It is important for dermatologists, primary care physicians, and other individuals who treat skin disorders to be “keenly aware” of the cultural and clinical nuances in the growing Hispanic, South Asian, and East Asian populations, according to a presenter at the Skin Spectrum Summit in Montreal on May 13.
“There is an overlap between structural and functional differences, culturally variations in skin and hair care practices, as well as, cultural standards in perceptions of beauty,” said Dr. Andrew Alexis, chair of the Department of Dermatology and the director of Skin of Color Center at Mount Sinai St. Luke's Hospital and Mount Sinai West in New York City. “This overlap produces variations in what skin conditions come into the office and the approach to treating them.”
Pigmentary concerns
Dr. Alexis said common pigmentary concerns in these patients populations include melasma, post-inflammatory hyperpigmentation, solar lentigines, erythema dyschromicum perstans (ashy dermatosis), and lichen planus pigmentosus.
“In addition to actual disorders of pigmentation, there is just a general concern among many of these populations about darkening of the facial skin and great efforts are made in many of these cultures to protect the skin from UV induced darkening,” he said.
A complex cultural desire for lighter skin has also led to a large skin lightening product industry, said Dr. Alexis.
“We have to be mindful of the potential hazardous ingredients that are found in skin lightening products,” he said, noting he has seen products containing mercury, clobatesol, potent corticosteroids, and unknown concentrations of hydroquinone. “The bottom line is to offer safe alternatives.”
Safe options for skin lightening, noted Dr. Alexis, include hydroquinone 4% (used for less than six months), non-hydroquinone agents (for more than six months), azelaic acid, topical retinoids, kojic acid, and other cosmeceuticals, as well as, chemical peels, laser, broad spectrum sunscreen (SPF 30 or higher), and cover-up cosmetics.
Cultural practices
Dr. Alexis presented a case of a patient with a nodule on the lateral malleolus that was caused from frequent praying. He called this a “prayer nodule”.
He noted that patients might experience contact dermatitis from a Hindu practice of smearing ash on the forehead—known as the vibhuti.
Henna tattoos, where the ink is mixed with paraphenylenediamine to generate the black colour of the dye, can also be a common cause of contact dermatitis in certain ethnic populations where applying these tattoos is a common practice, said Dr. Alexis.
An East Asian practice called “cupping” leaves circular purpura marks. Cupping involves alcohol saturated cotton balls, placed on a small patch on the skin, that are lit and then a glass cup is placed over the lit cotton balls to extinguish the fire.
“There can be cases where patients come in with all this purpura and without any history one can think there is an issue of abuse or other factors. Be aware that this practice is quite common and be able to recognize the dermaotologic manifestation,” said Dr. Alexis.
A similar East Asian practice called coining/spooning and this is used to revealed aches, pain, fevers, fatigue, flu and even abdominal pain. This is where oils or ointments are placed onto the skin and a coin or spoon is used to forcibly press in the oils. Dr. Alexis said this can cause linear lines of erythema, purpura, or ecchymosis.
More information about the Skin Spectrum Summit can be found at www.skinspectrum.ca. Registration is still open for the Vancouver Skin Spectrum on May 27.