As we close out the month of May and Asian American and Pacific Islander Heritage Month, it seems an opportune time to reflect on providing culturally competent and equitable dermatological care to the diverse Asian American and Pacific Islander (AAPI) community.
It is vital to note that achieving this requires a comprehensive understanding of the unique challenges and nuances that may arise in the diagnosis, treatment, and management of particular skin conditions in diverse patient populations. To shed light on this important topic, LiVDerm consulted with a team of expert dermatologists who shared their insights and experiences in successfully treating and diagnosing patients of AAPI heritage. By offering valuable perspectives on bridging the care gaps often encountered when treating this patient population, we can better equip dermatologists with the knowledge necessary to deliver personalized care that fosters trust and confidence.
Clinical Presentation and Prevalence of Inflammatory Skin Diseases in AAPI Patients
Understanding the clinical presentation and prevalence of inflammatory skin diseases in AAPI patients is crucial for delivering effective and culturally competent care.
Insights from Jennifer Soung, MD
Dr. Jennifer Soung highlights that inflammatory skin conditions in AAPI patients often present differently compared to other ethnic groups. The erythema associated with these inflammatory conditions for instance, is not bright red but rather appears more purple or dull red. Asian patients with atopic dermatitis (AD) often show clearer demarcation of lesions with more prominent scaling and lichenification. These presentations require dermatologists to not only be attentive, but also knowledgeable about these distinctions in order to ensure accurate diagnosis and effective treatment. This is supported by a systematic review by Cheng J, Wu JJ, and Han G., which provides a detailed characterization of AD in East Asian populations (Dermatol Ther (Heidelb). 2021).
Insights from James Song, MD
Dr. James Song adds that Asian patients are more likely to present with small plaque-type psoriasis and atopic dermatitis-psoriasis overlap. This highlights the heterogeneity in the presentation amongst different racial and ethnic groups. It also underscores the necessity for further research to determine whether our current therapies are effective across these diverse populations.
Moreover, while generalized pustular psoriasis (GPP) is an ultra-rare disease, it has been reported to be more common in Asian countries which emphasizes the need for heightened awareness and tailored therapeutic approaches for AAPI patients.
Challenges in Treating Dermatologic Disease in AAPI Patients
Treating dermatologic diseases in AAPI patients presents unique challenges that require specialized knowledge and careful consideration.
Insights from Dr. Jennifer Soung
Dr. Soung emphasizes the complexity of treating melasma in AAPI patients, mentioning that it can be more challenging as these patients appear to have less pigment. She adds that any sort of injury to the skin may leave dyspigmentation which necessitates extra caution when using topical retinoids, chemical peels, and lasers. Unfortunately, some dermatology clinics avoid treating these patients out of fear of potential complications due to a lack of experience or knowledge of patients with non-white skin, highlighting a significant gap in care.
Insights from Dr. James Song
Dr. Song notes that fair skin is often more desirable among Asian patients and because treatments like phototherapy can cause skin darkening, they are less appealing to this patient population. Additionally, Asian patients with psoriasis tend to have a lighter body weight (15-20 kgs in some studies) and generally experience superior efficacy to biologics than their non-Asian counterparts.
Furthermore, Asian patients may also be more prone to certain side effects with systemic therapies, including shingles with Janus kinase (JAK) inhibitors and severe cutaneous adverse reactions (SCARs) to anti-convulsants. This increased susceptibility necessitates careful monitoring and a thorough understanding of these potential adverse effects.
Cultural Considerations
Cultural preferences and ideals significantly influence both the perception and treatment of skin conditions.
Insights from Dr. Jennifer Soung
Dr. Soung highlights that melasma is more prevalent among individuals with darker skin types, including many Asian populations. This population also finds this condition more bothersome because there is a historical preference for lighter skin tones rooted in cultural ideals associated with wealth, social status, and notions of purity. In contrast, Western cultures have traditionally linked tanned skin with outdoor leisure activities and a healthy lifestyle.
Insights from Shasa Hu, MD
Dr. Shasa Hu, specifically addressing cosmetic dermatology procedures, points out distinct cultural differences that shape how patients select cosmetic procedures and providers.
"My Asian patients are mainly concerned about pigmentation, skin texture, and glowing skin as many Asian cultures value even, flawless skin as a key feature of beauty and youth. Masseter slimming, liquid rhinoplasty (nose filler), and chin filler are among the most popular injectable procedures in my Asian patients, as oval face shapes with a projected nose are deemed more desirable and feminine”.
Dr. Hu notes that while these beauty ideals also reflect Western influences, there is a growing homogenization of beauty standards across cultures and ethnicities. However, she observes that among Asian and African American patients, there is less desire for exaggerated lip enhancement compared to other populations.
Concluding Thoughts
Providing culturally competent dermatological care to the diverse AAPI community is an ongoing journey that requires continuous learning, empathy, and a steadfast commitment to inclusivity. The insights shared by our experts serve to highlight the importance of addressing the unique challenges faced by AAPI patients and working to overcome them. It is vital to not only adopt a patient-centric approach that values open communication and cultural sensitivity, but also one that builds trust and fosters a strong patient-provider relationship.
