Topical skin-lightening agents: Misuse and associated Complications.

Topical skin-lightening agents: Misuse and associated Complications.

Topical skin-lightening agents: Misuse and associated Complications.

The practice of skin lightening (or skin bleaching) means the use of depigmenting substances to lighten the color of skin. Skin-lightening is a general phenomenon that’s widely practiced among various communities in Africa, Asia, the Caribbean, the Middle East, and Central/South America, as well as in immigrant cohorts in North America, Europe, and elsewhere. Skin-lightening substances associated with many complications mostly contain hydroquinone, mercury, corticosteroids, & caustic agents. The included ingredient list in the package is frequently not accurate; particularly the products containing mercury may not be listed as an included ingredient.  

 

Mercury: Complications of mercury intoxication via the misuse of skin-lightening applicants include cutaneous, renal, & neuropsychiatric complications.

Cutaneous complications:  including contact dermatitis, erythroderma, flushing, purpura, gingivostomatitis, gray or blue-black facial discoloration owing to the dermal deposition of mercury-containing granules, in addition to nail discoloration.

Mercury toxicity: Systemic exposure to inorganic mercury or mercury salts can be observed as a result of cutaneous or oral absorption (e.g., misuse of mercury-containing cosmetics near the mouth or via hand-to-mouth transmission). The rate of dermal absorption of inorganic mercury is greatly related to the percentage of concentration of mercury and previous hydration of the skin. Dermal absorption is augmented if the mercury-containing cosmetics have been formulated in lipid soluble vehicles or applicated to compromised skin. Once absorbed, inorganic mercury is widely distributed and is excreted mainly via urinary excretion & the feces. Systemic complications may include: proteinuria, nephrotic syndrome, renal tubular acidosis, tremor, muscle weakness, peripheral neuropathy, metallic taste, hypersalivation, memory affection, erethism, depressive illness, anxiety disorders & psychosis (e.g., "mad hatter's disease"). Mercury exposure in pregnant women may adversely disrupt the neurologic & cognitive maturation of the fetus.

 

Use of skin-lightening applications may be associated with multiple cutaneous drawbacks, e.g. irritant contact dermatitis, exogenous ochronosis, skin atrophy, & skin dys-pigmentation. Serious systemic SE, e.g. mercury toxicity, Cushing's syndrome, & adrenal crisis, also can be seen. Early identification of the Sns of misuse of skin-lightening applicants is fundamental to halt long-term or permanent local and/or systemic sequelae. Ptns are usually unaware that they’re utilizing products with high-potency steroids and the other potentially harmful ingredients. Ptns engaging in skin-lightening agent’s abuse should be educated I regard to the potential local & systemic adverse effects. These applicants should be strictly withdrawn. Ptns with a history of skin-lightening applicants’ abuse should be particularly evaluated in regard to mercury toxicity.

 

REFERENCES

1)    Sagoe D, Pallesen S, Dlova NC, et al. The global prevalence and correlates of skin bleaching: a meta-analysis and meta-regression analysis. Int J Dermatol 2019; 58:24.

2)    Dlova NC, Hamed SH, Tsoka-Gwegweni J, Grobler A. Skin lightening practices: an epidemiological study of South African women of African and Indian ancestries. Br J Dermatol 2015; 173 Suppl 2:2.

3)    Lartey M, Krampa FD, Abdul-Rahman M, et al. Use of skin-lightening products among selected urban communities in Accra, Ghana. Int J Dermatol 2017; 56:32.

4)    Howard KL, Furner BB. Exogenous ochronosis in a Mexican-American woman. Cutis 1990; 45:180.

5)    Copan L, Fowles J, Barreau T, McGee N. Mercury Toxicity and Contamination of Households from the Use of Skin Creams Adulterated with Mercurous Chloride (Calomel). Int J Environ Res Public Health 2015; 12:10943.