Skin lightening practices, beliefs, and self-reported adverse effects among female health science students in Borama, Somaliland: A cross-sectional survey

Background

Skin-lightening (SL) products are common, especially in Africa. Adverse effects from these products represent a public health concern. Use of these products in Somaliland is unknown.

Objective

This study aimed to determine the prevalence of use of SL products among female health science students, beliefs about these products and practices, and adverse effects experienced.

Methods

This was a cross-sectional survey of a convenience sample of female health science students at Amoud University in Borama, Somaliland.

Results

Of the 400 students who were invited to participate, 265 completed the survey (response rate: 66%). Mean participant age was 21.1 years (standard deviation: 2.0 years). The majority of students were single (91.2%) with a Fitzpatrick skin type of 3 or darker (94.2%). Past or present use of SL products was reported by 25.6% of participants, and 52.2% admitted to current use. Compared with non-users, more SL product users agreed that lighter skin color gives a woman more confidence, helps a woman have better job opportunities, and increases chances of getting married. They also agreed that advertisements on television for SL products influence a women’s preference for a lighter skin tone (p < .05). More than 60% of participants were unsure what active ingredients were in their SL products. Only 9% denied any undesirable adverse effects, and the remainder reported an array of local and systemic adverse effects. The vast majority realize that SL products may cause undesirable local (92%) and systemic (89%) adverse effects.

Limitations

Generalizability is limited because a nonrandomized convenience sample from one university was studied. Response bias also may have skewed results.

Conclusion

Use of SL products among female health science students in Somaliland is common, and causes cutaneous and systemic adverse reactions. Use appears influenced by beliefs about the benefits of lighter skin color. Education is needed on the proper use of these products, how to avoid harmful products, and how to prevent complications.

Skin lightening products' violations in Europe: An analysis of the rapid alert system for dangerous non-food products 2005-2018

BACKGROUND

Skin lightening products containing dangerous levels of chemicals pose a serious health concern for consumers. However, to date, the extent of these products in Europe has not been extensively studied. The aim of this study was to determine whether harmful skin lightening products are available for sale in Europe and what violations exist regarding their composition.

MATERIALS AND METHODS

We queried the Rapex database, which is the Rapid Alert System for dangerous non-food products among 31 European countries, to identify skin lightening cosmetics reported between 2005 and 2018, and presented a detailed summary of these notifications.

RESULTS

In the years 2005-2018, of all violations regarding cosmetics, 26.3% concerned skin lightening products. In the database, 266 reports on skin lightening products were identified. Most of the notifications came from Germany (17.29%), France (17.29%), Portugal (15.41%), and the United Kingdom (11.65%). The majority of the registered products originated from non-European countries, mainly the Côte d'Ivoire (29.70%). The major reason for the violation was the content of hydroquinone, mercury, or clobetasol propionate.

CONCLUSIONS

Hazardous skin lightening products that are not in line with European cosmetics legislation are available on the European market. Most of the products are imported. The main risk associated with these products is the content of hydroquinone, mercury, and clobetasol propionate. It is important to bear in mind that this study focuses on the Rapex system and other sources of information may exist. Based on our findings, a more comprehensive evaluation by international authorities is justified.

Skin Bleaching and Dermatologic Health of African and Afro-Caribbean Populations in the US: New Directions for Methodologically Rigorous, Multidisciplinary, and Culturally Sensitive Research

Skin-bleaching practices, such as using skin creams and soaps to achieve a lighter skin tone, are common throughout the world and are triggered by cosmetic reasons that oftentimes have deep historical, economic, sociocultural, and psychosocial roots. Exposure to chemicals in the bleaching products, notably, mercury (Hg), hydroquinone, and steroids, has been associated with a variety of adverse health effects, such as Hg poisoning and exogenous ochronosis. In New York City (NYC), skin care product use has been identified as an important route of Hg exposure, especially among Caribbean-born blacks and Dominicans. However, surprisingly sparse information is available on the epidemiology of the health impacts of skin-bleaching practices among these populations. We highlight the dearth of large-scale, comprehensive, community-based, clinical, and translational research in this area, especially the limited skin-bleaching-related research among non-White populations in the US. We offer five new research directions, including investigating the known and under-studied health consequences among populations for which the skin bleach practice is newly emerging at an alarming rate using innovative laboratory and statistical methods. We call for conducting methodologically rigorous, multidisciplinary, and culturally sensitive research in order to provide insights into the root and the epidemiological status of the practice and provide evidence of exposure-outcome associations, with an ultimate goal of developing potential intervention strategies to reduce the health burdens of skin-bleaching practice.

Mercury, hydroquinone and clobetasol propionate in skin lightening products in West Africa and Canada

Skin lightening products are types of cosmetics (creams, gels, lotions and soaps) applied voluntarily on skin. Several of these products contain a variety of active ingredients that are highly toxic. Among those toxic agents, the present study focuses on mercury, hydroquinone, and clobetasol propionate. Out of the 93 lightening soaps and 98 creams purchased in large city markets in sub-Saharan West Africa and in small ethnic shops in Canada, 68-84% of all creams and 7.5-65% of all soaps exceeded regulatory guidelines for at least one active ingredient when considering different regulations. Mercury was found in high concentrations mainly in soaps, while hydroquinone and clobetasol propionate concentrations exceeded US FDA standards in some creams for all countries included in our study. Concentrations of the three compounds declared on labels of soaps and creams usually did not correspond to concentrations actually measured, particularly for mercury and hydroquinone. Overall, our results indicate that most studied skin-lightening products are potentially toxic and that product labels are frequently inaccurate with respect to the presence of toxic agents.

"The fairer the better?" Use of potentially toxic skin bleaching products

BACKGROUND

Skin bleaching is a widespread phenomenon in spite of their potentially toxic health effects.

OBJECTIVES

This study aimed to determine if such products are used in Sweden in particular by pregnant women, furthermore to explore immigrant women's view skin bleaching.

METHODS

455 pregnant women completed a questionnaire, which were statistically analysed. Focus groups and individual interviews were conducted with immigrant women, content analysis was used to assess the data.

RESULTS

Skin bleaching products were used by 2.6% of pregnant women, significantlly more by women born in non-European countries. Motivating factors were associated with the concept of beauty together with social and economic advantages. The women had low awareness of the potential health risks of the products. Regulations on the trade of skin bleaching products have not effectively reduced the availability of the products in Sweden nor the popularity of skin bleaching.

CONCLUSION

There is need for further research especially among pregnant women and possible effects on newborns. Products should be tested for toxicity. Public health information should be developed and health care providers educated and aware of this practice, due to their potential negative health implications.

Spectrometric analysis of mercury content in 549 skin-lightening products: is mercury toxicity a hidden global health hazard?

BACKGROUND

Cosmetic skin lightening is practiced worldwide. Mercury is a well-documented melanotoxin added to some lightening products. However, mercury can cause many dermatologic, renal, and neurologic problems. The Food and Drug Administration limits the amount of mercury in cosmetic products to trace amounts, 1 ppm.

OBJECTIVE

The objective of this study was to quantitatively evaluate a large international sample of lightening products for mercury content, focusing on products available to US consumers either online or in stores.

METHODS

A total of 549 skin-lightening products, manufactured in 32 countries, were purchased online in the United States, Taiwan, and Japan and in stores in the United States, China, Taiwan, Thailand, Japan, and Sri Lanka. Cosmetics were screened for mercury content above 200 ppm using a low-cost portable x-ray fluorescence spectrometer.

RESULTS

Of the 549 tested products, 6.0% (n = 33) contained mercury above 1000 ppm. In all, 45% of mercury-containing samples contained mercury in excess of 10,000 ppm. Of lightening products purchased in the United States, 3.3% were found to contain mercury in excess of 1000 ppm.

LIMITATIONS

Our study did not evaluate creams for other melanosuppressive ingredients. Only 1 sample of each product was tested.

CONCLUSION

Our study confirms the national and global presence of mercury in skin-lightening products.