Ethnic pediatric patients benefit from tailored treatment plan

Miami - Children of color sometimes require treatment approaches that are different from those used in their fair-skinned counterparts.

Post-inflammatory hyperpigmentation

"Even after the resolution of mild cases of acne in African American, Latin and Middle Eastern children, many are left with color changes in their skin that can last for as long as a year," Dr. Trowers tells Dermatology Times.

These long-term after-effects are seen in several conditions which typically leave no sequelae in fair-skinned patients.

The treatment for post-inflammatory hyperpigmentation is hydroquinone. There are over-the-counter (OTC) 2 percent formulations available, as well as prescription 4 percent formulations, some of which are combined with 0.025 percent tretinoin cream. Dr. Trowers says studies show the greatest degree of improvement in darker skin types with medications containing greater than 4 percent hydroquinone, so dermatologists should consider compounding these remedies for their patients. Use of a sunscreen containing a physical block, such as zinc oxide or titanium dioxide (preferably micro-ionized so that it does not give a white cast to dark skin), should be encouraged to protect the effects of the therapy.

Atopic dermatitis

Some ethnic patients are left with lifelong color changes in their skin resulting from moderate to severe childhood atopic dermatitis.

"Because of these aftereffects, I am very aggressive in my use of topical steroids in some of these patients," Dr. Trowers says. "Studies have shown that short-term use of moderate- to high-potency topical steroids on limited body areas in young children does not result in systemic effects, so my initial therapeutic plan may include this approach."

Tinea capitis

Tinea capitis is another common condition that needs to be treated differently in ethnic children. Furthermore, tinea capitis reportedly occurs more frequently among black children. Dr. Trowers points to a 1997 California study indicating that while only 12 percent of the children in the study were black, the rate of tinea capitis among these children was double that of other ethnicities.

"The typical recommendation for treating tinea capitis is to wash the child's hair three times a week with Nizoral (McNeil) shampoo to decrease fomite spread, along with oral griseofulvin 20 to 25 mg/kg, qd, for six weeks," Dr. Trowers says. "But this needs to be adjusted for some African American patients because their hair is thicker and coarser and may be washed less frequently than patients of other ethnicities. If you recommend three times a week, chances are some parents won't be fully compliant, or they and their child will have to suffer to comply with your instructions."

For these reasons, Dr. Trowers recommends that these patients shampoo with Nizoral once a week and apply Nizoral cream to the scalp twice a week. Dr. Trowers conferred with Boni E. Elewski, M.D., a fungus expert, and Dr. Elewski confirmed that the topical cream is probably equally as effective at decreasing transmission rates.

"Washing and combing thick hair three times a week can be traumatic for the child and the parent; however some children have thick hair that is washed every day. Thus, it's important for dermatologists to ask patients about their lifestyle so they can recommend regimens that better fit into the patients' daily lives," she says.

Scalp conditions

Dermatologists will inevitably increase compliance among ethnic patients when treating scalp conditions such as seborrheic dermatitis or atopic dermatitis if they inquire about the types of hair products the patient normally uses.