Latine patients with psoriasis report unique cultural, ethnic experiences in US

Key takeaways:

• Participants expressed an initial lack of familiarity with psoriasis and suspected their symptoms were from other conditions.
• An inclination toward natural remedies was a key trend among the Latine community.

Published results showed “Latine” patients with psoriasis in the U.S. have unique experiences with their disease and subsequent care, including lack of awareness about psoriasis, workplace difficulties and a preference for biologic treatment.

According to Nathaly Gonzalez, MS, BS, of the Medical College of Wisconsin, and colleagues, individuals who identify as Latine — which the authors described as a “gender neutral, linguistically appropriate description of individuals with an ancestral origin from within Latin American countries” — utilize less health care and work to overcome barriers to medical care by practicing folk or natural medicine.

“Studies have also found that Latine patients often avoid discussing home remedies with their clinicians,” Gonzalez and colleagues wrote. “Given these inequities and cultural context, we aimed to explore U.S.-residing Latine patients’ perceptions of and experiences with psoriasis and their attitudes toward treatment and research.”

In this qualitative study, the researchers interviewed 30 Latine participants (mean age, 50 years; 20 men; 22 preferred Spanish language) with moderate to severe psoriasis at an urban safety-net hospital’s outpatient dermatology clinic.

Results found six themes related to the experience of Latine patients.

Illness perception of psoriasis

Most of the interviewees expressed a lack of familiarity with psoriasis and its disease presentation, which ultimately caused frustration and concern. Multiple participants explained that psoriasis is not a well-recognized disease in the Latine community, and “a few” said their condition was diagnosed in their country of origin.

“We Latinos don’t know about all that, do we?” one of the interviewees said. “So, if they see a skin infection, then they say, ‘Oh, it’s contagious’ or that it’s this other one.”

Some of the other conditions initially suspected included atopic dermatitis, dry skin and fungal infections. In fact, none of the patients initially labeled their symptoms as psoriasis.

The driving factor that led participants to seek care was a belief that their symptoms were contagious.

When asked what they believed caused the disease, answers ranged from infections to allergies, from stress to food and even trauma, such as a death or divorce. Several expressed the belief that foods such as bread, sugar and alcohol exacerbated symptoms.

Reliance on socio-familial connections for medical decision-making

Many of the participants with friends or family members with psoriasis stated that they allowed their shared experiences to guide their treatment.

“I had a friend that also had it and he started to tell me how it was done and how he started his treatment,” a participant said. “He gave me all that information on how I could get it too because I was already very advanced. He began to advise me, because he had it longer and he told me how to do it.”

In some of these cases, participants reported family members providing treatments without confirming the diagnosis.

Impacts of psoriasis on work life

Certain work environments and situations reportedly aggravated the participants’ psoriasis, including working in kitchens or at construction sites and wearing work uniforms. The majority of interviewees worked manual labor jobs.

Some expressed fear of losing their jobs as well as experiencing work opportunity limitations due to the appearance of their skin lesions, even though their conditions did not impede their ability to work.

“Sometimes they wouldn’t give me a job because I have to wear special shorts or I have to wear T-shirts,” one participant said. “And they would say they couldn’t hire me because I had psoriasis in my hand and nails and they said no, they wouldn’t give me the job.”

On the other hand, other participants reported support from coworkers.

“I told my boss that I couldn’t wear the thick jeans, and he told me that he was going to get me some comfortable pants so I wouldn’t hurt myself. And yes, he got me the pants,” the participant said.

Barriers to accessing quality dermatologic care

While some interviewees expressed preference for a Latine clinician for cultural and/or linguistic reasons, others were indifferent to the clinician’s race and ethnicity as long as the language barrier was resolved.

As many of the participants were immigrants from Latin America, they struggled to navigate the insurance and health care system in the U.S. and questioned why certain drugs required out-of-pocket costs.

While the cost of medical care was a barrier to some, others stated that they had no trouble receiving a dermatology referral from their primary care physician and scheduling an appointment.

Several participants expressed mistrust and discomfort with disclosing their medical conditions to an interpreter as they felt this breached their right to medical privacy.

Lastly, some, but not all, participants explained that certain therapies, such as phototherapy, were inconvenient to their work schedule, causing them to delay treatment.

Receptiveness to prescriptions, nonprescription treatments

Natural remedies were very popular among the Latine participants, with many relying on these alternative treatments before discovering their condition was psoriasis, whereas one person continued to see a naturopathic practitioner even after receiving a psoriasis diagnosis. These treatments included vitamins, herbs and natural creams. Once some realized these treatments were ineffective, they consulted a dermatologist.

Those that were diagnosed by a clinician in their country of origin reported receiving prescriptions from outside the U.S., brought to them by family members or friends, even after living in the U.S. for quite some time and assimilating into the culture. After establishing care with a dermatologist in the U.S., most participants stopped using these medications.

The researchers also found that the majority of participants favored injectable systemic treatments rather than topicals.

“I took some pills too. And two kinds of pills. Had blood tests. Ointments, shampoo, but no. Hasn’t worked. Well, yes it has worked some. I am not going to say it hasn’t. But there is nothing as good as the injection,” one of the interviewees stated.

Positive perception, interest toward research

None of the participants had prior medical research experience; however, many of them were open to participating in future clinical studies.

“This is my first time participating, and thank you very much,” one of the participants said. “This isn’t only important for me because there are many people with psoriasis ... I am happy to participate and to share my opinions of the disease that I am overcoming, and maybe there is something in this that the medical understanding of psoriasis can evolve, a better medicine to be able to cure it already.”

On the other hand, all of the Spanish-speaking participants expressed that the concept of being a part of a study was unfamiliar to them and did not understand how it would benefit them.

Conclusion

Based on these findings, the authors recommend that dermatologists caring for Latine patients consider inquiring about nonprescribed treatments that their patients may be using and utilize biologics over topicals when appropriate.

“Clinicians and researchers should recognize that practices and attitudes toward research and treatments among racial and ethnic minority populations can vary,” the authors wrote. “Future studies should further explore educational interventions and acceptability of biologics and research among Latine populations.”