Acne and Rosacea: Special Considerations in the Treatment of Patients With Latin American Ancestry

March 2019 | Volume 18 | Issue 3 | Supplement Individual Articles | 124 | Copyright © March 2019


Mercedes Florez-White MD

Department of Dermatology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL

Dermocosmetic Care: Cosmeceuticals (cutaneous barrier restoring cleansers/moisturizers, antioxidants, niacinamide, colloidal oats, witch hazel, among others); Cold compresses; Thermal water.Topical Treatment: Oxymetazoline or brimonidine are the first line of treatment for ETR in combination with azelaic acid, if some papules or pustules are present; Ivermectin, azelaic acid, or metronidazole are the first line of treatment for PPR associated or not with brimonidine or oxymetazoline; If patient does not tolerate this treatment well, it should be switched to pimecrolimus or tacrolimus; For ocular rosacea the best topical treatment is ophthalmic cyclosporine.Systemic Treatment: The first line of treatment for PPR, in association with the topical treatment described above, is the use of modified release doxycycline: 40 mg (30 mg immediate release and 10 slow release). In patients which do not tolerate doxycycline, children or pregnant, macrolides (eg, clarithromycin) are the first choice. Patients with severe PPR, GH/PR or granulomatous rosacea, would benefit with the use of low dose of oral isotretinoin.The first line of treatment for phymatous rosacea is the use of ablative laser therapy (eg, CO2 laser) followed by dermabrasion, electro/radiosurgery, and cryosurgery.

CONCLUSIONS

There is no such thing as Hispanic skin. The Hispanic skin can range from white to black with diverse variation in colors/ shades as a result from the blend of different races/ethnicities. There is also a subclinical inflammatory process in patients with all skin colors even in cases of non-inflammatory acne that can result in PIH.PIH affects quality of life. Early measures, such as daily use of sunscreens, proper makeup, and anti-inflammatory agents with bleaching effect, like azelaic acid, should be considered. Treatments that may irritate the skin should be avoided to decrease the risk of PIHAlthough Rosacea is more frequent in phototype I and II (Fitzpatrick) it can also be suffered by people with darker skin color. We must consider rosacea in the differential diagnosis when we have a patient with dark skin, facial flushing, heat, eye symptoms, or papulopustular elements and absence of comedones, so as not to confuse the disease with adult acne, as may be happening in many of the cases not initially diagnosed as rosacea. Unlike acne, postinflammatory hyperpigmentation is rare in patients with rosacea.

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