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INTRODUCTION

Treatment of cosmetic skin ailments in Indian and Near Eastern populations requires an understanding of the fragility of such skin, and its predisposition to hyperpigment and scar in response to aggressive procedures. Additionally, cultural and religious factors can modulate how Indian and Middle Eastern patients view their and others skin, and which diagnoses and treatments they consider most salient.

DISORDERS OF PIGMENTATION AND ALOPECIA

Skin diseases that alter skin complexion or color may be particularly worrisome for Indian and Middle Eastern patients.1 For instance, melasma, vitiligo, and leprosy are associated with loss of self-esteem, social embarrassment, and depression.

Particularly in India, leprosy and vitiligo are stigmatizing conditions. Leprosy, in addition to the physical morbidity that results from the disease, is also considered a sign of moral fault in the afflicted. In some Indian religious texts, leprosy is said to result from a curse from God and serve as punishment for people who had committed a great offense in a past life. Social ostracism is further worsened by exaggerated concerns about how easily the disease can be spread. Individuals with vitiligo suffer much the same discrimination because the hypopigmented macules in vitiligo resemble those in leprosy. In ancient India, vitiligo was referred to as “Sweta Kushta,” meaning white leprosy. Consequently, people suffering from vitiligo in India may have more psychosocial problems than sufferers in other countries.1 These patients report depression and sleep disturbance at rates of 10% and 20%, respectively.2 They are often considered unsuitable mates for marriage, and women who develop vitiligo after marriage have more marital problems and higher rates of divorce.3 Women with vitiligo experience greater quality of life impairment than their male counterparts, according to a study by Borimnejad et al.4 Though new treatment options for this disease continue to be developed, there is still no therapy that is effective in all patients. Surgical treatment is the recommended treatment for disease recalcitrant to medical therapy5 and has been found to be effective in appropriately selected patients.6

Alopecia is another concern in Indian populations. Dalgard et al.7 report that hair loss is a dominant complaint in men and women from the Indian subcontinent and Middle East/North Africa. Abundant hair is a marker of status for both men and women in many parts of the world, and reflects beauty and good health.

Other common cosmetic disorders in Indian populations include contact dermatitis, hyperpigmentation, hypopigmentation, contact urticaria, acneiform eruptions, hair breakage, and nail breakage.8

CULTURAL AND RELIGIOUS CONSIDERATIONS

Visible Scars

When treating patients with Indian skin in particular, it is important to be aware of cultural and religious differences. Indian women usually wear a saree, leaving the midriff uncovered and visible, so in cases such as liposuction of the abdomen, care should be taken to avoid ...

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