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Cultural Dermatology

»	A child from southern India has had a recent decline in school performance and is noted to be anemic. On examination, the child has adorable, dark, mascara-like makeup around her eyes. As an astute cultural dermatologist, you suspect that the makeup is the cause of the difficulties in school and the hematologic profile. What is the name for the traditional Indian eye makeup?
»	What is surma made from? How did it affect the child?
»	A Vietnamese child is seen in the emergency department with an earache and, on examination, is noted to have several linear ecchymoses on her back. The physician suspects child abuse as the cause of the bruises, but the interpreter says it is not. What caused the marks on the child?
»	An older Chinese man is noted to have dozens of fairly uniform round scars on his back. They resemble self-inflicted cigarette burns, only much larger. The patient is unconcerned about the lesions and indicates that someone like you, a doctor perhaps, did this to him. What ancient Chinese medical practice produces burn scars?
»	What is moxibustion?
»	Can acupuncture cause dermatologic problems?
»	Do any Western medical practices cause permanent changes in the skin?
»	Where did the practice of tattooing start?
»	What does the word tattoo mean?
»	What culture has the most elaborate tattoos?
»	Why do sailors have tattoos?
»	Sailors sometimes have rooster and pig tattoos on their lower legs. Does this have a meaning?
»	Who is the Ice Man? Why are his tattoos so important?
»	A man from rural Nigeria has several sets of small parallel scars on his face. He says that his village doctor made these with a sharp stone when the man was young. What are ritually placed incisions called?
»	Scarification is performed in a number of societies. Why?
»	What is an omega brand?
»	Name the familiar dark-red spot placed on the central forehead of Hindu women.
»	What dermatologic problems can bindi cause?
»	While on a surfing trip to an outer island of Fiji, you notice that many of the men have dry, scaly skin. You guess there must be a hyperendemic focus of X-linked ichthyosis. The villagers laugh when you ask if the men are born that way and explain that the skin problem is called kani and is caused by drinking too much yanggona. What is this?
»	What is kava?
»	Your favorite professor has invited you to accompany her on an assessment of a refugee camp in southern Africa. In the camp, you see hundreds of children and adults with a strikingly similar shiny, slightly erosive eruption along exposed are of their clavicular regions and forearms. What is this eruption?
»	Why is pellagra abundant in the refugee camps?
»	What is betel nut? Who chews it?
»	What dermatologic changes are associated with chewing betel nut?
»	The visa of a Somali family living in your town has expired. The mother is fighting deportation because she fears that her daughters will be compelled to undergo circumcision if they return to Mogadishu. What is female circumcision?
»	What are the complications of female circumcision?
»	What is the most common culturally sanctioned mutilation in the United States?
»	What about culturally sanctioned surgical alterations of male genitalia?
»	What are artificial penile nodules?
»	Your cousin is marrying a woman from Mumbai (Bombay). On the wedding day, the bride’s hands are painted with an intricate filigree-like pattern of reddish-brown pigment. What is this form of ornamentation called?
»	Describe the use of henna on the skin.
»	Are there any medical problems associated with henna?
»	A patient with a referral to the otolaryngology clinic mistakenly arrives in the dermatology clinic. You see that the consultation is to “rule out congenital absence of the uvula.” Sure enough, on your examination, there is no uvula. What gives?
»	A 51-year-old Muslim woman from Saudi Arabia is noted to have asymptomatic thickening and hyperpigmentation on the forehead, knees, ankles, and on the dorsa of her feet. What does she have?
»	A 22-year-old man from India presents with tinea cruris that involves the penis. What most likely accounts for this highly atypical clinical distribution of infection?

What is surma made from? How did it affect the child?

Surma (kohl) is a fine powder resembling mascara that is applied to the margins of the palpebral conjunctiva. It was originally made from antimony sulfide or from carbon soot, but now it is often adulterated with lead sulfide.

This child has chronic lead toxicity caused by absorption of the lead-based pigments related to her surma-cosmetic plumbism. Surma usually has lead-based pigments and has created problems with lead toxicity in several Asian communities in the United Kingdom. For that reason, surma is now banned in England. In the Middle East, a similar traditional eye cosmetic has also been demonstrated to frequently contain high levels of lead.

Al-Ashban RM, Aslam M, Shah AH: Kohl (surma): a toxic traditional eye cosmetic study in Saudi Arabia, Public Health 118:292–298, 2004.

Mojdehi GM, Gurtner J: Childhood lead poisoning through kohl, Am J Public Health 86:578–587, 1996