By Mahlon Meyer
Northwest Asian Weekly
Dr. Jennifer Chen
Usually, Shirley Chang is in complete control. The Amazon executive has steely black pupils that cut right to the soul. But when she talks about her son, who has eczema, they become bewildered and sad.
So crucial is skin health to not just our physical, but our emotional wellbeing, that experts strongly caution us against neglecting it, as many people do.
For Asian American and Pacific Islanders (AAPI), the issues are complicated by a convergence of cultural and genetic factors that in some areas leave them even more vulnerable than their white counterparts.
In the case of skin diseases like eczema or cancer, AAPI kids and families confront unique challenges that in the end are quite surprising—but also can be equally debilitating or even deadly.
At the same time, dermatologists recommend special steps to care for skin of color.
Finally, Covid-19 complicates skin health, and experts recommend special care to avoid damage from mask wearing and other possibly-related afflictions.
Broad consequences
For people coming from an AAPI background, skin diseases can be particularly complicated.
With a cultural predisposition to emphasize strong academic performance or work achievement, they may neglect the devastating emotional consequences of having what appears to be a superficial illness.
Eczema is an example.
“Eczema can have a major impact on the lives of parents and caregivers in many different ways, affecting anything from sleep and mental health, to work productivity, for instance, if time needs to be taken off work for doctor appointments, skin infections, etc.,” said Jennifer Chen, a clinical professor of Dermatology at Stanford University.
“It can be very difficult for children with eczema, who aside from the itch and discomfort, often deal with social stigmatization, poor sleep quality, and increased rates of diagnoses such as ADHD and others.”
For her part, Chang (she asked for a pseudonym and for some details to be slightly changed for privacy and professional reasons) tells other parents how important it is to check on a child’s state of mind when he comes home from school rather than ask about his scores.
In her son’s case, his hands would grow scaly and bleed while at school.
“When the class had to hold hands, no one wanted to hold hands with him—they called him ‘grandpa hands,’” she said.
Her son would come home devastated and refuse to return to school.
“Without a sound emotional basis, no child can achieve anything,” she said.
She and her husband tried various measures, such as buying him gloves to wear. But the gloves after a while increased the infection by not letting in enough air.
Finally, they found other ways, such as encouraging him to join small, close-knit groups, such as his school’s band class.
Chang also gave lectures to his class about eczema, in conjunction with the school nurse.
To their dismay, they found that eczema and asthma often go together, as they did in her son’s case.
“This is quite common. Fortunately, we are finding that some of our medications can simultaneously treat both,” said Chen.
Chang and her husband had to apply their professional skills to their marriage to avoid blaming each other when their son had flare ups that left him hospitalized for long stretches.
“First, we would work together as a team to solve the immediate problem, then after he was better, we would trace back and find the cause,” she said.
In one case, it was an allergy to a particular product.
“They don’t all have the same level of quality control,” she said.
She and her husband never use the word, “You,” in talking about how their son got sick.
“That word is defensive,” she said.
Her husband was also empathetic for what she described as her sense of guilt.
While she was pregnant with her son, she was moving from the East Coast, starting a new job, building a new house, and her in-laws were sick.
“I tried to do too much,” she said.
As a result, she told herself, she had a difficult birth and had hemorrhaging.
When her son was finally born, his skin color was very dark.
“The doctor said he drank a lot of blood and had jaundice,” she said.
That led her to believe his eczema was her fault.
But her husband assured her that, as a child, he had had both eczema and asthma, and they both were genetic.
“As a mother, you always feel it’s your fault, but I was blessed by his reassurance,” she said.
Research bears out her husband’s claims.
“We know that eczema can deeply impact the lives of caregivers as well as patients. We are still learning what types of factors predispose to eczema. Family history of atopy does seem to increase the risk for eczema,” said Chen.
Dangerous products
People of AAPI backgrounds may also be susceptible to ineffective treatments.
Chang and her husband, first-generation immigrants from Taiwan, tried Chinese medicine for their son’s malady.
They first tried a Chinese medicine doctor in California. But when they returned home to Seattle, Chang’s husband decided against it.
“He said, ‘We don’t know what the ingredients are, and unless we clearly know what he’s going to be putting in his body, he’s not taking it,’” said Chang.
On a long visit to Taiwan, a Chinese medicine doctor prescribed snake soup.
Their son ate the soup while there, then for six months after returning.
“We didn’t notice any difference,” said Chang.
“Eczema can be a very challenging diagnosis,” said Chen, in response to questions about Chang’s case. “It is not uncommon for patients to seek alternative medicine avenues, but these can also be challenging since they often lack data on safety or efficacy.”
Other dangers
Given the current trend to add botanicals—“plants”—to health care products, this can create another, unforeseen problem, said Chen.
In eczema products, for instance, plants added to the mixture can trigger secondary skin allergies—as can fragrance.
The problem is that the Food and Drug Administration does not hold products that are marketed for beautification to the same standard as those that are sold strictly as medical treatments.
This gives huge leeway to marketers, and terms such as “hypoallergenic” or “for sensitive skin” are not actually regulated and do not necessarily mean much.
“The most important thing is to work with a board-certified dermatologist in selecting a product,” said Chen.
Even products labeled specifically to treat eczema may have these pitfalls.
Myth vs. reality
Skin cancer is another area where fact may not correspond to belief, particularly for people of AAPI ancestry.
There is a myth that white people are more prone to skin cancer, said Chen. But in fact AAPI people are also vulnerable. They are more likely to develop skin cancer on their hands and feet, said Chen, even while still being susceptible on their face and other parts of their bodies.
At the same time, AAPI people are more prone to hyper-pigmentation—dark spots on their skin—which in some traditional cultures that value fairer skin can be frowned upon.
Chen recommends that people of AAPI ancestry use tinted sunscreen, which contains iron and is able to block out visible light along with UV rays—all of these types of light cause the spots.
For everyone, Chen recommends examining your own skin once a month for any changes or growth in moles or pigmentation.
There are, unfortunately, no guidelines about how often to see a dermatologist. It is better to be examined by a dermatologist than a general practitioner, but many insurance companies require one to see the general practitioner first before being referred.
“One of our biggest challenges is that people seem to think dermatologists are just for beautifying the skin cosmetically. We certainly do that, but in fact we treat everything that has to do with the skin,” said Chen.
Covid-19 and skin
Covid-19 created a new set of challenges for skin health, ones which, again, persons of AAPI ancestry might commonly face.
While there are many phenomena that occurred during the pandemic that involve skin, such as “Covid toes” or other rashes, it is not definitively known if these are Covid-19 related.
“Covid toes,” for instance, when your toes turn purple, could be an epiphenomenon, meaning it’s not directly related to the pathogen, but is a side effect of so many people suddenly working from home and sitting for long periods. The research is ongoing.
But mask-wearing is known to cause irritation and sometimes acne, particularly for people who wear them for long periods. In skin of color, these skin issues can again result in hyperpigmentation.
Chen’s work includes evaluating the most effective way to mitigate the effects.
First, everyone should apply a non-comedogenic moisturizer (one that doesn’t clog pores), making sure to do so far enough in advance that it has time to dry before fitting on a mask.
“If having irritation behind the ears, choose a mask with straps that loop behind the head rather than behind the ears. Devices also exist that pin the ear loops of masks behind the head. Wear a tinted sunscreen on areas of the face not covered by the mask,” said Chen.
Finally, medications may sometimes be required. If not improving with the above, follow up with a board-certified dermatologist, said Chen.
General skin care
Beyond this, Chen’s recommendations are the same that we often hear:
—use a broad-spectrum SPF 30+ sunscreen
—reapply every 2-3 hours
—use other mitigating techniques, such as wearing hats or rash guards and seeking out the shade
—make sure eczema products are fragrance free, and if possible, plant free
Recent bad press about chemical sunscreens—claiming they harm coral or some chemicals are absorbed into the body—have turned some people off to their use, she said.
“However, this is controversial and requires further study. In the meantime, patients who are uncomfortable with this can stick with mineral (non-chemical) sunscreens that have an active ingredient of zinc or titanium dioxide.
There is a strong body of research showing that sun protection decreases the risk of skin cancer, hyperpigmentation, or signs of skin aging, and it behooves everyone to exercise sun protection,” said Chen.
Skin cancers are some of the most common types of skin cancer and may be preventable with good habits.
Mahlon can be reached at info@nwasianweekly.com.