CASE REPORT Self-Treatment with Bleach by a Latino Farmworker Shelley Cathcart, Steven R. Feldman, Quirina M. Vallejos, Lara E. Whalley, Sara A. Quandt, Gonzalo Cabral, Thanh Brooks, Patricia Earp, Alan B. Fleischer Jr, Mark R. Schulz, and Thomas A. Arcury Skin disease is common among migrant Latino farmworkers. These workers rarely use formal health care services but commonly engage in self-treatment of their skin disease. We present a patient with dermatitis who self-treated with bleach. This patient illustrates a common practice that exacerbates skin disease and sheds light on social and cultural factors of which health care providers serving this community should be aware. L ATINO IMMIGRANTS are an important part of the cultural milieu of the United States. Their growing numbers represent a cultural identity with which physi- cians in many regions of the United States may be unfamiliar. 1 Awareness of these patients’ culture, beliefs, and practices is important for providing health care. A significant number of Latino immigrants to the United States, particularly in rural communities, are employed as migrant and seasonal farmworkers. Farmworkers experi- ence significant barriers in accessing health care. 2 Migrant Latino farmworkers have distinctive attitudes toward skin disease and engage in self-treatment beha- viors. 3,4 Skin disease is a major concern among farm- workers. While farmworker beliefs about the causes of skin disease include exposure to sun and heat, chemicals, plants, insects, moisture, hygiene, and contagion, they also believe that these factors are moderated by each indivi- dual’s personal susceptibility to that cause. 3 Their self- treatment behaviors include the use of over-the-counter medicines (eg, alcohol) and home remedies (eg, lemon, vinegar, bleach). The use of these remedies causes a burning sensation that is believed to be necessary to treat the problem. 4 Case Report A 52-year-old Latino male presented with a 3-week history of an itchy rash on his arms and lower legs. He described itching, burning, and pain associated with the rash. He tried to treat the rash by applying bleach to the affected area. The condition continued to worsen until it impeded his ability to work, at which point he sought medical advice. He worked cultivating and harvesting tobacco, and he was unsure about his pesticide exposure. He had protected his skin at work with shirt, pants, and gloves and did not rewear clothes without washing them. He bathed every day upon returning home from work. On examination, the rash involved both forearms and legs. Erythematous plaques with overlying scale and lichenification were present on the forearms (Figs 1 and 2). Confluent shiny violaceous plaques with marginal erythema and thick overlying scale were present on the legs From the Department of Dermatology, the Department of Family and Community Medicine, and the Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Harvest Family Clinic, Carolina Family Health Centers, Inc., Wilson, NC; and Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC. Reprints not available. DOI 10.2310/6620.2008.07006 Figure 1. Dermatitis of the upper extremities. There was erythema and scale on the upper extremities, accentuated on the flexor surfaces. 102 Dermatitis, Vol 19, No 2 (March/April), 2008: pp 102–104 Made available courtesy of IOS Press: http://www.iospress.nl/