Skin lightening

I am often asked how I manage to cover so many different topics on this blog. Regular readers will know that by far the largest number of postings are about CLL and this is because I make a point of distilling most of the articles I read in Blood, B J Haem, Haemtologioca, Leukemia Research and Leukemia into less turgid prose for the benefit of patients. The next commonest category is religion and here I am aided by my devotional reading and the sermons I listen to.

Most of what else I write is inspired by what I read and this includes 4 daily newspapers, the BMJ, Lancet, NEJM and New Scientist and various books that I am working my way through.

For today's post I want to refer to an article in today's BMJ by Professor Yetunde M Olumide, a retired Professor of Medicine from the University of Lagos in Nigeria. It concerns the practice of skin lightening by the use of cosmetics. I suppose everybody was aware that Michael Jackson was unnaturally pale, but I had no idea how widespread is the use of such agents in Africa. A study among students of a tertiary institution in Enugu, Nigeria found that 71.9% of female students and 53.3% of male students were using these 'cosmetics'. Studies in Senegal and Jordan demonstrate that it is a problem not confined to Nigeria.

Professor Olumide says that the practice is fueled by racial prejudice and the idea that black skin is inferior and that someone with fairer skin is more attractive. In Africa, women with lighter complexions are more likely to be used to advertise alcohol, toiletries, cosmetics and clothing. Highly visible women in the entertainment industry bleach their skin. The message is being sent out that a light complexion equates with beauty and success. Users of these 'cosmetics' believe that they enhance self-esteem and make their prospects for employment and marriage greater.

Skin lightening creams alter the chemical structure of the skin by inhibiting the synthesis of melanin. Active ingredients include hydroquinone, mercury and highly potent fluorinated steroids like betamethasone and fluocinonide. Government regulatory agencies have tried to ban the use of these chemicals, but manufacturers have circumvented the regulations by introducing new chemicals of unknown safety such as niacinamide, oxybenzone and triethanolamine. Some products do not have a list of ingredients no place of manufacture in the label and there are many cheap, substandard or misbranded products easily available. Outside Africa the demand for these products is high. They are often exported by smugglers and are usually found only in local shops where ethnic foodstuffs are sold or in ghettos colonised by black Africans.

Does any of this matter? Yes; because they cause serious ill health. Exogenous ochronosis is particularly associated with the use of hydoquinone. It presents as a dirty, grey-brown, waxy pigmentation on sun-exposed skin. Colloid millium is a transluscent, cream-colored papule 1-5 mm in diameter. Lesions coalesce into nodules or plaques. Other features are of a rotten fish odour caused by the excretion of trimethylamine in the breath, urine, sweat and saliva and the typical steroid effects of skin thinning and infection.

Big pharma is undoubtedly well aware of the use of their products, especially steroid creams, as cosmetics (they should be marketed only as drugs) but they are undoubtedly a nice little earner, so a blind eye is turned. The Nigerian Food, Cosmetics and Drugs regulatory Agency have prohibited the manufacture of cosmetics containing hydroquinone and mercury, but Professor Olumide questions the wisdom of their approving something known as Venus Skin Toning Cream. Generally attempts to reduce the use of these skin lightening have been unsuccessful, and like most areas of public health a change of public attitude has to be engineered to change practice. I suppose some of my readers will think that it is up to the individual to safeguard his own health. But if the public are being lied to, someone should expose the lie.