Skin bleaching is the cosmetic application of topical ointments, gels, soaps and household chemicals to de-pigment or lighten (bleach) the skin complexion. The global production and marketing of skin bleaching products has become a multibillion-dollar industry worldwide, particularly in the low and middle-income countries.
It’s potentially one of the most harmful body modification practices worldwide. Obtaining perseverance rates on skin bleaching practices is challenging, in many Sub-Saharan communities it is documented to be between 26% – 67%. According to the World Health Organization, in Africa, Nigeria are the highest users of such products; 77% of Nigerian women uses the products on regular basis.
They are followed by Togo with 59%, South Africa with 35% and Mali at 25%. The prevalence in Namibia is not established, but clearly skin bleaching is on the rise.
Diverse ranges of products at various concentrations are used for skin bleaching. This includes hydroquinone and its derivatives, potent steroids, mercury, kojic acid, alpha hydroxyl acids and even hydrogen peroxide. Sometimes household chemicals such as toothpaste, washing liquid, washing soda and even battery acid may be mixed in homemade concoctions that are used for their caustic effects.
Skin bleaching agents are used in cream, lotion, oil, gel or soap, and are typically obtained from non-medical sources, including open markets and beauty stores.
This unregulated trade in skin de-pigmenting agents involving non-medically trained individuals has fuelled an international trafficking business, which needs to be curtailed. Numerous life-threating consequences of skin bleaching have been identified. Skin consequences include: thinning of the skin, bluish black tissue discolorations, eczema, bacterial and fungal infections, skin inflammation, poor wound healing and scarring.
Other more serious health risks include high blood pressure, diabetes mellitus, infertility, suppression of the immune system, blood cancer, insomnia, memory loss, hearing impairment and foetal abnormalities.
The risk of side effects occurring with bleaching depends on the nature and concentration of products used. This is complicated by the fact that on occasion products used may contain a higher concentration of active agents than stated on their packages. The US Food and Drug Administration (FDA) over the counter Miscellaneous Panel had designated 2% as a safe concentration for hydroquinone products until the 29th August 2006, when it proposes a ban to all hydroquinone products that have not been approved via a New Drug Application process.
This proposal arose following the failure of the manufactures to comply with a request by FDA for safety studies of hydroquinone. Additional contributory factors for the development of side effects with skin bleaching include the concurrent use of several de-pigmenting products, application of products over widespread areas of the body, application of products over prolonged periods and lack of sunscreen usage.
Dr David N. Emvula is a qualified medical doctor who holds a MBChB degree from the University of Pretoria. He is currently a fellow in Obstetrics and Gynecology at the University of Pretoria and co-runs Westcare Medical Center in Windhoek.