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    Subtle shadings: Wide range of skin types exists among people of Latin descent


    National report — When dermatologists classify skin as either Caucasian or skin of color, they are using too blunt a tool, an expert says.

    Dr. Taylor
    It's better to look at patients by skin and ethnic type, says Susan C. Taylor, M.D., founding director of the Skin of Color Center, division of dermatology, St. Luke's-Roosevelt Hospital Center, New York.

    "This week, for example, a Hispanic patient came to me because she'd been told by another dermatologist that nothing could be done about her excessive facial hair due to the possibility of scarring or hyperpigmentation," she says.

    However, there is a wide range of skin types among people of Latin descent, due to various waves of migration from Europe mixing or not mixing with indigenous Central and South American populations. Dr. Taylor determined that the patient was a good candidate for hair removal with a long-pulse Nd:YAG laser.

    Cultural considerations

    Dr. Taylor co-authored with A. Paul Kelly, M.D., the recently published McGraw Hill textbook Dermatology for Skin of Color. Several chapters were written by Hispanic dermatologists in Central and South America.

    In working with these physicians, Dr. Taylor says she was struck by the degree to which Latin Americans use folk healers who prescribe herbal remedies or say words or prayers to induce healing.

    "Dermatologists need to be aware of this possibility and try to work with the patient's belief system," Dr. Taylor says.

    In the United States, Latinos also may turn to alternative remedies due to lack of health insurance or lack of education about and exposure to allopathic medicine. When a patient does show up in the office, language barriers can compound cultural differences.

    "Have some-one on staff that speaks Spanish, and remember that nomenclature is very important. People of Spanish descent can be insulted by the term 'Hispanic,' but 'individuals of Latin descent' seems to be pretty palatable," Dr. Taylor tells Dermatology Times.

    Distinctive skin conditions

    "In Latin America," Dr. Taylor says, "some infectious diseases, such as cutaneous tuberculosis and leprosy, are more common. In the U.S., we see a lot of melasma in Latinos, probably tied to sun exposure. In Texas, it is very, very rampant.

    "Eczema is also common in darker-toned Latinos; it presents as bumps versus patches in Caucasians. Ashy dermatosis is rarer, but more common for people of Latin descent than for Caucasians."

    She says Latinos of lighter skin colors, such as Cubans, tend to develop skin cancers in the same distribution as Caucasians — on the arms, legs and back. In contrast, the distribution of cancer in darker-skinned Mexicans is concentrated on the palms of hands, soles of feet and nails.

    Dr. Paul Kelly is chief of dermatology at the Charles Drew University of Medicine and Science and a dermatologist at the Martin Luther King Jr. Multi-Service Ambulatory Care Center, both in Los Angeles. The patient population at the ambulatory center is more than 50 percent Latino.

    There, Dr. Kelly says, "I see a lot of melasma on the cheeks and forehead. About 90 percent of our patients are female. I also see a higher rate of psoriasis in Latinos than Caucasians."

    Many of his patients present with skin tags. He also treats a high rate of seborrheic dermatitis.

    Brazilians are notably enthusiastic about cosmetic surgery, and many procedures are developed there, but Dr. Kelly says he is now seeing a broader trend toward increased use of cosmetic procedures among Latinos in general. He attributes the trend to greater awareness, both in the patient population and among dermatologists, that Latinos are less predisposed to post-inflammatory hyperpigmentation than blacks.


    Dr. Kelly concurs with Dr. Taylor on the importance of communication.

    "You need someone on staff that can speak Spanish, or you need a link to a translation service. It's important to tell patients what you are going to do and what kind of outcome they can expect.

    "It's also important to go over their medications. Often, they have the right medicine but are not taking it in the right dose. Patients need to understand when to take their meds and when to stop taking them," Dr. Kelly says.

    He estimates that about 5 percent to 10 percent of patients at the county hospital use home remedies.

    Disclosures: Drs. Kelly and Taylor report no relevant financial interests.

    Rebecca Bryant
    Rebecca Bryant is a medical writer based in Fayetteville, Arkansas

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