The Perils of Skin Bleaching

Introduction

Bleaching of normal skin by black people is practiced by diverse communities worldwide. It involves the use of a wide range of products, applied to specific or widespread areas of the skin, the main function being to lighten normal black skin.

This practice is seen at all ages and in both men and women, however some studie1,2 indicate a much higher prevalence in young, unmarried and educated women. The reason for this observation maybe that this group is more likely to be influenced by Western concepts of beauty. Unfortunately, there are many adverse reactions, which occur as a consequence of this practice. This ranges from a paradoxical increase in skin pigmentation to severe systemic problems such as mercury poisoning.

There are several factors contributing to and perpetuating this behavior. First, black people are at a higher risk of pigmentary disorders of the skin3. Thus, the use of skin lightening products may be sought initially as a genuine treatment for this problem; however, it may be inadvertently abused due to a lack of understanding about the appropriate use of these products. Nonetheless, a significant proportion of individuals may intentionally abuse these products due to misconceptions about the presumed superiority and desirability of fair skin. This assertion is supported by studies in which users of bleaching agents have stated explicitly, that their motivation is a desire to change their skin colour2,4. It is a shame that such misconceptions and self-identity issues persist within certain members of the black community. Thus, in addressing this practice of skin bleaching we need to undertake a parallel discourse about both the dangers of this practice and also issues of racial self-identity. Furthermore, it is also important to explain to individuals that diverse skin types have developed as an adaptation to the natural surrounding environment.

Understanding skin types

Fitzpatrick, a famous skin doctor, devised a classification system for correlating the colour of the skin with how it reacts to ultraviolet radiation (either burning or tanning)5. Since it was developed to classify white skin, there are some limitations as to its usefulness in classifying black skin. Despite this, this classification system, is the most widely used method for classifying all skin types. The Fitzpatrick skin phototype system ranges from type 1 (the fair skinned Celtic, who burns easily with sun exposure) to type 6 (the black African, who does not burn with sun exposure).

Why the diversity of skin types?

The sun emits ultraviolet radiation, which can have beneficial or detrimental effects. Vitamin D production by the skin is a major beneficial effect of the sun on the skin. Vitamin D is required for calcium formation in the body, this latter mineral being required for developing strong bones. The detrimental effects of the sun are in inducing skin cancer and damaging elastic fibers of the skin, with the consequence of skin wrinkling. The presence of melanin pigment, produced by specialized cells in the skin called melanocytes, is important in protecting the skin from the harmful effects of the sun. Interestingly, individuals with different skin phototypes all have the same total number of melanocytes, but the differences in skin colour are due to variations in the amount of melanin pigment6.

Since melanin is important for protection against ultraviolet radiation, we can postulate that increased or decreased amount of melanin pigment in the skin will depend on the surrounding environment. In fact, darkly pigmented races inhabit parts of the world, where exposure to the sun is strongest. Given the fact that melanin is protective against the sun’s ray, it is easy to appreciate the advantages of having dark skin in such areas. On the other hand, fair skin types (with less melanin pigment in the skin) inhabit countries in the Northern hemisphere, where there is less sun exposure. Less melanin pigment allows more of the sun’s rays to be absorbed. This explains the high rates of skin cancer observed in this cohort when they migrate to countries like Australia7.

What is skin bleaching?          [ back to top ]

This is a process where different products are used for the purpose of lightening normally dark skin. These agents remove the melanin pigment, but do not destroy the melanin producing cells. Thus, daily use combined with minimization of exposure to the sun (which will stimulate more of the melanin pigment production), is required for persistence of the lightening effect. Given the above discussion on the advantages of pigmented skin in certain parts of the world, it is easy to appreciate the adverse consequences of this practice.

What agents are used for skin bleaching?

A wide range of products are available for skin bleaching, often sold under many brand names (Box 1)8. Often, these agents are obtained without a prescription, from non-medical personnel and are subsequently misused by individuals. The active agents used include hydroquinone, steroids (of which there are many types, with different potencies), mercury, lemon, citric acid and even cement water. Various concoctions may be used and for this reason, the active agent may never be known.

1. A study of 368 adult women (representative sample) attending a skin clinic in Dakar, Senegal (West Africa), showed that 52.7% of these women were current users of bleaching products. Within the group of bleaching agent users 92% applied these agents to the whole body8.
   
   
2. In Bamako, the capital of Mali (Africa), 25% of adult women reported current use of bleaching products9.
   
   
3. A study of patients over the age of 16 attending a skin clinic in
   Nigeria (West Africa) between February and October 2004, reported the use of
   skin bleaching agents in 92% of females and 5% of male patients. The reason
   cited for use of these agents was a desire to even out skin tones, a desire
   to lighten complexion, a desire to improve appearance of the skin to an
   event and dependency on these agents4.
   
   
4. A study carried out in two cities in Burkina Faso (West Africa) reported the use of skin bleaching agents in 39.5% and 49.2% of women in Ouagadougou and Bobo-Dioulasso respectively. Some of the reasons cited for use included a desire to change the color of skin and a desire to change the texture of the skin2.
   
   
5. Studies done in South Africa back in 1986 indicated that the total sales volume of skin lighteners was an estimated 30 million pounds, demonstrating the great demand for these agents10.

The uncontrolled use of skin bleaching agents is not restricted to Africa, as it has also been reported in black women living in Europe11 and in Hispanics living in North America12.