Treatment of pigmented skins
‘Much can be achieved using regular products actually’
Dr. Hamerlinck explains that skin problems occur more frequently in dark skin (he prefers the term pigmented skin, because there is a vast variety in colour, ranging from yellow to dark brown and everything in between) than in Caucasian skin. ‘People with dark skin suffer twice as much from eczema than people with lighter skin. I also see many children in my practice. Why? I am still investigating the reason for that. However, two possible causes stand out.
In the first place, in many children the complaints disappear when they go back to Suriname for a family visit for example. Sometimes this phenomenon is so extreme, that the complaints reoccur when they arrive at the airport in the Netherlands. Especially children suffer from this and I believe it is somehow related to the air pollution. Some gases precipitate near the ground and because children are smaller, they are more in contact with those gases. It also occurs that they, when they grow older, literally outgrow it.’
The second issue turns out to be the treatment. People with pigmented skin loose much fluid through their skin (and not via sweat glands like people with white skin), which subsequently dries out. Many doctors, when they encounter this problem, prescribe a fatty cream, like Vaseline. This turns out to have an adverse effect. The skin is shut off, making it unable to dispose of its fluid and becomes irritated. Dry skin turns out to be at the core of the problems, but has to be treated differently. Dr. Hamerlinck has booked good results using a combination of Cremor Cetomacrogol and 5% cetyl palmitate (a synthetic product, which replaces the wax of the sperm whale). The combination of Cremor Cetomacrogol/cetyl palmitate is an example of how Dr. Hamerlinck treats the pigmented skin. However, much research still has to be done.
Patients from Amsterdam-Zuidoost
Dr. Hamerlinck started his practices in Amsterdam-Zuidoost at the end of the Eighties. Even then Amsterdam-Zuidoost was a melting pot of people with different nationalities and cultures, among them many people with pigmented skin. The practice became very crowded; currently Dr. Hamerlinck treats 60 patients a day.
Much of the knowledge Dr. Hamerlinck has, is based on experience and afterwards elaborated with scientific research. But the time he spend in Congo, before opening his practice in the Netherlands has also brought him much knowledge and insight.
Previously the issue of dry skin due to sweating has been discussed. Dr. Hamerlinck has more examples of wrong diagnoses concerning pathology of the pigmented skin: in frizzy hair, fungal infections are overlooked, resulting in completely faulty treatment. Also, many doctor in the Netherlands are not able to recognize leprosy. This is understandable, because the disease is hardly ever encountered here.
Patient with pigmented skin have different reactions on skin problems than Caucasian Dutch patients. Dr. Hamerlinck had a patient, who suffered from severe acne. The treatment went well, the acne disappeared, but the patient developed black spots instead. The patient was shocked and would not leave the house anymore. ‘It has to be taken into account,’ says Dr. Hamerlinck, ‘that due to the cultural aspect, it is important to understand how people experience skin problems. Patients from some regions of the world who develop one or several white spots on their skin, first of all want to exclude the possibility of it being leprosy. Every spot is worth investigating.
Therefore, that has to be researched (and excluded) rapidly for the patients’ relief.
However, much research still has to be done (for example hydrophobic creams prove to be more effective than hydrophilic creams, but the reason is yet unclear), but much progression has already been made. Dr. Hamerlinck is troubled by the policy of the government and medical insurance companies. He would like to prescribe simple and cheap medication. The classic Cetomacrogol is very cheap, but often the insurance companies do not compensate for it anymore. Newer, more expensive products like the so-called topical immunomodulators often are compensated, but according to Dr. Hamerlinck’ s experience, they may cause irritation in the pigmented skin. Therefore it has become difficult to acquire the cream he believes is necessary for his patients. It seems as if there is little interest in this section of the population and the treatment of the skin. ‘It is a minority and perhaps it is not spectacular enough: using simple means can result in much benefit.’
Perhaps this will change, as Dr. Hamerlinck is producing a few television commercials, which he hopes, will raise awareness about the ins and outs of treatment of patients with pigmented skin.