Skin-bleaching products such as hydroquinone are classically and successfully used in hyperpigmentation disorders such as melasma around the globe. However, according to one expert, these products are being heavily abused for a much different reason in the sub-Saharan countries of Africa. Here, they are commonly used to achieve lighter skin in order to "belong" to a "higher" social status, sometimes causing very serious medical problems.
Meaux, France - In sub-Saharan countries, it is generally considered by societies, and reflected through the media, that people with lighter skin may have a higher social status. Skin bleaching, therefore, has become a fashion, and is a dangerous common practice.
"There is some epidemiological data in Africa, such as in Mali,where it has been shown that 25 percent of women use skin-bleaching products. These women are heavily burdened by this 'clear skin fever' and use bleaching agents which are naturally accompanied by a slew of potentially harmful side effects," says Antoine Mahé, M.D., a dermatologist who worked at the Institute of Social Hygiene, Dakar, Senegal, and who is now posted in Meaux (near Paris), France.
Dr. Mahé says that in countries such as Senegal, this practice of skin bleaching has become rampant and might be practiced by up to 60 percent of women. According to Dr. Mahé, skin bleaching has become a kind of fashion, aimed at reflecting the social status. In these countries, a lighter skin has "erroneously" become synonymous with a higher social status.
According to Dr. Mahé, there is a major black market industry for these steroid creams, and they can, unfortunately, be very easily acquired in certain milieus.
Skin bleaching is a very common adverse effect seen in dark skin as a result of the use and abuse of potent corticosteroids. However, the women who use these creams experience the the gamut of adverse effects, such as skin atrophy, striae, steroid acne, and superinfections such as mycoses and pyodermas.
"Some of these misguided women use more than 100 grams of these potent topical corticosteroids creams a month to cause skin bleaching, and unfortunately, the systemic effects of the drug also become evident. Symptoms of hypertension, diabetes mellitus and iatrogenic Cushing's are sometimes the result of such abuse," Dr. Mahé tells Dermatology Times.
He says the adverse events of bleaching drugs such as hydroquinone can elicit pigmentation disorders such as Berloque dermatitis, facial hyperpigmentations and ochronosis. Other depigmentation creams or soaps contain mercury, resulting in mercury poisoning, and can ultimately cause serious renal disease.
Dermatologists and other healthcare professionals are confronted with the very difficult task of trying to convince these women not to use these products. However, the social stigmas associated with darker skin in these countries can sometimes psychologically weigh more heavily than personal health issues.
"These women believe that the fact that they are able to purchase these creams, which are not inexpensive, shows that they have the money to do it - automatically propelling them into a higher social circle and level. The thinking is that if you can bleach your skin, you are considered quite rich. Interestingly, though, men do not follow this practice nearly as much as women," Dr. Mahé says.
He says that most women do not believe it is a shame to be black, and they do not try to have a white skin, but they simply try to lighten their skin.
According to Dr. Mahé, white skin is not considered the most beautiful, but these women try to achieve a color that is slightly tanned or brown and not "too black."
"One approach to these women who are bent on proving a certain social status via skin bleaching is to make them feel guilty of the practice. Another is to rationally explain to them the dangers and risks of the practice, but I do not think that it will be very efficacious in most situations.
"Another approach that I would recommend in most situations is to rationally explain to them the dangers and risks of the practice, especially during a pregnancy, a period during which the practice might be enhanced," Dr. Mahé says.
According to Dr. Mahé, migrant populations are a reality in today's world, and it is important for dermatologists to be aware of this skin-bleaching practice, because, for instance, an unresponsive case of steroid acne or a widespread mycosis may very well be due to such abuse of corticosteroids.