Pigmentation Disorders

BUENOS AIRES — Cultural sensitivity is essential for dermatologists who work with Hispanic and Latino patients, Dr. David Rodriguez said at the 21st World Congress of Dermatology.

"Many immigrants continue to adhere to their cultural views of health and disease," he said. Failure to understand cultural background leads to miscommunication in the doctor-patient relationship and can result in poor treatment compliance.

Approximately 42 million people in the United States are ethnically identified as Hispanic. The term Hispanic came into widespread use in the United States in the 1970s, when it was first used as a classification in the national census. Hispanic refers to someone of Spanish descent, and in the United States it is a governmental designation of ethnicity. Latino refers to the Latin-based or Romance languages.

"When you say Latino, you would include the people of Portugal and Brazil," said Dr. Rodriguez, a dermatologist in Coral Gables, Fla. "When you say Hispanic, you talk about the people who come from Spain." The terms, however, are often used interchangeably.

The Hispanic population is racially diverse. Hispanics can be white, black, American Indian, or a mixture of racial groups. "The Hispanic population is also culturally diverse. When we look at Hispanics we cannot think of them as just one group," he said. "There are great differences between someone from Argentina, and what he or she does, and someone from El Salvador." Understanding the cultural proclivities for each patient is important.

Cultural differences that might impede care of Hispanic patients include reluctance to question the physician, who may be seen as an authority figure, and hesitation to discuss their disease because of embarrassment. Cultural belief in fatalismo also can impede treatment: Patients might accept their condition as the will of God and feel powerless to change it.

Acne, eczema/contact dermatitis, photoaging, facial melasma, and hyperpigmentation are the major dermatologic conditions seen in Hispanic patients in private clinics. Disorders of pigmentation are especially important to Hispanic patients because they consider them disfiguring.

Conditions like melasma or acne can have a profoundly negative impact on self-esteem, quality of life, and job pros-pects, said Dr. Rodriguez.

Melasma is common in Hispanics, particularly in women. "Hispanics commonly attribute melasma to a sick liver, aging, poor nutrition, or lack of sleep," he said, so patients need to understand the role of UV radiation in triggering or exacerbating the condition.

Special care must be taken in treating acne in Hispanic patients because Fitzpatrick skin types IV-VI are susceptible to hyperpigmentation. Hispanic patients are often unaware that they have acne, but they may be concerned about "dark scars or spots," said Dr. Rodriguez. "We must educate them that they have to stop touching or picking their face."

Like other patient populations, Hispanics have misconceptions about the causes of acne, and may attribute outbreaks of acne to certain foods, sex, or ill health. They need to know that the ointments and oils, especially cocoa butter, in popular Hispanic hair and skin treatments can clog pores and worsen acne, he said.

There is a widespread misconception that individuals with dark pigmented skin cannot get skin cancer, so many Hispanics consider sunscreens necessary only for the beach or the pool and do not understand the importance of using sunscreen on a daily basis. Dr. Rodriguez said he recommends that Hispanic patients be reminded to use sunscreen, particularly in regions of the country, such as South Florida, where incidental sun exposure can be intense.

Ideally, dermatologists who treat Hispanic patients should provide Spanish-language materials in the waiting room and offer bilingual take-home instructions. Practices that treat many Hispanic patients should have a bilingual staff, he said.

BUENOS AIRES — Cultural sensitivity is essential for dermatologists who work with Hispanic and Latino patients, Dr. David Rodriguez said at the 21st World Congress of Dermatology.

"Many immigrants continue to adhere to their cultural views of health and disease," he said. Failure to understand cultural background leads to miscommunication in the doctor-patient relationship and can result in poor treatment compliance.

Approximately 42 million people in the United States are ethnically identified as Hispanic. The term Hispanic came into widespread use in the United States in the 1970s, when it was first used as a classification in the national census. Hispanic refers to someone of Spanish descent, and in the United States it is a governmental designation of ethnicity. Latino refers to the Latin-based or Romance languages.

"When you say Latino, you would include the people of Portugal and Brazil," said Dr. Rodriguez, a dermatologist in Coral Gables, Fla. "When you say Hispanic, you talk about the people who come from Spain." The terms, however, are often used interchangeably.

The Hispanic population is racially diverse. Hispanics can be white, black, American Indian, or a mixture of racial groups. "The Hispanic population is also culturally diverse. When we look at Hispanics we cannot think of them as just one group," he said. "There are great differences between someone from Argentina, and what he or she does, and someone from El Salvador." Understanding the cultural proclivities for each patient is important.

Cultural differences that might impede care of Hispanic patients include reluctance to question the physician, who may be seen as an authority figure, and hesitation to discuss their disease because of embarrassment. Cultural belief in fatalismo also can impede treatment: Patients might accept their condition as the will of God and feel powerless to change it.

Acne, eczema/contact dermatitis, photoaging, facial melasma, and hyperpigmentation are the major dermatologic conditions seen in Hispanic patients in private clinics. Disorders of pigmentation are especially important to Hispanic patients because they consider them disfiguring.

Conditions like melasma or acne can have a profoundly negative impact on self-esteem, quality of life, and job pros-pects, said Dr. Rodriguez.

Melasma is common in Hispanics, particularly in women. "Hispanics commonly attribute melasma to a sick liver, aging, poor nutrition, or lack of sleep," he said, so patients need to understand the role of UV radiation in triggering or exacerbating the condition.

Special care must be taken in treating acne in Hispanic patients because Fitzpatrick skin types IV-VI are susceptible to hyperpigmentation. Hispanic patients are often unaware that they have acne, but they may be concerned about "dark scars or spots," said Dr. Rodriguez. "We must educate them that they have to stop touching or picking their face."

Like other patient populations, Hispanics have misconceptions about the causes of acne, and may attribute outbreaks of acne to certain foods, sex, or ill health. They need to know that the ointments and oils, especially cocoa butter, in popular Hispanic hair and skin treatments can clog pores and worsen acne, he said.

There is a widespread misconception that individuals with dark pigmented skin cannot get skin cancer, so many Hispanics consider sunscreens necessary only for the beach or the pool and do not understand the importance of using sunscreen on a daily basis. Dr. Rodriguez said he recommends that Hispanic patients be reminded to use sunscreen, particularly in regions of the country, such as South Florida, where incidental sun exposure can be intense.

Ideally, dermatologists who treat Hispanic patients should provide Spanish-language materials in the waiting room and offer bilingual take-home instructions. Practices that treat many Hispanic patients should have a bilingual staff, he said.

BUENOS AIRES — Cultural sensitivity is essential for dermatologists who work with Hispanic and Latino patients, Dr. David Rodriguez said at the 21st World Congress of Dermatology.

"Many immigrants continue to adhere to their cultural views of health and disease," he said. Failure to understand cultural background leads to miscommunication in the doctor-patient relationship and can result in poor treatment compliance.

Approximately 42 million people in the United States are ethnically identified as Hispanic. The term Hispanic came into widespread use in the United States in the 1970s, when it was first used as a classification in the national census. Hispanic refers to someone of Spanish descent, and in the United States it is a governmental designation of ethnicity. Latino refers to the Latin-based or Romance languages.

"When you say Latino, you would include the people of Portugal and Brazil," said Dr. Rodriguez, a dermatologist in Coral Gables, Fla. "When you say Hispanic, you talk about the people who come from Spain." The terms, however, are often used interchangeably.

The Hispanic population is racially diverse. Hispanics can be white, black, American Indian, or a mixture of racial groups. "The Hispanic population is also culturally diverse. When we look at Hispanics we cannot think of them as just one group," he said. "There are great differences between someone from Argentina, and what he or she does, and someone from El Salvador." Understanding the cultural proclivities for each patient is important.

Cultural differences that might impede care of Hispanic patients include reluctance to question the physician, who may be seen as an authority figure, and hesitation to discuss their disease because of embarrassment. Cultural belief in fatalismo also can impede treatment: Patients might accept their condition as the will of God and feel powerless to change it.

Acne, eczema/contact dermatitis, photoaging, facial melasma, and hyperpigmentation are the major dermatologic conditions seen in Hispanic patients in private clinics. Disorders of pigmentation are especially important to Hispanic patients because they consider them disfiguring.

Conditions like melasma or acne can have a profoundly negative impact on self-esteem, quality of life, and job pros-pects, said Dr. Rodriguez.

Melasma is common in Hispanics, particularly in women. "Hispanics commonly attribute melasma to a sick liver, aging, poor nutrition, or lack of sleep," he said, so patients need to understand the role of UV radiation in triggering or exacerbating the condition.

Special care must be taken in treating acne in Hispanic patients because Fitzpatrick skin types IV-VI are susceptible to hyperpigmentation. Hispanic patients are often unaware that they have acne, but they may be concerned about "dark scars or spots," said Dr. Rodriguez. "We must educate them that they have to stop touching or picking their face."

Like other patient populations, Hispanics have misconceptions about the causes of acne, and may attribute outbreaks of acne to certain foods, sex, or ill health. They need to know that the ointments and oils, especially cocoa butter, in popular Hispanic hair and skin treatments can clog pores and worsen acne, he said.

There is a widespread misconception that individuals with dark pigmented skin cannot get skin cancer, so many Hispanics consider sunscreens necessary only for the beach or the pool and do not understand the importance of using sunscreen on a daily basis. Dr. Rodriguez said he recommends that Hispanic patients be reminded to use sunscreen, particularly in regions of the country, such as South Florida, where incidental sun exposure can be intense.

Ideally, dermatologists who treat Hispanic patients should provide Spanish-language materials in the waiting room and offer bilingual take-home instructions. Practices that treat many Hispanic patients should have a bilingual staff, he said.

MIAMI — Nearly one-third of women of African descent exercise less because they have concerns about hairstyle management, according to a survey presented at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

"Sweating out their hairstyle and the time to wash, dry, and style their hair were the top two reasons they did not exercise as frequently," Shani F. Smith said. "We believe hair care should be explored as another barrier to exercise in this population."

The obesity epidemic is well known in the U.S. population, and "it is also known that African American women are disproportionately affected," said Ms. Smith, a fourth-year medical student at Wake Forest University, Winston-Salem, N.C. The departments of dermatology and public health collaborated on the survey.

A total of 31% of 103 women indicated they reduced physical activity levels because of concerns over hairstyle management. "They were three times less likely to meet exercise levels [odds ratio, 2.94] if their hairstyle was a concern," Ms. Smith said. Of this group, 88% did not meet physical activity guidelines recommended by the Centers for Disease Control and Prevention or the American College of Sports Medicine.

"Time and motivation are common and ethnically indistinct barriers [to physical activity], but hairstyle management may be a unique barrier for African American women.

Effective physical activity promotion strategies to address this barrier should be utilized," Ms. Smith said at the meeting, which was also sponsored by Howard University.

Half the respondents said they had considered modifying their hairstyle to accommodate exercise, she said. Hair braiding and wearing a ponytail were the leading considerations.

Respondents were aged 21-60 years. Most (72) identified themselves as African American, while 12 were African, 3 were Caribbean or West Indian, and 15 identified themselves as "other black" or of African descent. One person listed multiple ethnic backgrounds, Ms. Smith said.

The women were considered active if they reported 150 minutes of physical activity per week or 30 minutes per day at least 5 days per week. "Although 100% of respondents believe it's important for them and other African American females to exercise, very few are meeting this physical activity cutoff," she pointed out.

"Daily living was the No. 1 reason they engage in physical activity, mostly related to housework or other similar things," said Ms. Smith, who had no relevant conflicts to disclose.

The survey also asked about hair care practices. A total of 42% of the respondents said that they spent more than 1 hour per week on hair care, including regular visits to a salon.

MIAMI — Nearly one-third of women of African descent exercise less because they have concerns about hairstyle management, according to a survey presented at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

"Sweating out their hairstyle and the time to wash, dry, and style their hair were the top two reasons they did not exercise as frequently," Shani F. Smith said. "We believe hair care should be explored as another barrier to exercise in this population."

The obesity epidemic is well known in the U.S. population, and "it is also known that African American women are disproportionately affected," said Ms. Smith, a fourth-year medical student at Wake Forest University, Winston-Salem, N.C. The departments of dermatology and public health collaborated on the survey.

A total of 31% of 103 women indicated they reduced physical activity levels because of concerns over hairstyle management. "They were three times less likely to meet exercise levels [odds ratio, 2.94] if their hairstyle was a concern," Ms. Smith said. Of this group, 88% did not meet physical activity guidelines recommended by the Centers for Disease Control and Prevention or the American College of Sports Medicine.

"Time and motivation are common and ethnically indistinct barriers [to physical activity], but hairstyle management may be a unique barrier for African American women.

Effective physical activity promotion strategies to address this barrier should be utilized," Ms. Smith said at the meeting, which was also sponsored by Howard University.

Half the respondents said they had considered modifying their hairstyle to accommodate exercise, she said. Hair braiding and wearing a ponytail were the leading considerations.

Respondents were aged 21-60 years. Most (72) identified themselves as African American, while 12 were African, 3 were Caribbean or West Indian, and 15 identified themselves as "other black" or of African descent. One person listed multiple ethnic backgrounds, Ms. Smith said.

The women were considered active if they reported 150 minutes of physical activity per week or 30 minutes per day at least 5 days per week. "Although 100% of respondents believe it's important for them and other African American females to exercise, very few are meeting this physical activity cutoff," she pointed out.

"Daily living was the No. 1 reason they engage in physical activity, mostly related to housework or other similar things," said Ms. Smith, who had no relevant conflicts to disclose.

The survey also asked about hair care practices. A total of 42% of the respondents said that they spent more than 1 hour per week on hair care, including regular visits to a salon.

MIAMI — Nearly one-third of women of African descent exercise less because they have concerns about hairstyle management, according to a survey presented at an international symposium sponsored by L'Oréal Institute for Ethnic Hair and Skin Research.

"Sweating out their hairstyle and the time to wash, dry, and style their hair were the top two reasons they did not exercise as frequently," Shani F. Smith said. "We believe hair care should be explored as another barrier to exercise in this population."

The obesity epidemic is well known in the U.S. population, and "it is also known that African American women are disproportionately affected," said Ms. Smith, a fourth-year medical student at Wake Forest University, Winston-Salem, N.C. The departments of dermatology and public health collaborated on the survey.

A total of 31% of 103 women indicated they reduced physical activity levels because of concerns over hairstyle management. "They were three times less likely to meet exercise levels [odds ratio, 2.94] if their hairstyle was a concern," Ms. Smith said. Of this group, 88% did not meet physical activity guidelines recommended by the Centers for Disease Control and Prevention or the American College of Sports Medicine.

"Time and motivation are common and ethnically indistinct barriers [to physical activity], but hairstyle management may be a unique barrier for African American women.

Effective physical activity promotion strategies to address this barrier should be utilized," Ms. Smith said at the meeting, which was also sponsored by Howard University.

Half the respondents said they had considered modifying their hairstyle to accommodate exercise, she said. Hair braiding and wearing a ponytail were the leading considerations.

Respondents were aged 21-60 years. Most (72) identified themselves as African American, while 12 were African, 3 were Caribbean or West Indian, and 15 identified themselves as "other black" or of African descent. One person listed multiple ethnic backgrounds, Ms. Smith said.

The women were considered active if they reported 150 minutes of physical activity per week or 30 minutes per day at least 5 days per week. "Although 100% of respondents believe it's important for them and other African American females to exercise, very few are meeting this physical activity cutoff," she pointed out.

"Daily living was the No. 1 reason they engage in physical activity, mostly related to housework or other similar things," said Ms. Smith, who had no relevant conflicts to disclose.

The survey also asked about hair care practices. A total of 42% of the respondents said that they spent more than 1 hour per week on hair care, including regular visits to a salon.