Treating the mosaic of Asian skin

Rancho Mirage, Calif. - The Asian population has a spectrum of skin types, from the porcelain white of the Japanese to the browner Pacific Islanders, according to Wendy E. Roberts, M.D. She is a dermatologist here, and assistant clinical professor of medicine at Loma Linda University Medical School, Loma Linda, Calif.

Asian women, in general, want unblemished skin, free of pigmentation, according to Dr. Roberts.

Unique anomalies

It has a nerve distribution, affecting the area around the eye, temples and forehead, and nevus of Ota can go to the nose and cheek area or involve the white of the eye.

Another is a related and similar looking lesion, called nevus of Ito, which tends to occur on the shoulder area, neck and upper arm.

"There is no risk of melanoma from either of these," Dr. Roberts says. "We often treat nevus of Ota and nevus of Ito with the Q-switch ruby laser."

Asian babies might have the mongolian spots, which are blue, purple and sometimes green spots at the base of the spine.

"These tend to resolve themselves," Dr. Roberts says. "Then, there is Riehl's melanosis, which is a pigmentation of brown-gray spots on the face. This condition among some Asians is suspected to be a response to contact dermatitis."

Asians are less likely than Caucasians to have acne, but when they do, it tends to be a deeper inflammatory and cystic type.

Some of the more prominent skin conditions among Asians, Dr. Roberts says, include disorders having to do with hyperpigmentation, such as postinflammatory hyperpigmentation after acne and traumatic postinflammatory hyperpigmentation.

"We often see melasma among Asians who take oral contraceptives or hormone replacement therapy. In the older age group, you start getting solar lentigines, seborrheic keratosis and dermatosis papulosa nigra (DPN) growths on the face, which are especially common among Asian, Latins and African Americans," Dr. Roberts says.

Common Chinese maladies

The literature suggests that contact dermatitis and atopic dermatitis are common among Chinese.

Atopic dermatitis is particularly common among Chinese infants. There is also an increase in this population in variants of atopic dermatitis, such as nummular dermatitis, dyshydrosis and xerosis, according to Dr. Roberts.

Asian hygiene practices of taking long, hot showers and baths could exacerbate some conditions that cause dryness, although these cultural ways are not the cause, according to Dr. Roberts.

"It could be that genetic and environmental components are to blame. The Japanese have a dryer climate, while it is more humid in Southeast Asia," she tells Dermatology Times.

Dr. Roberts says she sees hyperpigmentation among Asian patients. Some traditional cultural medical practices that might lead to increases in pigmentation and contact dermatitis include coining, where people apply oil to the skin and then press a coin onto the skin to cause friction.

Inherent protection against skin cancer

Asians have a much lower incidence of skin cancer compared to Caucasians.

"They fall into the same type of skin cancer risk as African Americans because of the UVA protective effect of melanin," she says. "When skin cancers occur, they tend to be pigmented basal cell skin cancers, or pigmented Bowens, which is squamous cell carcinoma in situ. When melanoma occurs, it tends to be the acral-lentiginous type, which is a much more aggressive form of melanoma that occurs on nails, hands, feet, scalp."

Treatment parameters

Asian women, in general, do not like to have a lot of body hair; so, hirsutism can bring an Asian woman in for treatment.

Dermatologists should first exclude medical causes of hirsutism before treating the condition.

"Then, I always recommend hair removal laser," she says.