Dermatological
Disorders and Cultural Practices
August 2002
B y the year 2050, you’re likely to have a vastly more diverse and complex patient base. Estimates indicate that 50% of the population will be non-Caucasian by then. Currently, you may already have a diverse ethnic patient population in your office, particularly if you practice in a larger metropolitan area. However, in the coming years even dermatologists in the heartland of the United States will increasingly see pockets of ethnic populations that were not previously encountered.
How will our practices differ when we experience this new patient diversity? In many ways. In particular, there are cultural practices in members of ethnic groups that can be associated with skin lesions or skin disease. Here, we’ll discuss some of these practices and their effects on skin and hair in African Americans, Asians and Latinos. It’s important that you know about these practices and their effects so you can recognize the signs and symptoms when patients present in your practice.
African-American Skin and Scalp Disorders
A variety of disorders occur on the skin and the scalp that are caused by cultural practices seen almost exclusively in the African-American population. Some of these disorders seen on the scalp include trichorrhexis nodosa, acne keloidalis nuchae and traction alopecia. Pomade acne, a disorder of the skin seen primarily in African Americans, is also caused by cultural practices.
Acquired trichorrhexis nodosa (TN) is a disorder, which is secondary to physical and/or chemical trauma to the hair.1 It’s usually further subdivided into distal or proximal types depending on where the pathology is located in the hair.
Proximal TN occurs mostly in the African-American population. On examination, the hair is short in the affected area and nodules are seen on microscopic examination of the hair shaft.2 This disorder develops after many years of physical trauma leading to damage of hair shafts. Damage is caused by practices such as hair straightening with hot combs, permanent weaves, excessive brushing and combing, hair styles that put stress on the hair, heat, trichotillomania, scratching and pulling, shampooing, hair setting, the use of chemicals and dyeing the hair. Many African-American women and men use a variety of the methods mentioned above at home or at their hair stylist/barber to obtain these hairstyles, which cause trauma to the hair shaft.
Acne keloidalis nuchae (AKN) is a chronic, progressive folliculitis resulting in a foreign body granuloma formation around a hair released from a disintegrated hair follicle. This condition primarily affects African-American men and is located in and below the hairline of the posterior aspect of the neck (see top photo). Although AKN is often asymptomatic, it can cause pain, itching and suppuration, but patients present mainly because of cosmetic concerns.3
A number of etiological factors cause AKN. One that’s associated with cultural practices in African-Americans may be a close haircut that’s tapered at the neck, a style known as the “fade,” or with shaving the head, which is currently in vogue. This can also be seen in African-American women who use a razor edge to sculpt the back of the neck (see bottom photo).
A follicular, pustular eruption develops on the posterior neck at or below the hairline. As the disease process progresses, firm follicular papules develop and eventually large keloids with sinus tracts, pus and scarring alopecia may form. The keloidal nodules actually contain the crypts of trapped hair.4
Traction alopecia is another condition of the scalp that’s frequently encountered in the African-American population as a result of hairstyles used by many women and men. Some of these hairstyles include braiding the hair, cornrowing, tightly rolled hair and dread locks5 (see photo at top of next page). Traction alopecia usually presents as areas of symmetrical hair loss around the hair margins in the areas in front of the ear.6 The condition, present for a substantial length of time, causes the hair follicle to become atrophic, which results in hairs that are short and thin. If the traction alopecia persists for longer durations, there’s an absence of hair follicles.7 The pattern of hair loss varies depending on the hairstyle involved and which hair follicles are under tension because of the specific hairstyle.
Early recognition and diagnosis is critical in managing traction alopecia. If it’s recognized early enough and the hairstyle is modified, the process may be reversible.
Pomade acne is a skin condition seen primarily in African Americans secondary to grooming substances used on the scalp that spread to the forehead and scalp (see bottom photo). Pomades were formerly used as hair straightening agents. Although the use of pomades has been on the decline, secondary to the popularity of other agents and methods used to straighten hair, pomades are still used for other purposes such as lubricating the scalp.8 Pomades or other hair products used on the hair and scalp contain comedogenic compounds such as lanolins, isopropyl myristate, and its analogues, which may cause pomade acne.9 Pomade acne, which is a variant of acne cosmetica, presents clinically as perifollicular papules, pustules and comedones occurring mainly on the forehead and temples.10
Alternative Asian Medicine Practices and Effects
The Asian population in the United States has increased significantly over the last decade and will continue to grow substantially this decade. This population includes people from East, Southeast and South Asia. The dermatological disorders seen in the Asian population that are related to cultural practices are primarily in the East and Southeast Asian groups.
The disorders result from the practice of using alternative medicines that are popular in those areas of the world. These practices are brought to the United States by new immigrants and are also used by East Asians and Southeast Asians who have lived in the United States for many years.
Ecchymotic streaks on the skin of patients from this ethnic background may be due to the practice of coin rubbing or skin scraping, which originated in China but was later adopted by Southeast Asian cultures in Vietnam, Cambodia, Thailand, Malaysia and Indonesia.11
Although traditionally a coin was used, current instruments used include coins, combs, spoons and the edge of a jar cap.12 It’s believed that through skin scraping, symptoms of flu, fever and headaches can be relieved by improving circulation within soft tissue.12 The technique is to massage an ointment or oil on the skin and then stroke the skin firmly in a downward motion with the coin or instrument. This is done in a parallel and symmetrical distribution, which causes ecchymotic streaks on the skin to appear in a similar pattern.
Cupping, a technique used to relieve the primary symptoms of abdominal discomfort, is another alternative medicine practice used in Asian cultures that may cause skin lesions. This method is thought to increase circulation and help eliminate toxins trapped in tissues.12,13 In cupping, a cotton ball is soaked with alcohol or another ignitable fluid and then lit and placed in a cup or jar. The cup or jar is then inverted and placed on the skin. The flame extinguishes, creating a vacuum effect, which causes the skin to be pulled into the cup or jar as the temperature of the cup or jar cools. The resulting lesion on the skin is circular and ecchymotic.
Moxibustion could be the cause of second-degree burns. This practice is used to treat asthma and pain in Asian cultures.12,14 An incense-like material is lighted and the heat from this material is applied to the skin at acupuncture points.12,14 The material is usually applied indirectly to the skin, which results only in transient erythema. It may be applied as it’s burning directly to the skin, which can result in second-degree burns.
The skin lesions that occur from these cultural practices of Asian medicine may mimic physical abuse in children and adults.15,16 Most are transient; however, permanent scars may occur with moxibustion.15,17,18 You should be able to recognize these symptoms during history or physical exam.
Latino Population
The Latino population in the United States now comprises 22% of the total population and continues to increase.
Capsaicin dermatitis is a common problem that can be seen in this population that’s caused by contact with chile peppers — a commonly used condiment in the Latino diet. Peeling the peppers is frequently done barehanded and often causes prolonged, delayed burning pain, erythema and irritation.
Patients should be advised to wear gloves when handling chile peppers in order to prevent this reaction. Topical anesthetics and high-potency corticosteroids may be used to lessen the pain and erythema.19
Allergic contact dermatitis is seen in the Latino population because agricultural workers make up a percentage of the Latino population and many are migrant workers. Several farm chemicals and materials, which are used for veterinary care, are causative agents for allergic contact dermatitis.
Among the sources of this problem are many fertilizers, pesticides, latex and topical antimicrobials made for veterinary use. Zoonotic disorders are common among agricultural workers and range in severity from fungal infections, such as tinea corporis, that are easily treated to disorders that are life-threatening problems such as anthrax.20
Pomade acne, which we discussed in relation to African Americans, is also common among the Latino population, although it occurs predominantly in blacks. In Latinos, it primarily affects males who apply various oils and lubricating agents to the hair, scalp and face as a part of their grooming. The lesions are usually closed comedones present on the forehead, temples, cheeks and chin. The comedogenicity of various pomades has been established.
Contact stomatitis is seen in cases of sensitivity to dental prostheses. Some of these include gold, nickel, chromium, mercury and zinc. In the Latino population, gold is commonly used. Some of the clinical signs are erythema of the tongue and buccal mucosa with erosions, as well as angular cheilitis.21
Importance of Understanding
Knowledge of cultural practices in the diverse ethnic groups now seen in the United States can be helpful to you, wherever you may practice. Cultural practices can be elicited by a patient history, or you might note evidence of these cultural practices upon examination of the patient. It’s important to understand how these practices may cause skin or hair disease and how they may influence therapy of the resultant dermatological problem.
Editor’s Note: Dr. Halder is editing a book titled Dermatology and Dermatology Therapy of Pigmented Skins to be published by CRC in fall 2003. The book’s content will include manifestations and treatment of dermatological disease in non-white populations. There will also be special emphasis on the effect of cultural practices on the manifestation of dermatological disorders.
B y the year 2050, you’re likely to have a vastly more diverse and complex patient base. Estimates indicate that 50% of the population will be non-Caucasian by then. Currently, you may already have a diverse ethnic patient population in your office, particularly if you practice in a larger metropolitan area. However, in the coming years even dermatologists in the heartland of the United States will increasingly see pockets of ethnic populations that were not previously encountered.
How will our practices differ when we experience this new patient diversity? In many ways. In particular, there are cultural practices in members of ethnic groups that can be associated with skin lesions or skin disease. Here, we’ll discuss some of these practices and their effects on skin and hair in African Americans, Asians and Latinos. It’s important that you know about these practices and their effects so you can recognize the signs and symptoms when patients present in your practice.
African-American Skin and Scalp Disorders
A variety of disorders occur on the skin and the scalp that are caused by cultural practices seen almost exclusively in the African-American population. Some of these disorders seen on the scalp include trichorrhexis nodosa, acne keloidalis nuchae and traction alopecia. Pomade acne, a disorder of the skin seen primarily in African Americans, is also caused by cultural practices.
Acquired trichorrhexis nodosa (TN) is a disorder, which is secondary to physical and/or chemical trauma to the hair.1 It’s usually further subdivided into distal or proximal types depending on where the pathology is located in the hair.
Proximal TN occurs mostly in the African-American population. On examination, the hair is short in the affected area and nodules are seen on microscopic examination of the hair shaft.2 This disorder develops after many years of physical trauma leading to damage of hair shafts. Damage is caused by practices such as hair straightening with hot combs, permanent weaves, excessive brushing and combing, hair styles that put stress on the hair, heat, trichotillomania, scratching and pulling, shampooing, hair setting, the use of chemicals and dyeing the hair. Many African-American women and men use a variety of the methods mentioned above at home or at their hair stylist/barber to obtain these hairstyles, which cause trauma to the hair shaft.
Acne keloidalis nuchae (AKN) is a chronic, progressive folliculitis resulting in a foreign body granuloma formation around a hair released from a disintegrated hair follicle. This condition primarily affects African-American men and is located in and below the hairline of the posterior aspect of the neck (see top photo). Although AKN is often asymptomatic, it can cause pain, itching and suppuration, but patients present mainly because of cosmetic concerns.3
A number of etiological factors cause AKN. One that’s associated with cultural practices in African-Americans may be a close haircut that’s tapered at the neck, a style known as the “fade,” or with shaving the head, which is currently in vogue. This can also be seen in African-American women who use a razor edge to sculpt the back of the neck (see bottom photo).
A follicular, pustular eruption develops on the posterior neck at or below the hairline. As the disease process progresses, firm follicular papules develop and eventually large keloids with sinus tracts, pus and scarring alopecia may form. The keloidal nodules actually contain the crypts of trapped hair.4
Traction alopecia is another condition of the scalp that’s frequently encountered in the African-American population as a result of hairstyles used by many women and men. Some of these hairstyles include braiding the hair, cornrowing, tightly rolled hair and dread locks5 (see photo at top of next page). Traction alopecia usually presents as areas of symmetrical hair loss around the hair margins in the areas in front of the ear.6 The condition, present for a substantial length of time, causes the hair follicle to become atrophic, which results in hairs that are short and thin. If the traction alopecia persists for longer durations, there’s an absence of hair follicles.7 The pattern of hair loss varies depending on the hairstyle involved and which hair follicles are under tension because of the specific hairstyle.
Early recognition and diagnosis is critical in managing traction alopecia. If it’s recognized early enough and the hairstyle is modified, the process may be reversible.
Pomade acne is a skin condition seen primarily in African Americans secondary to grooming substances used on the scalp that spread to the forehead and scalp (see bottom photo). Pomades were formerly used as hair straightening agents. Although the use of pomades has been on the decline, secondary to the popularity of other agents and methods used to straighten hair, pomades are still used for other purposes such as lubricating the scalp.8 Pomades or other hair products used on the hair and scalp contain comedogenic compounds such as lanolins, isopropyl myristate, and its analogues, which may cause pomade acne.9 Pomade acne, which is a variant of acne cosmetica, presents clinically as perifollicular papules, pustules and comedones occurring mainly on the forehead and temples.10
Alternative Asian Medicine Practices and Effects
The Asian population in the United States has increased significantly over the last decade and will continue to grow substantially this decade. This population includes people from East, Southeast and South Asia. The dermatological disorders seen in the Asian population that are related to cultural practices are primarily in the East and Southeast Asian groups.
The disorders result from the practice of using alternative medicines that are popular in those areas of the world. These practices are brought to the United States by new immigrants and are also used by East Asians and Southeast Asians who have lived in the United States for many years.
Ecchymotic streaks on the skin of patients from this ethnic background may be due to the practice of coin rubbing or skin scraping, which originated in China but was later adopted by Southeast Asian cultures in Vietnam, Cambodia, Thailand, Malaysia and Indonesia.11
Although traditionally a coin was used, current instruments used include coins, combs, spoons and the edge of a jar cap.12 It’s believed that through skin scraping, symptoms of flu, fever and headaches can be relieved by improving circulation within soft tissue.12 The technique is to massage an ointment or oil on the skin and then stroke the skin firmly in a downward motion with the coin or instrument. This is done in a parallel and symmetrical distribution, which causes ecchymotic streaks on the skin to appear in a similar pattern.
Cupping, a technique used to relieve the primary symptoms of abdominal discomfort, is another alternative medicine practice used in Asian cultures that may cause skin lesions. This method is thought to increase circulation and help eliminate toxins trapped in tissues.12,13 In cupping, a cotton ball is soaked with alcohol or another ignitable fluid and then lit and placed in a cup or jar. The cup or jar is then inverted and placed on the skin. The flame extinguishes, creating a vacuum effect, which causes the skin to be pulled into the cup or jar as the temperature of the cup or jar cools. The resulting lesion on the skin is circular and ecchymotic.
Moxibustion could be the cause of second-degree burns. This practice is used to treat asthma and pain in Asian cultures.12,14 An incense-like material is lighted and the heat from this material is applied to the skin at acupuncture points.12,14 The material is usually applied indirectly to the skin, which results only in transient erythema. It may be applied as it’s burning directly to the skin, which can result in second-degree burns.
The skin lesions that occur from these cultural practices of Asian medicine may mimic physical abuse in children and adults.15,16 Most are transient; however, permanent scars may occur with moxibustion.15,17,18 You should be able to recognize these symptoms during history or physical exam.
Latino Population
The Latino population in the United States now comprises 22% of the total population and continues to increase.
Capsaicin dermatitis is a common problem that can be seen in this population that’s caused by contact with chile peppers — a commonly used condiment in the Latino diet. Peeling the peppers is frequently done barehanded and often causes prolonged, delayed burning pain, erythema and irritation.
Patients should be advised to wear gloves when handling chile peppers in order to prevent this reaction. Topical anesthetics and high-potency corticosteroids may be used to lessen the pain and erythema.19
Allergic contact dermatitis is seen in the Latino population because agricultural workers make up a percentage of the Latino population and many are migrant workers. Several farm chemicals and materials, which are used for veterinary care, are causative agents for allergic contact dermatitis.
Among the sources of this problem are many fertilizers, pesticides, latex and topical antimicrobials made for veterinary use. Zoonotic disorders are common among agricultural workers and range in severity from fungal infections, such as tinea corporis, that are easily treated to disorders that are life-threatening problems such as anthrax.20
Pomade acne, which we discussed in relation to African Americans, is also common among the Latino population, although it occurs predominantly in blacks. In Latinos, it primarily affects males who apply various oils and lubricating agents to the hair, scalp and face as a part of their grooming. The lesions are usually closed comedones present on the forehead, temples, cheeks and chin. The comedogenicity of various pomades has been established.
Contact stomatitis is seen in cases of sensitivity to dental prostheses. Some of these include gold, nickel, chromium, mercury and zinc. In the Latino population, gold is commonly used. Some of the clinical signs are erythema of the tongue and buccal mucosa with erosions, as well as angular cheilitis.21
Importance of Understanding
Knowledge of cultural practices in the diverse ethnic groups now seen in the United States can be helpful to you, wherever you may practice. Cultural practices can be elicited by a patient history, or you might note evidence of these cultural practices upon examination of the patient. It’s important to understand how these practices may cause skin or hair disease and how they may influence therapy of the resultant dermatological problem.
Editor’s Note: Dr. Halder is editing a book titled Dermatology and Dermatology Therapy of Pigmented Skins to be published by CRC in fall 2003. The book’s content will include manifestations and treatment of dermatological disease in non-white populations. There will also be special emphasis on the effect of cultural practices on the manifestation of dermatological disorders.
B y the year 2050, you’re likely to have a vastly more diverse and complex patient base. Estimates indicate that 50% of the population will be non-Caucasian by then. Currently, you may already have a diverse ethnic patient population in your office, particularly if you practice in a larger metropolitan area. However, in the coming years even dermatologists in the heartland of the United States will increasingly see pockets of ethnic populations that were not previously encountered.
How will our practices differ when we experience this new patient diversity? In many ways. In particular, there are cultural practices in members of ethnic groups that can be associated with skin lesions or skin disease. Here, we’ll discuss some of these practices and their effects on skin and hair in African Americans, Asians and Latinos. It’s important that you know about these practices and their effects so you can recognize the signs and symptoms when patients present in your practice.
African-American Skin and Scalp Disorders
A variety of disorders occur on the skin and the scalp that are caused by cultural practices seen almost exclusively in the African-American population. Some of these disorders seen on the scalp include trichorrhexis nodosa, acne keloidalis nuchae and traction alopecia. Pomade acne, a disorder of the skin seen primarily in African Americans, is also caused by cultural practices.
Acquired trichorrhexis nodosa (TN) is a disorder, which is secondary to physical and/or chemical trauma to the hair.1 It’s usually further subdivided into distal or proximal types depending on where the pathology is located in the hair.
Proximal TN occurs mostly in the African-American population. On examination, the hair is short in the affected area and nodules are seen on microscopic examination of the hair shaft.2 This disorder develops after many years of physical trauma leading to damage of hair shafts. Damage is caused by practices such as hair straightening with hot combs, permanent weaves, excessive brushing and combing, hair styles that put stress on the hair, heat, trichotillomania, scratching and pulling, shampooing, hair setting, the use of chemicals and dyeing the hair. Many African-American women and men use a variety of the methods mentioned above at home or at their hair stylist/barber to obtain these hairstyles, which cause trauma to the hair shaft.
Acne keloidalis nuchae (AKN) is a chronic, progressive folliculitis resulting in a foreign body granuloma formation around a hair released from a disintegrated hair follicle. This condition primarily affects African-American men and is located in and below the hairline of the posterior aspect of the neck (see top photo). Although AKN is often asymptomatic, it can cause pain, itching and suppuration, but patients present mainly because of cosmetic concerns.3
A number of etiological factors cause AKN. One that’s associated with cultural practices in African-Americans may be a close haircut that’s tapered at the neck, a style known as the “fade,” or with shaving the head, which is currently in vogue. This can also be seen in African-American women who use a razor edge to sculpt the back of the neck (see bottom photo).
A follicular, pustular eruption develops on the posterior neck at or below the hairline. As the disease process progresses, firm follicular papules develop and eventually large keloids with sinus tracts, pus and scarring alopecia may form. The keloidal nodules actually contain the crypts of trapped hair.4
Traction alopecia is another condition of the scalp that’s frequently encountered in the African-American population as a result of hairstyles used by many women and men. Some of these hairstyles include braiding the hair, cornrowing, tightly rolled hair and dread locks5 (see photo at top of next page). Traction alopecia usually presents as areas of symmetrical hair loss around the hair margins in the areas in front of the ear.6 The condition, present for a substantial length of time, causes the hair follicle to become atrophic, which results in hairs that are short and thin. If the traction alopecia persists for longer durations, there’s an absence of hair follicles.7 The pattern of hair loss varies depending on the hairstyle involved and which hair follicles are under tension because of the specific hairstyle.
Early recognition and diagnosis is critical in managing traction alopecia. If it’s recognized early enough and the hairstyle is modified, the process may be reversible.
Pomade acne is a skin condition seen primarily in African Americans secondary to grooming substances used on the scalp that spread to the forehead and scalp (see bottom photo). Pomades were formerly used as hair straightening agents. Although the use of pomades has been on the decline, secondary to the popularity of other agents and methods used to straighten hair, pomades are still used for other purposes such as lubricating the scalp.8 Pomades or other hair products used on the hair and scalp contain comedogenic compounds such as lanolins, isopropyl myristate, and its analogues, which may cause pomade acne.9 Pomade acne, which is a variant of acne cosmetica, presents clinically as perifollicular papules, pustules and comedones occurring mainly on the forehead and temples.10
Alternative Asian Medicine Practices and Effects
The Asian population in the United States has increased significantly over the last decade and will continue to grow substantially this decade. This population includes people from East, Southeast and South Asia. The dermatological disorders seen in the Asian population that are related to cultural practices are primarily in the East and Southeast Asian groups.
The disorders result from the practice of using alternative medicines that are popular in those areas of the world. These practices are brought to the United States by new immigrants and are also used by East Asians and Southeast Asians who have lived in the United States for many years.
Ecchymotic streaks on the skin of patients from this ethnic background may be due to the practice of coin rubbing or skin scraping, which originated in China but was later adopted by Southeast Asian cultures in Vietnam, Cambodia, Thailand, Malaysia and Indonesia.11
Although traditionally a coin was used, current instruments used include coins, combs, spoons and the edge of a jar cap.12 It’s believed that through skin scraping, symptoms of flu, fever and headaches can be relieved by improving circulation within soft tissue.12 The technique is to massage an ointment or oil on the skin and then stroke the skin firmly in a downward motion with the coin or instrument. This is done in a parallel and symmetrical distribution, which causes ecchymotic streaks on the skin to appear in a similar pattern.
Cupping, a technique used to relieve the primary symptoms of abdominal discomfort, is another alternative medicine practice used in Asian cultures that may cause skin lesions. This method is thought to increase circulation and help eliminate toxins trapped in tissues.12,13 In cupping, a cotton ball is soaked with alcohol or another ignitable fluid and then lit and placed in a cup or jar. The cup or jar is then inverted and placed on the skin. The flame extinguishes, creating a vacuum effect, which causes the skin to be pulled into the cup or jar as the temperature of the cup or jar cools. The resulting lesion on the skin is circular and ecchymotic.
Moxibustion could be the cause of second-degree burns. This practice is used to treat asthma and pain in Asian cultures.12,14 An incense-like material is lighted and the heat from this material is applied to the skin at acupuncture points.12,14 The material is usually applied indirectly to the skin, which results only in transient erythema. It may be applied as it’s burning directly to the skin, which can result in second-degree burns.
The skin lesions that occur from these cultural practices of Asian medicine may mimic physical abuse in children and adults.15,16 Most are transient; however, permanent scars may occur with moxibustion.15,17,18 You should be able to recognize these symptoms during history or physical exam.
Latino Population
The Latino population in the United States now comprises 22% of the total population and continues to increase.
Capsaicin dermatitis is a common problem that can be seen in this population that’s caused by contact with chile peppers — a commonly used condiment in the Latino diet. Peeling the peppers is frequently done barehanded and often causes prolonged, delayed burning pain, erythema and irritation.
Patients should be advised to wear gloves when handling chile peppers in order to prevent this reaction. Topical anesthetics and high-potency corticosteroids may be used to lessen the pain and erythema.19
Allergic contact dermatitis is seen in the Latino population because agricultural workers make up a percentage of the Latino population and many are migrant workers. Several farm chemicals and materials, which are used for veterinary care, are causative agents for allergic contact dermatitis.
Among the sources of this problem are many fertilizers, pesticides, latex and topical antimicrobials made for veterinary use. Zoonotic disorders are common among agricultural workers and range in severity from fungal infections, such as tinea corporis, that are easily treated to disorders that are life-threatening problems such as anthrax.20
Pomade acne, which we discussed in relation to African Americans, is also common among the Latino population, although it occurs predominantly in blacks. In Latinos, it primarily affects males who apply various oils and lubricating agents to the hair, scalp and face as a part of their grooming. The lesions are usually closed comedones present on the forehead, temples, cheeks and chin. The comedogenicity of various pomades has been established.
Contact stomatitis is seen in cases of sensitivity to dental prostheses. Some of these include gold, nickel, chromium, mercury and zinc. In the Latino population, gold is commonly used. Some of the clinical signs are erythema of the tongue and buccal mucosa with erosions, as well as angular cheilitis.21
Importance of Understanding
Knowledge of cultural practices in the diverse ethnic groups now seen in the United States can be helpful to you, wherever you may practice. Cultural practices can be elicited by a patient history, or you might note evidence of these cultural practices upon examination of the patient. It’s important to understand how these practices may cause skin or hair disease and how they may influence therapy of the resultant dermatological problem.
Editor’s Note: Dr. Halder is editing a book titled Dermatology and Dermatology Therapy of Pigmented Skins to be published by CRC in fall 2003. The book’s content will include manifestations and treatment of dermatological disease in non-white populations. There will also be special emphasis on the effect of cultural practices on the manifestation of dermatological disorders.
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