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

Abstract
Acne is a common disease among patients with Latin American ancestry. Its presentation is very similar to that in all skin types, but nodulocystic acne is more frequent in patients with oily and darker skin than in white Caucasians. Acne sequelae in patients with Latin American ancestry and with darker skin include postinflammatory hyperpigmentation (PIH) and atrophic and hypertrophic scars or keloids, with PIH being the most common complication affecting the quality of life of patients. Lately, more attention has been paid to rosacea in patients with darker skin. It has been seen that some of the patients, especially women, diagnosed with adult acne and who did not respond to treatment, were actually patients with rosacea. It is important to recognize the clinical characteristics of this disease in patients with darker skin in whom erythema and telangiectasia are difficult to observe. Here, we present the most relevant clinical characteristics of both diseases, as well as their treatment in patients with darker skin with Latin American ancestry. J Drugs Dermatol. 2019;18(3 Suppl):s124-126.

INTRODUCTION

Acne is a common disease among patients with Latin American ancestry. As in the white, Caucasian population, acne affects, to a greater or lesser degree, around 85% of young people between the ages of 12 and 24 years. In recent years, an increase in acne has been observed in individuals older than 25 years of age, especially in women (adult acne).1In some scientific and non-scientific publications, it has been determined that Latin or Hispanic skin is that of olive, medium to dark brown color, which generally tans and that seldom burns, with dark eyes and hair. However, this description is not exact. Although, a good part of the population has yellowish skin and dark hair and eyes, there is a great variety of skin types in Latin Americans, ranging from white skin with light eyes and reddish hair, to very dark skin, black, going through different shades of pink, light brown, chestnut, yellowish, and others, resulting from different racial mixtures. We must bear in mind that in Latin America, miscegenation was not only of Europeans with natives, but with slaves from Africa and also Chinese and Japanese, especially in Brazil, Peru, and Mexico, which resulted in a kind of skin color that is difficult to classify.

The Color of the Skin in Latin America

As mentioned above, all skin colors are found in Latin America as a result of the different mixes that have existed throughout the ages. Before the conquest of America, there were natives of the continent. These were called indigenous, that is, they came from the Indies because Columbus and his companions thought they had arrived in the Indies. Later, it was learned that they were not in the Indies, but a new continent called America, in honor to Amerigo Vespucci. These Amerindians mixed with the white Europeans giving rise to the Mestizos. The Spaniards also brought slaves from Africa and they also mixed with whites giving rise to the Mulattos, and with indigenous people, giving rise to the Zambos.2,3Nowadays, due to the easy ways to travel, communications, and globalization in general, it is harder for us to classify people by the color of their skin, since mixtures are much more frequent and of different origins. One way would be through a color palette as shown in Figure 1.

Acne: Clinical Considerations

All types of acne are seen in Latin Americans from the comedonal variant to the nodulocystic. This last form of acne has been observed more frequently in individuals with medium to dark brown skin than in lighter skin.4From the beginning of the disease, even in cases with comedonal acne alone, a hyperpigmented halo is observed around the lesion, which could, in part, explain the post-inflammatory hyperpigmentation (PIH) that often emerges as an acne sequel. This is a very important characteristic that would denote the presence of inflammation and the indication for the early treatment of the disease.5,6

Topical Treatment