Hispanic skin conditions: Understanding diseases, cultural issues key

Key Points

Like other individuals with skin of color, Hispanic Americans have a tendency to have long-lasting pigmentary changes. The Hispanic population is very heterogeneous in nature, and includes patients that span the spectrum of Fitzpatrick skin phototypes, according to Dr. Miguel Sanchez, M.D., associate professor at New York University and director of dermatology at Bellevue Hospital in New York.

"There are Hispanic people who are light-skinned and those who are darker-skinned," Dr. Sanchez says.

Still, Latinos with lighter complexions have greater hyperpigmentation than their Caucasian counterparts. Exposure to ultraviolet light exacerbates hyperpigmentation, making sun protection essential through the use of sunscreens.

In addition, several familial and genetic skin diseases that occur more commonly in Latino populations include actinic prurigo, Hermansky-Pudlak Syndrome and Kindler's syndrome.

Hispanics may also acquire capsaicin dermatitis, balanitis xerotic obliterans, acanthosis nigricans and prayer callouses.

Apart from pregnancy, oral contraceptives, genetic predisposition and the use of certain cosmetics have been linked to the appearance of melasma, which typically presents with uniform tan-brown to gray macules and patches.

Treatment options

Dermatologists must assess whether the pigmentation is epidermal, dermal or mixed. Examination with wood's light and skin biopsy may be instrumental in making that assessment.

Azeleic acid and tretinoin are compounds that can permit re-pigmentation, but may need several months to produce a response. Dermabrasion and laser therapy can also be therapeutic for melasma.

The standard treatment for superficial melasma is hydroquinone, a phenolic compound that inhibits tyrosinase, which can improve pigmentation within weeks of application, but between 65 percent and 80 percent of cases require simultaneous treatment with another agent or procedure.

There is a particular skin condition called ashy dermatosis, with the majority of diagnosed cases occurring in Latin Americans. Eruptions of this condition can be widespread, can involve much surface area on the body, and can be disfiguring from a cosmetic point of view.

There are few treatments for ashy dermatosis, but some case reports have indicated efficacy with dapsone and clofazimine, and with systemic steroids in other instances. Clofazimine, however, is no longer available in the United States.

Another condition, known as Pityriasis alba, is idiopathic in origin and has been seen with some frequency in rural Mexicans. Topical corticosteroids and calcineurin inhibitors have demonstrated some efficacy in treating this condition.

Cultural aspects

An interesting cultural aspect of skincare in the Latino population is the belief in and use of folk remedies. Using home remedies is a practice that transcends educational and income levels in the Hispanic population, Dr. Sanchez tells Dermatology Times.

"Individuals may not think of these remedies as medicines, but individuals may develop contact dermatitis in using these remedies," Dr. Sanchez says, adding that some of the topical creams that are sold in botanicas have elevated mercury levels, and use of them can potentially result in mercury poisoning.

The use of sunscreens is not yet common among the Hispanic population in the United States, because most Hispanics consider themselves at very low risk for developing skin cancers, Dr. Sanchez says.

However, melanoma and nonmelanoma skin cancer rates are rising in Latinos across the globe. Sadly, most diagnoses are now occurring at an advanced stage of disease, resulting in poorer prognosis.

"Hispanics who have a darker complexion have better protection (than Caucasians) from skin cancer because of the melanin in their skin, but it is not enough to fully protect them," Dr. Sanchez says.

"When Hispanics do present with melanomas, they tend to be thicker and more advanced," he says.

Culturally, moles and birthmarks have been regarded as symbols of beauty or uniqueness in Hispanic culture, and contribute to the delay in Hispanics presenting to a general practitioner or dermatologist to have a mole examined. Moreover, Hispanics may face other obstacles to healthcare such as lack of health insurance, poverty, minimal education and language impediments, Dr. Sanchez says.