Hispanic patients pose unique issues for dermatologic evaluation, care

Chicago - As the Latino population continues to be the fastest growing minority group in America, dermatologists should be prepared to treat an increasing number of patients of Hispanic origin and for the unique situations they may pose regarding evaluation and management, said Miguel R. Sanchez, M.D., at the American Academy of Dermatology's Academy '05, here.

"Diversity is a key feature of the Hispanic population as it is comprised of people with a variety of skin types and cultural backgrounds," he tells Dermatology Times. "However, these individuals also share a number of characteristics in common with respect to disease risk and beliefs about health and skincare. Understanding of that information is the foundation for optimizing effective communication and medical management."

Dr. Sanchez is associate professor of dermatology, New York University School of Medicine, New York.

While the type and prevalence of various skin diseases affecting persons of Hispanic origin generally mirrors that of the overall population with acne and eczema topping the list, Latinos are distinguished by their increased risk for pigmentary disorders, particularly melasma and post-inflammatory hyperpigmentation.

Furthermore, persons of Hispanic descent are likely to suffer significant psychological distress as a result of their persistent, pigmented lesions.

"Hispanic patients treated for acne may return for follow-up with effective clearing of their papules and pustules, but still complaining that their skin is not any better because they are upset by the appearance of post-inflammatory hyperpigmentation," Dr. Sanchez says.

Certain therapeutic agents may have a particular role in treating inflammatory skin diseases in Hispanics due to their concomitant hypopigmenting activity.

For example, tretinoin, benzoyl peroxide and azelaic acid may be good choices for acne therapy. However, because prevention is the best management for post-inflammatory hyperpigmentation, dermatologists may need to be particularly aggressive in treating the primary disease. Unfortunately, lack of insurance and language barriers may both pose obstacles to providing appropriate care.

"Although a patient with severe acne may be a candidate for treatment with a tetracycline or isotretinoin and a patient with extensive psoriasis may be considered for methotrexate, physicians may be reluctant to prescribe those medications for fear that the patient may not understand the warnings about avoiding pregnancy or may share their prescriptions with others," Dr. Sanchez explains. "Those and other very effective medications may also be withheld based on concerns that the patient may be noncompliant with follow-up monitoring for other safety risks."

Over-the-counter patrons

It is not uncommon for Hispanic persons to seek over-the-counter cures for treating hyperpigmentation.

Not only are those agents likely to be ineffective, but they can also pose safety concerns. Notably, cases of mercury poisoning have been recently associated with the use of various skin bleaching creams and anti-acne products sold in Hispanic stores specializing in herbal and folk medicine remedies.

Cutaneous infections

Another recently emerging dermatologic problem in the Hispanic population relates to the identification of clusters of cutaneous infections caused by rapid-growing, nontuberculous mycobacteria.

These cases have occurred among persons who have traveled to various Latin American countries for a variety of cosmetic procedures or who were treated in U.S. metropolitan areas at cosmetic procedure clinics run by non-medical personnel with "training" from foreign countries. The deep-seated abscesses and wound infections developing in these patients have been linked to mycobacterial contamination of filler materials or surgical instruments used in the procedures.

"These infections do not respond to the standard antibiotics for treating skin and soft tissue infections, and so it is important to maintain an index of suspicion for this atypical etiology, obtain specimens and make sure they are cultured in appropriate media for growing mycobacteria," Dr. Sanchez says.

Acanthosis nigricans

In caring for Hispanic patients, dermatologists are also more likely to see cases of acanthosis nigricans as its prevalence is fivefold higher in the Hispanic versus Caucasian population.