Hispanic influences more than skin deep

Jun 01, 2007, 4:00am

In addition to presenting more frequently than Caucasians with conditions such as melasma and postinflammatory hyperpigmentation, Hispanics also can present with issues such as periorbital syringomas or melanomas in places like the feet or under the nails.

Key Points

With the diversity often represented in the Hispanic population, the precise skin type, even within the sub-population, can influence the course of treatment.

"I teach residents that when you treat patients of Latino origin, you really need to know the genetic background of the patient you're treating," says Maritza Perez, M.D., an associate professor of dermatology at Columbia University and director of cosmetic dermatology at St. Luke's Roosevelt Medical Center in Manhattan.

"There are Latinos whose origins can range from African American to Cuban to Spanish.

"In addition, you can have Latinos from Argentina, for instance, whose ethnic background is Italian and German, so you don't want to tag them as simply Latino," Dr. Perez tells Dermatology Times.

Dr. Perez says she is, in fact, planning a book on the diversities of Latino skin.

Where there is common ground

Some of the most common skin conditions impacting Hispanics of nearly all origins are melasma and postinflammatory hyperpigmentation (PIH), Dr. Perez says.

"It's not that Hispanics present differently, it's just that they present more frequently, and it impacts the quality of their life more," she says.

Dr. Perez advocates a unique treatment approach that involves gauging the severity of the condition in order to determine a course of action.

"I first divide the melasma into mild, moderate or severe, depending on how extensive it is in the face and how dark it is compared to the patient's skin color," she says.

In gradating the condition, mild cases fall into a one to five category, moderate cases are graded from five to seven, and more severe cases are graded from seven to 10.

"Depending on the severity, the more aggressive you are with the treatment," she says.

Treatment modalities that Dr. Perez uses include microdermabrasion, chemical peels including salicylic acid peels or glycolic acid peels, sun avoidance and sunblock lotions. Once patients begin to respond, they can graduate to maintenance therapy, such as retinoids at night and over-the-counter bleaching creams. In most cases, year-round, broad-spectrum sunblock with a sun protection factor of 30 is important.

"You're not going to remove the tendency for the patient to develop the melasma again if the patient has chronic sun exposure, so I tell patients that if they are going to be walking around town unprotected from the sun, they're going to wind up back at square one," she says.

Let there be light

Lasers can be effective in the treatment of melasma and PIH in Hispanics, and Dr. Perez says her laser of choice is nonablative Nd:YAG 1064, which she uses in conjunction with intense pulsed light (IPL).