Dr. Meena Singh is a Harvard Medical School graduate, board-certified dermatologist and dermatologic surgeon in Kansas City who specializes in hair transplant and ethnic skin. She is the Medical Director for KMC Hair Center whose multiple locations include Shawnee, Leawood, and Kansas City. We recently sat down with Dr. Singh to discuss eczema in darker skin patient populations and the importance of cultural competency. Here’s what she had to say:
MDNewsline: Dr. Meena what changes and advances are you seeing in the world of dermatology as it relates to treating diseases like atopic dermatitis?
Dr. Meena: Dermatology is seeing advances in treatments that are extremely exciting for our patients. While in residency, it was all about topical steroids. Over time, there has been more emphasis on restoring the defective skin barrier and targeting different components of the inflammatory cascade. The need for topical steroids may be decreased with moisturizers that can restore the skin barrier with components such as ceramides. Medications like Eucrisa, that are anti-inflammatory but spare patients from using steroids, are also being seen on the market.
For people with more aggressive cases, treatments like wet wraps and phototherapy can also become an option. For some patients, however, this may not be feasible since they would need to come into the office at least three times a week. Dupixent is a new injectable biologic medication that targets the immune cascade components specific to eczema. Understanding the individualized needs of patients is important and culture certainly plays a role in that.
MDNewsline: How does culture play a role in assessing dermatological disorders like atopic dermatitis/ezcema?
Dr. Meena: Understanding culture is the foundation of creating relevant and effective treatment plans. When looking at ethnic populations and eczema it’s important to note that people of color, culturally, treat our skin differently. We’re used to using greasier ointments, butters, and oils– which is not always the best-case scenario for skin that is suffering from eczema. We also use washcloths. Because we know eczema is exacerbated by mechanically irritating the skin many doctors may not think to ask a patient about using a washcloth, but in our culture NOT using a washcloth is taboo.
When treating eczema in patients of color it is also important to note that it may present differently in darker-skinned populations. Sometimes it can present as papular eczema, where the skin is bumpy over the extremities as opposed to the more common rough, scaly patches. Patients of color may also see their skin get darker, rougher, and thicker, which is more difficult to treat.
MDNewsline: How important is cultural competency and a strong physician-patient relationship in achieving positive patient outcomes?
Dr. Meena: Effective doctor/patient relationships start with trust. A lot of what we do is give patients instructions and hope that they follow. If they don’t trust us, we may never see improvement. Without Cultural competency, the trust of the patient may wane, and the opportunity to improve their outcomes may be lost. If you have a patient you are not completely comfortable with, you can also refer them to someone who is more comfortable. Know your limitations.
Dr. Singh encourages doctors to seek further education; shadow doctors that treat predominantly skin of color populations, and read more about it.
Dr. Meena Singh is a board-certified dermatologist and dermatologic surgeon. She attended Harvard Medical School, trained at the Mayo Clinic, and completed a fellowship with the International Society for Hair Restoration Surgery. Dr. Singh is the medical director of the KMC Hair Center. She specializes in treating ethnic skin and hair.