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South Asians represent the skin color spectrum, from light to dark. Still, people from this region of the world share common concerns, including acne scarring, pigmentary disorders and dark circles under the eyes.
Dermatologists must consider both cultural and ethnic backgrounds when treating these patients, whose most common skin complaints are pigmentary disorders, says Vic A. Narurkar, M.D., San Francisco, assistant clinical professor of dermatology at University of California, Davis, School of Medicine, Sacramento, Calif.
Regional, cultural differences
The most important cultural factor about South Asia for dermatologists to recognize, he says, is that there are many types of regional differences.
"'Indian' implies just from the country of India, and there are other countries that fall into the traditional category called East India," Dr. Narurkar tells Dermatology Times.
Dr. Narurkar was born in the United States but is of Indian descent. He says that identifying South Asian ancestry offers important clues not only about how patients will respond to treatment, but also about their cosmetic and cultural concerns.
The first step in cultural awareness is embracing the many ethnicities, he says.
"There are more than 5,000 years of culture, with so many different ethnicities who have come to that country, ranging from the original indigenous people (also called the aboriginal people of India); then, the invasion of people from Persia, Arabic countries, Greece and European influences in the colonial era," he says.
"Patients from north India or of north Indian descent might have blue eyes, light hair and fair complexion and a greater risk of developing skin cancers. Then, you have patients from Sri Lanka, the southern part of India and Bangladesh who have darker skin types," Dr. Narurkar explains.
"The Indian subcontinent is almost like a miniaturized Europe. Each province has its own language. With each province, there are cultural mores. When we see these patients we have to realize that we cannot lump them all into one group and call them 'East Indian,'" he says.
"There are also religious differences. There is Hinduism, Buddhism, Judaism, Islam and Christianity, so it is important to realize those differences and what is appropriate. We also need to realize that what we consider appropriate cosmetically by Western standards may not necessarily be appropriate to our South Asian patients.
"It is a combination of not only ethnicity but also culture. For a physician to understand South Asian skin, the physician needs to embrace the multiculturalism."
Dr. Narurkar says he does not refer to traditional Fitzpatrick skin types when assessing South Asian patients; rather he relies on thorough history-taking, asking patients about their country and region of origin.
The most common conditions among people of South Asian descent are disorders of pigmentation, including a high incidence of postinflammatory hyperpigmentation (PIH), according to Dr. Narurkar.
He also sees a high incidence of dark circles under eyes.
"Hyperpigmentation and dark circles under the eyes are huge cosmetic concerns for people with South Asian skin," he says. "Dermatologists should also know that the majority of South Asian skin - even very fair complexioned South Asian skin - behaves with a high incidence of postinflammatory hyperpigmentation."
Often dermatologists will see, in South Asian skin, exaggerated manifestations of skin conditions that are prevalent in all ethnicities. For example, vitiligo might be more pronounced because people with darker skin will have a more exaggerated form of vitiligo.
"We also see quite a bit of ashy dermatosis and melasma," he says.