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