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 Skin & Hair

November 2009
Skin Whitening is it safe?
Dr R.K. Joshi
 
Normal skin colour depends on haemogram, carotenoids and melanin pigment. Major differences in skin colour in different races and ethnic groups are related to melanin containing organelle called melanosomes. These are produced by the melanocytes (the pigment cell present in the middle layer of the skin) and are transferred to the skin surface.

Two types of melanin pigmentation occur in humans. The first is constitutive skin colour which is the amount of melanin pigmentation that is genetically determined and is not effected by the skin and other influence. The second is facultative in which the skin colour or tan is effected by the skin exposure, dietary changes, lifestyle, environment etc.

Since ancient times, light or white skin has been considered to be beautiful and this norm is generally accepted in the society even today. In those days it was a fashion to use vitamin C in one form or the other, both topically and systemically, to lighter the skin colour. It was common practice to use different remedies to exfoliate the skin with the aim to make it look fairer.

If we survey the sale of cosmetics in the present scenario, skin whitening products are on top of the list. Certainly a lot of skin-whitening products are available in the market and to select one which is suitable for your skin is not easy. Some work better for some skin types than others and some products might have side effects on the short or long term basis. Your best source of information however would be a dermatologist / cosmetologist who can examine your skin to make a correct diagnosis of a possible cause of your pigmentation, do necessary investigations as needed to help you to select the best product suitable to your skin type.

Skin-lightening Products
In general, there are 2 types of pigmentation, superficial (epidermal) or deep (dermal). While selecting the treatment for pigmentation, the depth of the discoloured pigment is a very significant factor to be considered. As one expects, superficial or epidermal pigmentation is likely to give us better results when treated with various skin lightening products available in the market, for example: hydroquinone 2 – 4% either alone or in combination with tretinoin and / or mild topical steroids to enhance its effect, topical azelaic acid 10 – 20% is also efficacious, tretinoin is specially useful in treating hyperpigmentation of photo-damaged skin, kojic acid alone or in combination with glycolic acid or hydroquinone woks better in some.

Other skin lightening products are mulberry extract, licorice extract, arbutin, niacinamide (Vitamin B3), kumkumadi tailum, mercury salt, bismuth subnitrate, hydrogen peroxide, magnesium peroxide, zinc peroxide, topical Vitamin C, Q10 preparations, melatonin (pineal body extract) etc.

For deep pigmentation, the outcome with treatment is not very encouraging and chances of recurrences after stopping the treatment are very frequent.

The therapy needs a combined approach using topical skin whitening product as already mentioned, different chemical peels microdermabrasion and laser treatment.

Points to remember when selecting a skin-lightening product
  1. Ideally one ought to consult a dermatologist / cosmetologist to establish any underlying cause of our pigmentation. It might be due to different skin conditions for example freckles, lentiginosis, lichen planus, melasma, collagen vascular diseases, drug induced, genetically influenced like periorbital melanosis, etc. On the other hand pigmentation could well be due to hormonal imbalance and other systemic diseases like thyroid disease, adrenal disease, diabetes mellitus, amyloidosis, hepatic cirrhosis, chronic renal failure, Vitamin B12 deficiency, neoplastic disease, lymphoma and nutritional causes.
  2. Assessment of skin type whether it is oily, dry, combination, sensitive or irritable – as all available products are not agreeable to every type of skin.
  3. Different products work differently and it's quite logical to know how it's going to work. Is it purely exfoliative, bleaching product or interferes in the mechanism of melanin formation? Some products have combined mechanism of action.
  4. All whitening products may not be entirely safe, so be alert for any possible side effects. Some ingredients in these preparations can cause irritational or allergy contact dermatitis, photo sensitivity, redness of face, acne eruptions etc. On long term use some skin whitening products can cause:
    • Excessive hair growth (hypertrichosis) due to their steroid content
    • Chemical induced leucoderma (vitiligo)
    • Pigmentation can get worse due to deposition of hydroquinone which is an ingredient in many whitening products
  5. Bleach, peel, exfoliants are primarily irritating to the skin. Their overuse can cause rosacea, DNA degeneration with risk of developing skin cancer. Their use needs expert supervision.
  6. Ingredients like mercury and arsenic are nephrotoxic and can cause kidney problems on longterm skin application. They can also cause anaemia, abdominal pain, bowel irregularity and blood diarrhoea.
  7. One needs to take an extra care in selecting skin whitening creams if one suffers with facial dermatitis, acne, rosacea, lupus, photodermatitis etc, as ingredients present in the whitening products can aggravate these conditions.
  8. Do not just go after the big brand names, rather read the label of their ingredients.
  9. Always use sun protection of some form during the treatment period as most of skin-whitening products make your skin sensitive to the ultra violet rays. Sun protective lotions / gels of SPF 30+ generally provide an adequate cover.
  10. If there is a reaction after applying any preparation on your skin, then you might need allergy skin tests to establish the culprit ingredients to avoid in future. These allergy tests are commonly available with a dermatologist.
Keep a Balance
It is very important that we need to keep a balance between use and abuse of different skin whitening products as well as the use of other modalities available in this respect including peels and lasers. No doubt in some, skin colour can cause marked cosmetic disability and mental stress. Sensible use of these skin-whitening products can be a boon for some; on the other hand, long term and unsupervised use can lead to undesirable consequences. Be sensible, be aware and enjoy these available cosmetics to make you feel more confident and to have a high selfesteem.
 
Dr. R.K.Joshi Senior Consultant Dermatology & Venereology at Indraprastha Apollo Hospitals, New Delhi

    
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