Dermatologist Freddy Hamerlinck, originally from Belgium, started his practice about 30 years ago in Amsterdam-Zuidoost, close to the Academic Medical Centre (AMC), where he obtained his PhD with a thesis on tropical skin infections. 85% of his patients have dark or coloured skin. During the past 15 years, he has become an expert in this field. Africans, Chinese, Hindustani, Creoles, Moroccans and Turkish patients from all over the country visit his crowded practise.
‘Doctors have little knowledge when it comes to treating the dark skin.’ Says Dr. Hamerlinck. ‘Treating a patient with pigmented skin is difficult and requires a special approach. For example the red colour, which occurs in an infection, is not visible on the dark skin. Also, many people from Suriname or Ghana discover a year after their arrival in the Netherlands that they suffer from skin complaints. Often they are unfamiliar with the fact that psoriasis runs in their family because nobody had suffered from it, perhaps due to the sunlight, in their home country.’
Disadvantages of the climate
People with dark skin who suffer from psoriasis, suffer from three harmful consequences of our climate: 1. they lose too much fluid and develop a dry skin, 2. the pigmentation of their skin blocks the little sunlight there is in the Netherlands, because of which they cannot benefit from it, 3. they produce little Vitamin D, because the sun can hardly penetrate their skin.
A major difference between dark and light skin is the permeability. A person with dark skin in the Netherlands loses, strangely enough, too much fluid through his epidermis. Consequently the skin becomes very dry and starts to flake off. In their home country, the skin had adapted completely to the climatological conditions, through which less fluid is lost. In the cold and humid climate of the Netherlands, the skin tries to adapt to the new situation. Unfortunately it is unable to do so and therefore people lose too much fluid through the epidermis. Applying Vaseline will shut the skin off, which causes the skin to lose even more fluid. Therefore, a lotion containing an emulsifying agent, to let the skin breathe and fluid to be absorbed is preferred.
Due to the high levels of pigment in their skin, Africans and Creoles are less likely to develop skin cancer. The disadvantage however, is that patients suffering from psoriasis cannot benefit from the little sunlight there is in the Netherlands. Compared to people with lighter skin, the sunlight does not sufficiently penetrate the skin. Luckily, artificial UV light can be very beneficial, even more than in light coloured skin patients. ‘It is very important to start treatment with a low dose. Dermatologist often start with a dose which is too high, because the redness of the skin in not visible in the determination of the lowest dose.’ Dr. Hamerlinck suspects light therapy combined with a vitamin D preparation to have a beneficiary effect. Dr. Hamerlinck also achieves good results through corticoid creams, which inhibit inflammation. ‘Also when treating with a cream, it is important to use the right dose. Chinese skin is more permeable than Ghanaian skin. Therefore it is important to apply a less powerful cream, especially when concerning children.’ Dr. Hamerlinck prescribes medicines as ciclosporin, fumaric acid and the new ‘biologicals’ only when strictly necessary. They are expensive, the long-term effects are still unknown and, as he admits, these drugs are relatively unknown to him.
A relatively high number of his patients also visit alternative doctors or counsellors from their own culture. Dr. Hamerlinck: ‘Especially if those treatments are aimed at stress, they can be beneficiary for people who believe in them.’ Dr. Hamerlinck is relatively unfamiliar with alternative medicine, however he is definitely not against it. He would even encourage more scientific research on alternative medicine. ‘The psyche and the soma (physical disease) might be more related to each other than we suspect them to be. After all, the brain and skin are formed from the same embryonic germ layer.’
Whatever therapy, it is important to use common sense. Dr. Hamerlinck resents protocols in medicine. General protocols, which have been formulated by a group of doctors, serve as guidelines for each treatment. ‘Coloured or dark skin should be treated completely differently than white skin.’ Therefore the standard protocols are useless to Dr. Hamerlinck.
Treatment of dark skin is insufficiently emphasised in the training of dermatologists, according to Dr. Hamerlinck. Naturally, this was a lesser issue 30 years ago, but now it is time to put colored skin more prominently on the agenda. ‘It would be very useful for Dutch students to do a rotation in Suriname for example. ‘A great deal of expertise has been build up over there by now,’ according to Dr. Hamerlinck.