SKIN DEEP; Learning To Speak To Latino Complexions

THE light-brown complexion of Vilda Vera Mayuga glows in a way that suggests she devotedly visits a dermatologist, sits for facials or drowns her skin in expensive creams and serums. But Ms. Mayuga, 30, a lawyer and native Puerto Rican who lives in Manhattan, hasn't been to the dermatologist in more than five years. Instead, she relies on remedios caseros -- home remedies that the women in her family have used for generations -- as the cornerstone of her otherwise spare skin-care regimen.

"I like to use the cream that comes out of the cactus," she said, referring to sabila, or aloe vera, which she uses for dry skin, dark spots and scars, her most common problems. "You cut it and you squeeze it out and you boil it, and then you put it against your skin."

It is no secret among physicians that natural remedies like these are popular among Hispanics in the United States. But skin care companies with products to sell are nonetheless setting their sights on Latinos -- the nation's fastest-growing ethnic group, which the United States Census Bureau projects will make up one-fifth of the population by 2030 and one-quarter by 2050.

"I don't think it's lost on anyone that our population is shifting," said Margo Weitekamp, vice president for new ventures at Johnson & Johnson Consumer Products Company. That's why, in 2004, her company bought AMBI Skincare, a brand made for black women, and has since adapted it to appeal to women of Hispanic and Asian descent, too. Their products include fade creams, a moisturizer with sunscreen and an acne-clearing treatment to help reduce the dark marks that pimples can leave behind.

Neutrogena and Aveeno Active Naturals, also owned by Johnson & Johnson, now offer a scrub, a peel, a night treatment, an eye cream and moisturizers to even the skin's tone or erase lingering acne marks -- common concerns among Hispanics.

Meanwhile, Avon, which has a devoted Latina following, allocated nearly 15 percent of its media expenditures to Hispanic-specific ad campaigns in 2004, the last year tracked, and Procter & Gamble spent nearly $150 million on Hispanic-geared media, according to the market research firm Mintel International Group.

But even as marketers try to develop new products and appeal to the needs of the Hispanic community -- a multitude of ethnicities -- a larger question remains of whether Hispanic skin differs among its subgroups and from other ethnicities and if so, how.

"The answer is that no one really knows for sure," said Dr. Jeffrey Dover, an associate clinical professor of dermatology at the Yale University School of Medicine, who licenses his line, Skin Effects by Dr. Jeffrey Dover, to CVS.

Dr. Roopal V. Kundu, director of the Center for Ethnic Skin at Northwestern's Feinberg School of Medicine in Chicago, said she believes that there could be qualities and characteristics shared by many Hispanics that are not common to non-Hispanics. But the research is thin.

"As a scientist-dermatologist, it would be nice to know if there was actually some sort of structural or biological difference" among ethnicities, Dr. Dover said. "We'd understand the mechanism of disease better, and we'd find treatments better, and we wouldn't be just guessing with ones that really don't work very well."

In a comprehensive review of scientific studies that have been conducted on ethnic skin, Naissan O. Wesley and Dr. Howard I. Maibach of the University of California, San Francisco, found few studies devoted to Hispanics. But writing in 2003 in the American Journal of Clinical Dermatology, they examined objective data for 10 characteristics aside from pigmentation and concluded that the evidence for nonpigment distinctions between Hispanics and others was "contradictory" and "inconclusive."

THE problem is compounded by the fact that Hispanic is a broad category. "Basically people have been doing these studies in 'Hispanics,' in quotation marks, and I say, 'Well, who was your group -- Mexican-Americans, Puerto Ricans?' " said Dr. Miguel Sanchez, an associate professor of dermatology at New York University School of Medicine, who lectures on Latino skin.

Academic centers like the Center for Ethnic Skin are hoping to further the research devoted to Latinos. Physicians, too, who are seeing more Hispanic patients, are striving to learn how to better treat their skin.

"Nowadays dermatologists recognize that there are variances, differences in the way that ethnic skin behaves," Dr. Sanchez said of pigmentation, "and so they have actually been flocking to courses at conferences."

Dr. Gary Brauner, associate clinical professor of dermatology at Mount Sinai School of Medicine in New York, said that because "descriptions of all classic dermatologic diseases are descriptions on white people," dermatologists often find it difficult to discern harmful conditions in patients who have skin that's medium-brown or darker.

"You may see black lesions growing all over the place and you think, 'My God, do they have melanomas all over?' " he said. "When in fact, they are just ordinary moles or very dark seborrheic keratoses, just spots you get as you get older."

Other skin issues also stand out among people of Hispanic descent. Inflammatory conditions like acne or eczema can leave lasting dark marks, Dr. Kundu said. Melasma, dappled pigment across the forehead, cheeks and upper lip, is common in women. There's also ashy dermatosis -- grayish blotches on the limbs and trunk -- and vitiligo, a disease of pale patches of skin.

Such pigmentary disorders can be so severe that they "ruin some women's lives," Dr. Dover said.

Hispanic women said that even a mild injury to the skin -- a nick, a burn, an hour in the sun or an adverse reaction to a drug -- may contribute to hyperpigmentation that lasts for weeks or even months. "If I even have a scratch, it will turn a little dark," said Damarys Vargas, 42, a portfolio manager at Citicorp in Manhattan.

Still, the biggest concern of many dermatologists is not appearance but rather that their Hispanic patients are facing an increased risk for skin cancer. The disease is on the rise among Hispanics in the United States, and diagnosis is often made weeks or months later than it is for Caucasians, Dr. Sanchez said.

"We think because we have a better ability to tan, we don't need to wear sunscreen, and then when we start getting skin cancer, we're shocked," said Dr. Flor A. Mayoral, a Miami dermatologist who has lectured or done research for a few pharmaceutical and dermatology companies.

Dermatologists recommend that even Latinas with dark skin guard against the sun by wearing sunscreen with S.P.F. 15 or higher. Doctors also urge Latinas to seek medical treatment if a mole bleeds or looks uneven, or if skin changes become distressing.

"Folk remedies that are so common in the Hispanic communities are wonderful things," Dr. Sanchez said. "We just want people to remember that should not be a substitute for traditional medicine when things are not going well."

When Skin of Color Has Many Shades

SEVERAL months ago, Dr. Flor A. Mayoral, a Miami dermatologist, began intense pulsed light therapy on a patient to help ease her rosacea, setting the machine at a level appropriate for Caucasian skin.

"I treated a couple of spots, and by the time I turned around and looked at her again, her skin looked gray," Dr. Mayoral said. Although the patient "looked white, totally white,"Dr. Mayoral said, she was actually Haitian, with African heritage. "I thought, Oh, no, the setting was too high."

Such problems are not uncommon among nonwhite patients who undergo therapy with lasers or lights. And one factor, dermatologists say, is the imperfect scale that is commonly used to describe different skin shades and sometimes also used to predict how they will react to treatments.

After inspecting a patient's complexion, most dermatologists will assign the skin one of the six categories set out by the Fitzpatrick phototyping scale, a grading system that was developed in the 1970s to help doctors tailor ultraviolet light treatments to psoriasis patients. Type 1 refers to fair skin that has a strong tendency to burn, while Type 6 is a richly pigmented black that never burns.

But dermatologists say that many people, and especially those of mixed heritage -- like the patient Dr. Mayoral treated -- do not fit into any of the six skin types. And a designation of whether the skin burns or tans "really doesn't give us valuable information for treating darker skin tones," said Dr. Susan C. Taylor, president of the Skin of Color Society, a group of dermatologists who specialize in brown and black skin.

So this summer, the Skin of Color Society started working on a new scale to be used along with the Fitzpatrick rating. It will be based on objective measurements to determine the skin's shade, and its response to inflammation, hyperpigmentation, photoaging and scarring, Dr. Taylor said. The scale will probably have at least 10 types for skin of color alone, she said.

Dermatologists say that if it is effective, they will eagerly embrace the new typing system. Dr. Darrell S. Rigel of New York University said, "If it helps us to better differentiate patients in terms of their reactions to a variety of drugs and environmental issues, we would be quite happy to have it." LAUREL NAVERSEN GERAGHTY