More than 50% of patients who walk through the doors of Vivian Bucay’s cosmetic surgery practice in San Antonio are Hispanic. A number of these patients make the trek all the way from Mexico to receive treatment from Bucay because of her expertise with Hispanic skin. While there is no unifying trait that applies to all Hispanic skin, it does call for some special care and attention.
A seasoned veteran of treating Hispanic skin problems, Vivian Bucay, MD, FAAD, practiced cosmetic dermatology in Mexico City for 8 years after completing her dermatology training at the University of Miami and the Baylor College of Medicine.
A pioneer in dermatology in Mexico City, Bucay is responsible for bringing the first carbon dioxide laser for skin resurfacing to Mexico.
HISPANIC SKIN ISSUES
“The word ‘Hispanic’ refers to an individual whose ancestry has roots in populations indigenous to the Americas, as well as Spanish—Portuguese in the case of Brazil—ancestry,” Bucay says. “People of Hispanic descent carry a diverse gene pool.”
The skin tone of a Hispanic patient should not be categorized under a limited pool of possible skin dilemmas. The genetics underneath the darker pigment of Hispanic skin often hold a much more diverse story than is sometimes expected. For example, rosacea, which is typically associated with fair skin types, is not at all unusual in Bucay’s Hispanic patients due to the genetic diversity of Hispanic skin, which often includes Irish or German ancestry.
“Other than an increased tendency for hyperpigmentation, there is not a unifying skin trait that applies to all Hispanics,” she says.
“In practical terms, UVR damage and an increased risk for skin cancer may be overlooked in these individuals, unless a thorough history is taken and a complete skin examination is performed,” she adds.
Pigmentary disorders are common among the Hispanic population. One of the most common pigmentary disorders treated by Bucay is melasma discoloration of the skin, which is associated with the female hormones estrogen and progesterone and often appears in women. However, Bucay says that she does sometimes treat Hispanic men with melasma.
Though not as frequently, Bucay treats vitiligo—a condition in which the skin loses melanin, the pigment that determines the color of the skin. Vitiligo is seen more frequently in latitudes approaching the equator.
Another condition she treats, acanthosis nigricans, is characterized by dark, thick, velvety skin in body folds and creases.
Postinflammatory hyperpigmentation is common secondary to skin disorders such as acne, eczema, and psoriasis, but can also follow trauma such as burns, skin irritants, and insect bites.
As a rule, treatments for skin problems, whether a skin care program, chemical peel, or laser treatment, should be utilized in a way that minimizes irritation or injury to the skin in order to avoid hyperpigmentation.
“Hyperpigmentation following laser hair removal and skin resurfacing procedures is becoming an increasingly frequent reason for which Hispanic patients seek treatment, as more of these procedures are performed by individuals not familiar with the care of Hispanic skin,” Bucay says.
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Although the severity of skin conditions such as eczema and acne may not be more pronounced in Hispanics, the resulting postinflammatory hyperpigmentation and hypopigmentation are often more noticeable because of the contrast with the surrounding unaffected skin.
Bucay treats many Hispanic patients for acne problems that have underlying medical conditions, such as metabolic syndrome as a result of a hereditary predisposition to diabetes stemming from obesity.
Treating Hispanics for acne can be a tricky undertaking. “I have found that Hispanic patients can be very sensitive to products containing benzoyl peroxide, an ingredient found in countless over-the-counter as well as prescription medications for acne,” Bucay says.
Irritation of Hispanic skin from reactions to acne medications can lead to hyperpigmentation. It is also not unusual to see “bleaching” of treated skin in individuals who do not experience irritation from these products, according to Bucay.
SKIN CANCER AMONG HISPANICS
“There is a misconception that Hispanic patients are immune or exempt from melanoma or nonmelanoma skin cancers,” Bucay says.
She cites a study conducted by researchers at Stanford University Medical Center in which data collected between 1992 and 2004 showed that the incidence of melanoma continues to rise at an annual rate of 3.1%. This increase applies to melanoma of all thicknesses and at all stages. Bucay uses this study to back her belief that the increase in melanoma is not due to better detection methods.
Bucay stresses the importance of screening Hispanic patients for skin cancer. “Although Hispanic skin may not be as susceptible to sunburn or as prone to show sun-related changes, such as fine lines and wrinkles, the potential to develop skin cancer may be the result of vitamin D deficiency,” she says.
See also “Leading the Way,” by Rich Smith, in the September 2008 issue of PSP.
“Recent medical literature suggests that vitamin D levels may be linked to cancer in general,” she adds. “Darker skin types may be more susceptible to vitamin D deficiency, because their skin does not manufacture vitamin D upon sun exposure to the same degree that lighter skin types do.”
Choosing sunblock can be tricky for those many Hispanic patients who complain of oily skin. Broad-spectrum UV sunblocks often contain zinc oxide and titanium dioxide, which provide excellent UVA and UVB protection but can cause a whitish or ash-like cast to the skin. Bucay recommends sunblocks containing micronized versions of these ingredients. The smaller particle size of these minerals reflects UV rays but not visible light, so they appear invisible on the skin.
Certain types of melanoma can be especially dangerous for Hispanics. For example, acral-lentiginous melanoma, which is seen more commonly among Hispanic and African American skin types, are usually located on the hands, feet, or under the nails. Because of their location, melanomas of this type are often detected at a more advanced stage and, hence, portend a grimmer diagnosis.