Some skin-lightening creams conceal dark side

In pursuit of a lighter complexion, some people could be putting their health at risk.

Some skin-lightening products have dangerous side effects for those who misuse them or buy counterfeit brands, dermatologists say.

Also known as bleaching creams, these products "are a double-edged sword," says Dr. George Cohen, assistant professor of Dermatology and Cutaneous Surgery at the University of South Florida. "The effects are good initially, but if you use the products for a long time they can cause serious damage to your skin."

The New York Times recently profiled a 45-year-old woman who used lightening creams, including Fair & White and Hyprogel, for years to brighten her face, neck and hands. In addition to getting lighter skin, she now has persistent acne and broken capillaries, and her skin bruises at the slightest touch. All three conditions were side effects of prescription-strength steroids in over-the-counter bleaching creams she bought at a beauty supply store.

Some bleaching creams contain powerful steroids that thin the skin; others contain hydroquinone, a dangerous and toxic chemical that interferes with the skin's pigmentation process. Hydroquinone has been banned in several countries. The chemical has been linked to kidney damage and some kinds of cancer. It also can cause low birth weight in babies when mothers use it during pregnancy.

In the United States, hydroquinone is classified as an over-the-counter drug that may be used in
concentrations of up to 2 percent. Creams and gels with a hydroquinone concentration of up to 4 percent are available with a prescription.

Dermatologists say bleaching creams with hydroquinone and steroids are safe to reduce the appearance of brown spots or smaller blemishes - if used as directed and only for a short period of time.

"You can get over-the-counter hydroquinone in relatively low concentrations, but these are short-term medications," Cohen says. "They shouldn't be used for more than four weeks. The use of hydroquinone for long periods can create worse pigmentation rather than lighter skin."

Long-term use of use of bleaching creams lead to a disfiguring condition called ochronosis, a skin disorder marked by darkening and thickening of the skin. Misuse also can lead to hypertension, elevated blood pressure and stretch marks.

The ease with which illegal skin whiteners can be purchased online also has contributed to more cases of skin damage, Cohen says.

He recently treated a patient for black blotches on her skin. For years she had been using a skin whitener she ordered online from Jamaica.

When Cohen checked the ingredients, he found it contained mercury, an illegal toxin that can damage the nervous system.

"I wasn't so much worried about her skin as I was the exposure to mercury," he says. "The main problem with people buying unknown cosmetics is that they don't know what's in them."

Not everyone uses a bleaching cream for medical purposes, or to treat one troubling spot. In many societies, there is often greater acceptance of light skin than dark skin, Cohen says. In certain countries, the lighter you are, the higher your status socially and economically. Light skin may be seen as a mark of beauty, intelligence and success.

Former Chicago Cubs slugger Sammy Sosa surprised fans in November when he was photographed at the Latin Grammys with much lighter skin. Sosa later acknowledged using skin-bleaching creams.
"No one likes admitting to using these creams to better their lives, but many do," Cohen says.

Anyone who has a problem with hyperpigmentation, or skin darkening, should see a dermatologist to be evaluated. If a bleaching cream causes redness, burning or itching, you should immediately discontinue using it.

"If you correct the underlying medical problem, the hyperpigmentation often will resolve itself. Don't try to do it yourself," Cohen says. "If you decide to use [a bleaching cream], make sure you know what ingredients it contains."