Chapter 63 Cultural dermatology
1. 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?
2. 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 It was originally made from antimony sulfide or from carbon soot, but now it is often adulterated with lead sulfide.
Mojdehi GM, Gurtner J: Childhood lead poisoning through kohl, Am J Public Health 86:578–587, 1996.
3. 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?
Cao gió (phonetically pronounced gow yaw), or coin rubbing. This is a traditional Vietnamese medical practice. The traditional healer massages the patient’s skin with a liniment and then rubs a metal object, usually a coin, forcefully over the area. Petechiae and linear ecchymoses often develop. These have been mistaken many times for stigmata of battering by Western providers who are unfamiliar with cao gió.
Yeatman GW, Dang VV: Cao gió (coin rubbing), JAMA 244:2748–2749, 1980.
4. 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?
5. What is moxibustion?
It is derived from the words moxa and combustion. Moxa is from mokusa, the Japanese word for wormwood (Artemisia moxa of the sagebrush and absinthe genus), is a commonly used combustible medicinal herb. Moxibustion is the ancient oriental medical practice of igniting medicinal herbs on the skin. When the healer extinguishes the flame, the herb’s therapeutic properties supposedly enter the body. A burn scar is the necessary sequela of properly conducted moxibustion. The sites on which moxibustion is performed are often the same as those used in acupuncture, and it, along with cupping and acupressure, is considered to be a nonneedle forms of acupuncture. The practice is still taught in Chinese colleges of traditional medicine.
6. Can acupuncture cause dermatologic problems?
Yes. In a large survey of more than 6300 acupuncture patients in the United Kingdom, patients reported at least one adverse event in about 10% of cases; however, only 3 patients had a serious adverse event. There have been reports of abundant petechiae (in one case, resembling meningococcemia) caused by acupuncture needles. Hematomas and ecchymoses occur frequently. Pyoderma, prolonged anesthesia, needle breakage, burns, itching, foreign body granuloma, “carcinoma of the skin,” and the Koebner phenomenon have been reported. Transmission of HIV and hepatitis virus has occurred via acupuncture needles.
8. Where did the practice of tattooing start?
Archaeologic evidence, such as human remains, shows that tattooing was part of indigenous cultures worldwide. For whatever reasons, tattoos were used in ancient Europe, the Mediterranean region and Middle East, southern Asia, northern Japan, the Americas, and throughout the Pacific islands.
Levy J, Sewell M, Goldstein N: A short history of tattooing, J Dermatol Surg Oncol 5:851–856, 1979.
10. What culture has the most elaborate tattoos?
The Marquesan Islanders of French Polynesia once applied tattoos to almost the entire body. Hawaiians, Samoans (Fig. 63-1), and New Zealand Maoris also had extensive tattoos. The practice is experiencing a cultural resurgence in many Polynesian groups today. Japanese tattoos (horimono) are often regarded as the most skillful and artistically prepared.
12. Sailors sometimes have rooster and pig tattoos on their lower legs. Does this have a meaning?
Yes, many ethnic groups, cultures, and even subcultures, including sailors, have tattoos with specific meanings. For example, the reason that sailors tattoo a rooster and pig on their lower legs (Fig. 63-2
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