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There is more to treating skin of color than meets the eye. Cultural influences can be important factors in patients' maladies as well as issues of noncompliance and treatment choices. Learning about the culture is as important as learning about the physiology.
National report - "Cultural competence" is an area in which dermatologists will need to become increasingly more proficient in the coming years, as a growing percentage of their practices likely will comprise patients of color.
All skin is not alike, and dermatologists will need to be aware not only of physiological differences in skin types, but also the societal and cultural differences among their patients.
That's the message shared by two dermatologists who specialize in the skin needs of patients of color: Marta I. Rendon, M.D., of Boca Raton, Fla., and Susan C. Taylor, M.D., of Philadelphia and New York City.
"Dermatologists need to realize that by the year 2050, 50 percent of the population is going to be non-Caucasian," Dr. Rendon explains. "Within these patients of color are a lot of multicultures - Hispanics, Asians, blacks - and each particular ethnicity has a philosophy of its own in terms of their belief systems in regards to physicians."
Dr. Rendon, associate clinical professor in the biomedical science program at Florida Atlantic University, Boca Raton, cites historical traditions within ethnic communities that will bear on doctor/patient relationships.
"For example, Hispanics view physicians as God and will believe whatever the physician says. They're very respectful to their doctors and will not interrupt them. That's why there are not a lot of lawsuits in the Hispanic community; that's not even a consideration in Latin American countries," she says.
Dr. Taylor, founding director of the Skin of Color Center in New York City, director of Society Hill Dermatology in Philadelphia and an assistant clinical professor at Columbia University, New York, contends that cultural and behavioral customs are important if dermatologists want to be trusted by their patients of color.
"A perfect example relates to hair care. Many African-American patients wash their hair once every one or two weeks," she says. "If a dermatologist prescribes a therapy that requires washing it on a daily basis, not only is that patient not going to be compliant, but the patient will not return, because they know the doctor does not understand their customary practices and has no idea how much work is required to groom their hair on a daily basis."
"In many Asian communities, the practice of 'cupping,' where suction cups are placed on the skin to remove the 'bad winds' or 'humors' for different illnesses, is popular," she says. "Cupping can leave round marks that have the appearance of bruises, so if the dermatologist is unaware of that custom, they might suspect parents of child abuse."
Bridging the gap
Both doctors recommend that physicians learn all they can about these differences through coursework at the American Academy of Dermatology (AAD) or the American Medical Association (AMA) meetings and by reading books on cultural competence.
In lieu of speaking the language, both dermatologists recommend having access to someone who can translate for the patient.