The skin on Caesar Esperanza's face started changing color four years ago. White patches began to speckle his bronze Filipino complexion.
The first one was small, on an eyelid. Then larger ones appeared on his nose, eyebrows, forehead and cheeks.
"They just keep popping up," said Esperanza, a 70-year-old retired postal worker. "It's just so ugly."
It didn't take Esperanza long to guess he had vitiligo, a loss of skin pigmentation with no known cause — the same skin condition that Michael Jackson is believed to have had. While distressed about the change and how visible it is, he didn't seek out treatment until just a couple of months ago.
"Everybody told me there is no treatment," he explained.
That's a common myth, one that a new dermatologist at the University of South Florida is working hard to dispel, particularly among people of color.
Dr. George Cohen says patients tell him about it every day. "They will hear nothing can be done, that treatment will make it worse, that their options are limited, when in fact there is a lot that can be done."
Cohen joined USF's Department of Dermatology and Cutaneous Surgery in July after serving as chief of dermatology at the Veterans Affairs Medical Center in Washington, D.C. He says African-American, Hispanic and Asian people need to seek out dermatologists who specialize in the unique needs of ethnic skin.
The same products and procedures that work well for white or light-skinned patients may not be best for someone with brown or black skin. Also, new technology has made certain procedures, such as laser hair removal, possible today that may have been out-of-reach a few years ago.
"Older lasers worked well on light skin with dark hair, but not well at all on dark skin with dark hair. Now, new lasers make hair removal safe and effective in dark-skinned patients, in the hands of an experienced practitioner," Cohen said.
Hair loss can be a major problem in black women who have bald spots from overly aggressive use of hot combs, chemical hair straightening and tight braiding, Cohen said. They might be candidates for hair transplantation, despite what they may have heard.
"Many patients have told me doctors don't do black patients. But they can get transplants as long as they have sufficient donor hair. I've done hundreds and hundreds of them," he said.
Keloid formation is another skin problem associated with dark skin color, although Cohen said it doesn't affect most people of color. This over-growth of scar tissue after surgery or injury can be unsightly and troubling, but it is not inevitable.
The key is figuring out early that a keloid is forming and getting treatment right away, such as medications and surgical removal. "But the earlier the better. That's when therapies are most successful," he said.
Treatment for vitiligo, the skin condition causing problems for Esperanza, is also more promising today than ever, thanks to lasers that help repigment the skin. Esperanza is undergoing a series of 20, twice-weekly procedures and is seeing some good results. For the first time in years, he says he is encouraged about his skin condition.
Irene Maher can be reached at firstname.lastname@example.org or (813) 226-3416