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.