Bleached to Perfection

by egndukwe on October 17, 2012

Image Courtesy of Luigi Diamanti/FreeDigitalPhotos.net

From the late Michael Jackson to startling recent images of Sammy Sosa, skin color is a loaded issue. And although skin color is often controversial, one thing society seems to agree on is that whatever your skin color, having an even skin tone is a must. The media is filled with images of beautiful, flawless people. Men and women with seemingly perfect complexions are heralded as the standard, the goal. But life happens. The scar from falling off your bike when you were younger becomes less of a battle scar and more of an embarrassment as you get older. Acne scars may be constant reminder of a humiliating time in your life. Increasingly, individuals are finding relief in skin bleaching products that promise to correct uneven skin tone. However, in recent years ingredients in such products have come under fire, leaving many consumers unsure of their safety.

How does skin become uneven?

Human skin color is mostly determined by a pigment known as melanin. Melanin is produced by “melanocytes” which are cells in the skin. An uneven complexion can result from insufficient or excess amounts of melanin. In particular, the overproduction of melanin can lead to hyperpigmentation, which refers to the darkening of areas of skin.

Skin bleaching products frequently use topical corticosteroids, mercurials or hydroquinone (HQ) to lighten the skin. HQ, the active ingredient most commonly used in over the counter preparations of skin lightening creams, works primarily by limiting the production of melanin. An active ingredient refers to the component of the cream that actually causes the desired effect. On the other hand, the inactive ingredients are the parts that are not responsible for the desired effect and instead may aide in application, appearance or smell among other factors. In the US, HQ is available over the counter in concentrations up to 2% and can be obtained by prescription up to a 4% concentration.

Can HQ be harmful?

This question is widely debated. Although HQ can be safely, and effectively used to lighten skin discolorations, there are several widely known side effects including irritant contact dermatitis (seen in up to 70% of patients using HQ) and exogenous ochronosis. Characterized by the bluish black discoloration of the skin, exogenous ochronosis is often considered the most severe side effect and is arguably worse than the initial skin discolorations.

In 1994, the International Journal of Toxicology published the Addendum to the Final Report on the Safety Assessment of Hydroquinone in which they concluded that HQ was safe in concentrations of no more than 1% and should not be used in leave-on products. As a result, the European Union, France and some Asian and African countries banned products containing HQ.

 

Although still legal in the US, HQ has long been on the FDA’s radar. In 1982 the FDA proposed that over the counter creams with concentrations of HQ up to 2% were generally recognized as safe and effective (GRASE). However, in 2006, after tests in animals suggested that orally ingested HQ could cause cancer, the FDA proposed to withdraw HQ’s classification as GRASE until further studies could be done. Currently, the matter is being investigated by the National Toxicology Program with proposed studies to examine: metabolic effects of HQ from both oral ingestion and through the skin, effects on reproduction from oral consumption, and potential to cause cancer from absorption through the skin.

How worried should I be about hydroquinone?

The FDA stated that one major benefit of removing HQ from the market is the reduction in cases of exogenous ochronosis every year. This then begs the question, just how common are cases of exogenous ochronosis? The answer is not very. In fact, there have been a total of 789 cases of ochronosis in the world, with only 22 of those cases occurring in the US from 1983-2006. This is despite an estimated 15 million tubes of bleaching creams containing hydroquinone that are sold each year.

Of the cases that occurred in the US, 21 resulted from the use of HQ up to a 2% concentration, and one case resulted from a 4% concentration. Two cases resulted from a usage duration of 3 months, all other cases reported a duration of at least a year.

What does this all mean?

The decision to lighten your skin is a personal one and can be chosen for many different reasons. Although society often and perhaps vainly correlates even skin tone to a higher level of beauty, the psychological effects of an uneven complexion should not be minimized. Skin lightening creams can increase the psychological well being of both men and women, however there can be danger in starting a skin bleaching regimen on your own. Current literature and legislation regarding the safety of HQ is conflicting and therefore further research is needed to truly determine the effects of hydroquinone on humans. In the meantime, if you choose to use a skin bleaching cream to alter your complexion, be sure to consult a physician, use a reputable product, and adhere strictly to physician orders and the product instructions. On the other hand, although sometimes more difficult to come by, self-confidence is a cheaper, safer alternative to bleaching creams that works every time.

Sources:

Ladizinski, B., Mistry, N., & Kundu, R. (2011). Widespread Use of Toxic Skin Lightening Compounds: Medical and Psychosocial Aspects. Dermatologic Clinics 29(1).

Levitt, J. (2007). The safety of hydroquinone: A dermatologist’s response to the 2006 Federal Register. Journal of the American Academy of Dermatology 57(5) 854-872. 

 

Brian Robinson October 17, 2012 at 4:16 pm

Ezinne,

This is a decent piece. I liked the explanations, and the science seemed precise (though it’s not an area I have much expertise on).

However, I was left with a “so what?” response. As an explanatory piece it’s fine, but would seem to be something more suited to a “how it works” kind of article. I would have liked something more solid upfront about why you are writing it. Most of the information you include seems to go back years, and so is well known. Is there anything new that this would relate to? Has there been a sudden upsurge in medically related complaints? Have there been studies showing what the psychological impact of this fixation with skin tone is having on various populations? I read through the piece because I’m interested in the writing, but anyone coming to the story who is not so invested in it might have left off at the first graf. You need a real lede on this .

If it’s something that you have personal experience with — that is, the reactions of people to you because of your skin tone — it would make a much more arresting lede if you could get something of that upfront. Or maybe you think the FDA is unnecessarily barring people from products that you feel can help them. You just need something to make the general population of readers want to put the time in to read on from the first graf.

On a more stylistic note — you tend to use too many qualifiers which gives this a hesitant feel, and that can put readers off also. You need to be more active and assertive. You’ve got good stuff, at least the beginnings of a good piece, but I don’t think you are making the most of it.

egndukwe October 24, 2012 at 4:58 pm

Brian, thank you so much for your comments! You’re right that my intention with this piece was to give an overview of this practice. In my experience, people who utilize bleaching creams tend not to pay attention to what is actually in the products, nor are they aware of the impact these products can have. I wanted give these individuals a reference point, explaining what they should be concerned about and how to properly and safely use these products–so I can see how those who aren’t invested in this practice could lose interest. Thank you again for your feedback! They were extremely constructive and will be helpful in drafting my future posts.

Angela October 17, 2012 at 9:01 pm

Thank you for your post! With many, I share a concern about the extremes to which these products are marketed. Don’t know if you’ve come across the bleaching genital wash that was advertised in India, Thailand and other Asian countries. People around the world got very angry at the product (the ad got posted on social media like crazy), which drew attention to the perverse advertising that is happening in this area, e.g. http://www.bbc.co.uk/news/magazine-18268914
I was actually surprised that the products weren’t more toxic. I also wondered how the bleaching products compared to tanning products in terms of toxicity/skin diseases.

egndukwe October 24, 2012 at 5:04 pm

Thank you for so much for your comments. I hadn’t seen or heard about the bleaching genital wash so thank you for bringing that up! The development of products like these show just how complex a topic skin bleaching has become in some groups. Thanks for reading!

PF Anderson October 17, 2012 at 9:21 pm

I agree with the previous request for some sort of personal connection to the post topic. For me, I was immediately riled up, just seeing the title, because of personal connections who’ve suffered terribly from the fad for tooth whitening, following the procedures as directed by their healthcare provider. I suspect that whitening agents for the skin are even MORE dangerous than those for teeth!

Likewise, another slant that might have made this more personal are the health conditions for which skin discoloration are a warning sign, or when bleaching them might serve to mask a more serious condition. Many possible slants and permutations to this topic.

Relative to Angela’s comment on culture and color, it is also very interesting to look at historic ways in which various cultures addressed this issue. For example, I believe the Japanese women used whiteface and blackened their teeth, and I think the French did likewise at one point in their history. I’m wondering if there were ridiculous risks (like mercury in hats) or old ways that are perhaps safer than what we do now (zinc paste?).

Margaret October 18, 2012 at 1:50 pm

Ezinne,
I liked your organization and explanations that you gave in this post. Like many of the readers I have been lucky enough to not have a personal interest in skin bleaching treatments. In fact I did not even know that they were around until I read your post.

Thanks,
Margaret

a300976 December 23, 2012 at 6:56 am

I’ve said that least 300976 times. SCK was here

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