different ages?
Dr. Wang: In general, we tend to see less psoriasis in children—it’s just not as common in children. The greatest onset is between the ages of 20 and 30. With that in mind, for most of the medications we have available for psoriasis—the older medications, newer agents, and biologics—we tend to have more experience with their use in adults. Generally, older patients have more medical problems. Some of the agents we use to treat psoriasis we don’t necessarily want to use if the patient has congestive heart failure, lupus, or some other medical problems. This I learned more in practice and beyond than in school.
Q: What do you wish you had learned earlier about how psoriasis can impact people with different skin types?
Dr. Wang: The drier your skin is, the more likely it is your psoriasis will be worse. If a patient has psoriasis and they’re not doing basic moisturizing of the skin, that tends to worsen psoriasis. That can be compounded when it’s wintertime—the air is cold and dry. All that dryness from the weather will worsen psoriasis. It can be a little trickier to treat during this time of weather. It can certainly lead to a flare-up. If someone’s skin is dry and they are not moisturizing, psoriasis will flare up. Dry skin, in general, is going to make psoriasis worse.
Q: What do you wish you had learned about how else psoriasis can impact a person’s life?
Dr. Wang: With such minimal exposure to dermatology as a medical student, we didn’t cover how psoriasis can impact a patient’s quality of life. I now teach medical students, and, knowing that we have limited time, I’m more interested in making sure they know that psoriasis exists. But I also want them to know that it’s more than skin deep. Psoriasis impacts a patient’s quality of life, their ability to do normal things, and maybe even have a job. You can imagine how difficult it is to have psoriasis if you’re an actor or are in the public eye. I want students to know psoriasis can influence internal problems as well, like cardiac disease and arthritis—that’s something that I mostly learned about after medical school.
Dr. Wang’s reflections emphasize the need for a more comprehensive and inclusive approach to medical education regarding dermatological conditions like psoriasis. This includes recognizing the diverse ways in which psoriasis can manifest across different skin types, age groups, and lifestyles, as well as understanding its profound impact on patients’ quality of life beyond the visible skin symptoms. By addressing these knowledge gaps and raising awareness about the multifaceted nature of psoriasis, we can ensure that healthcare providers are better equipped to diagnose, treat, and support patients who contend with this challenging condition, regardless of their individual characteristics and circumstances.
