Consultant Physician and Dermatologist at the Lagos State University Teaching Hospital, Ikeja, Lagos, Dr Olufolakemi Cole-Adeife, speaks with LARA ADEJORO on how skin bleaching has become a public health issue in Nigeria and its adverse effects on the skin and body
Why do people bleach their skin?
Skin bleaching, also known as skin lightening, skin whitening, brightening, glowing, and toning, among other things, is the act of using cosmetic products like soaps, creams, oils, and mixtures, cosmetic procedures, or even pills or injections to physically lighten the skin’s colour by reducing melanin production in the skin.
It is practised by both women and men, but tends to be more commonly practised by women.
People bleach or lighten their skin for various reasons, including colonial influences, western standards of beauty, socio-cultural norms, socio-economic advantage, pre-existing skin conditions, and media and entertainment influence, among others. Many of these factors promote the misconception that lighter skin is more attractive than darker skin.
Many individuals who bleach their skin have healthy skin but desire a lighter skin tone because it is perceived to be more beautiful and has social and economic advantages like wealthier suitors, increased job prospects, and so on.
However, some people also lighten their skin in an attempt to even out their skin tone, which has been darkened by sun exposure, or to treat hyperpigmentation (dark spots and patches) from skin conditions like acne.
How dangerous are skin-bleaching products?
Skin-bleaching cosmetic products often have short-term, intermediate-term, and long-term complications involving the skin and the whole body.
Most contain controlled chemical substances with known adverse effects, especially with prolonged use. These agents include hydroquinone, resorcinol, and potent corticosteroid creams such as betamethasone dipropionate, clobetasol propionate, and mercury.
Except for mercury-containing products, most of these agents are used by dermatologists and aestheticians to treat skin discolouration issues (dyschromia) like post-inflammatory hyperpigmentation or melasma and are safe when used by trained medical practitioners in a controlled manner and for a specified period.
However, they can lead to various adverse effects when used without supervision, for prolonged periods, or by untrained personnel on otherwise healthy skin just for skin lightening.
Some of these adverse effects include aggravation of acne and acne-like skin blemishes, allergic and irritant skin reactions, skin sensitivity, sunburn, an increasing amount of Dermatosis Papulosa Nigra, known as skin tags, skin thinning, stretch marks, opportunistic infections, offensive body odour, poor wound healing, and abnormal scarring.
Topical corticosteroids are widely accessible in the form of triple-action creams and are commonly used for skin bleaching. They particularly result in stretch marks, skin redness, visible and thin veins, increased facial hairiness, and aggravated acne. They can also be absorbed into the bloodstream and cause internal or systemic complications like diabetes, hypertension, cataracts, Cushing’s syndrome, post-surgical wound breakdown, and immune suppression.
Prolonged hydroquinone use causes a skin condition called exogenous ochronosis, a blue-black skin discolouration on sun-exposed areas, typically the face and neck. It can also lead to skin thinning, irritant dermatitis, patchy white spots on the arms and legs, and nail discolouration similar to what occurs in kidney disease. Fish-odour syndrome (trimethylaminuria) occurs in some people, and using hydroquinone while pregnant can cause foetal growth retardation.
For mercury-containing products, systemic issues can occur, including kidney damage and failure, tremors, and memory loss.
How often do you see patients with damaged skin as a result of bleaching creams, soaps, and other ingredients in your clinic?
Patients come quite frequently to the skin clinic with adverse effects or complications of skin lightening.
In a recent analysis, about 28 per cent of patients seen in one year had dermatological conditions associated with skin bleaching practices. These issues ranged from aggravated acne, stretch marks, fungal skin infections, exogenous ochronosis, allergic and irritant skin conditions, and other skin discolourations.
Have you seen patients who have reported damaged kidneys due to bleaching creams?
Yes, on some occasions, patients presenting to the hospital with kidney damage or failure have a significant history of prolonged use of skin-lightening agents.
However, we need to conduct scientific studies to fully ascertain that these agents are the major cause of kidney failure in such cases.
Are organic creams dangerous to the skin?
Many creams touted or marketed as “organic,” which connotes that they are made of purely unprocessed and natural ingredients, are often not what they claim. Some studies have found that some “organic” creams contain topical corticosteroids and hydroquinone, leading to the same adverse effects as other skin-bleaching cosmetics.
They also appear to contain very high concentrations of these agents due to the rapid onset of adverse effects associated with using some of these creams.
This has also been confirmed by several videos on social media showing the makers of these creams mixing potent steroids like clobetasol into the creams.
Furthermore, some unprocessed or natural ingredients can irritate the skin, and the fact that something is natural does not mean it is safe to apply to the skin.
Thus, people should be careful with these so-called organic creams, especially those that do not have ingredient labels.
How can one identify bleaching creams, soaps, and ingredients?
Some of these products may be difficult to identify on the shelf. This is because many products omit some ingredients from the labels or use technical, scientific names for the bleaching agent, which the average person may be unable to decipher. Creams containing hydroquinone should not be used for more than three months. Creams or soaps with mercury should be avoided. Triple-action creams should not be mixed into creams or butters, especially for children, as is wrongly practised by some parents, to our utmost horror.
In addition, a general recommendation is that soaps, creams, or skin care products with these phrases or words as part of the name—”white, whitening, light, tone, fair, glow, bright,” “half-caste, mulatto,” or anything to connote lightening of the skin—may have bleaching agents and should be avoided or used with caution.
What are the steps to take to achieve good skin?
Good skin can be achieved through a healthy diet and lifestyle and by using good skin products in moderation. Eat a balanced diet rich in fruits, vegetables, lean meats, and nuts. Avoid refined sugars and foods as much as possible. Drink a lot of plain water every day. Reduce exposure to the sun and to pollutants like smoke and fumes. Use gentle soaps, creams, or oils that do not have the words mentioned above or contain mercury or hydroquinone. Do not buy creams from so-called skin care vendors without any ingredient labels. Avoid using triple-action creams. Seek the advice of a dermatologist or a trained aesthetician to recommend a skin care regimen suitable for your particular skin type, as some skin care products may be good for some but inappropriate for others. The use of sunscreen creams is also encouraged to reduce the effects of ultraviolet rays from the sun, which cause darkening or tanning of the skin.
How do you know which skin care products are good?
Good skincare products are usually gentle. If you prefer natural products, try plain, unadulterated shea butter or coconut oil, depending on your skin type. Otherwise, use skincare products from reputable brands or companies that are not marketed for skin lightening. The best soaps to use are pH-balanced; this is usually written on the pack. Avoid using too many different skin care products, as too many can damage the skin barrier and cause irritation and skin sensitivity.
The Director General of NAFDAC recently declared a state of emergency on bleaching among Nigerians. Why is it so?
This declaration may be due to a report from 2018 that said Nigeria had the highest prevalence of skin-bleaching in Africa, with about 77 per cent of Nigerian women lightening their skin. That figure is probably even higher now. Skin bleaching has become a public health issue in the country and requires decisive action by policymakers and NAFDAC, as well as much more advocacy and enlightenment in the media. Otherwise, the disease burden from this practice will continue to increase and negatively impact the quality of life and overall health indices. We are concerned that if nothing is done now, we may begin to see a rise in skin cancer, hypertension, diabetes, and kidney failure cases associated with skin bleaching in the future.
Should shops selling skin-lightening creams be fined?
Yes, I believe shops selling skin-lightening products containing unregulated or unsafe skin-bleaching agents should be fined. This is done in some countries in the developed world. In the UK, a few cosmetic shop sellers have been arrested and fined heavily for selling contraband skin-bleaching products. It was from one of these raids that it was discovered that a popular skin-lightening cream also sold in Nigeria, which claimed to contain two per cent hydroquinone, actually contained up to 13 per cent of hydroquinone, which is far above the concentration that is safe for use, even by professionals. However, such a policy may be difficult to enforce here in Nigeria, but it is worth a try.
-Punch
