Wednesday, August 4, 2010

Cultural Practices Affecting the Skin

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active.

I learned of this article (full reference below) via a tweet from @MDLinx last week
Cultural practices affecting the skin of children: Current Opinion in Pediatrics #GM #mdlinx
Thanks to friends I was able to obtain a pdf copy of the article which I would recommend to anyone who see children (pediatricians, family doctors, ER doctors, dermatologists, plastic surgeons, nurses, etc). 
The article reviews cultural practices that present with dermatologic manifestations in the pediatric population.  Most of us have had minimal exposure to these cultural practices.  This can lead to misunderstandings, misdiagnosis, and (unfounded) child abuse accusations. 
The article points out that the 2000 Census counted approximately 28 million first-generation immigrants in the United States.  This increasing diversity means we in health care have to learn more about the diverse cultural practices.  
Here are just a few of the culture practices mentioned in the article:
Coin rubbing and spooning
Coin rubbing or spooning is the cultural practice of
repeated pressured strokes over lubricated skin with a
smooth edge such as a worn coin, a metal cap with a
rounded edge, a ceramic Chinese soup spoon, an even honed animal bone, a water buffalo horn, a piece of jade, or a piece of ginger root. The process involves placing the smooth edge against the preoiled skin surface, pressing down firmly, and then moving down the muscles, with each stroke being 4–6 in. in length. This is also referred to as friction stroking and follows along the pathway of the acupuncture meridians on the surface of the skin, which in this case is on the spine. The resulting extravasation of blood leads to petechiae and ecchymoses, which is referred to in Chinese medicine as the ‘Sha’ rash………….
This photo of gua sha rash is not from the article, but was found here.

Gridding is an underreported folk remedy that is most
commonly practiced in Russian cultures as well as Ukraine and other eastern regions of the former Soviet
Union.  Gridding describes the practice of painting the back with iodine in a criss-cross pattern. This results in a hyperpigmented grid-like pattern on the back.  This practice is typically used as a treatment for respiratory illness because the topical application of
iodine results in a warm and mild burning sensation that is thought to aid in relief of cough and congestion….
The traditional practice of cupping dates from as early as 3000 B.C. and has been practiced in a variety of cultures worldwide, including Egyptian, Chinese, Greek, European, and Middle-Eastern cultures.
Cupping is the practice of creating a small area of low air pressure next to the skin with a cup leading to suction. Various tools, methods, and procedures are used in creating this reduced air pressure. ……..
More commonly in Middle-Eastern cultures, the skin may be lanced prior to placing the cup, so that the vacuum draws blood into the cup as part of the treatment; this is referred to as wet cupping and is
also a form of bloodletting.  ……..
This photo is not from the article, but was found here

Moxibustion is a traditional Chinese medicine therapy
that is also used in other Asian cultures such as Japanese, Korean, Vietnamese, Tibetan, and Mongolian.  ……… This often leads to erythema and commonly causes burns, especially with the direct application. Moxibustion ……… may mimic signs of physical abuse such as those seen with cigarette burns.
Phytophotodermatitis and photodermatitis
Phytophotodermatitis causes skin lesions that result from the interaction of ultraviolet light with photosensitizing compounds present in various plants. The resulting skin lesions due to phototoxicity can manifest as erythema, hyperpigmentation, vesicles, bullae, or all. Lesions are often in unusual shapes and can appear within hours to days of exposure………..
The most common phytophotodermatitis is that of lime
juice. Lime juice is used in various cultures as a folk
remedy for ……various ailments, such as for acne, fungal infections, and scars, as well as for skin and hair lightening. …... Other agents that can cause phototoxic effects include lemons, celery, carrots,  oranges, parsley, parsnips, tobacco, figs, garlic, and hot peppers, in addition to numerous other agents.

It is an article well worth reading.

Cultural Practices Affecting the Skin of Children;   Parisa Ravanfar,  James G. Dinulos;  Current Opinion in Pediatrics, August 2010 - Volume 22 - Issue 4 - p 423–431, doi: 10.1097/MOP.0b013e32833bc352

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