During the "What’s New in Skin of Color" session at American Academy of Dermatology Virtual Meeting Experience 2021, Seemal R. Desai, MD, FAAD discussed the skin bleaching epidemic, a growing issue seen in patients of color.
The social and cultural stigma present in various cultures related to skin color is prevalent, Dr Desai began. It is generally believed that lighter, fairer skin is considered higher in status; thus, the epidemic of skin lightening, and bleaching, has been tied to a long enforced cultural belief.
In fact, recent progressive movements have surfaced with a recent global campaign centered around the hashtag #unfairandlovely making the rounds on social media as a clapback on colorism while addressing the issues and challenges created by fair skin values. Additionally, overseas marketing has done little to destigmatize the issue and continues to perpetuate the beliefs surrounding colorism.
Starting with glutathione, Dr Desai explained that this is a potent antioxidant with indirect inactivation of tyrosinase that assists in converting eumelanin to phaeomelanin. While typically used orally, it’s also available as an intravenous drug in Asia but is controversial due to bioavailability. It is found to be dangerous despite availability in the United States and all over the world. Dr Desai emphasized that we should not be advocating for this, especially because there are no double-blinded placebo-controlled trials for it.
There are many countries are cracking down on skin bleaching products, with more than 60 countries banning the use of mercury, cadmium, and more that are found within most skin bleaching products. Interestingly, while higher socioeconomic countries enforce regulations, lower socioeconomic countries do not. These products can be found online after making their way through these developing countries and, thus, find themselves in our backyard, Dr Desai explained.
Recent studies have found how many metals can be found in these products such as mercury, arsenic, and more. Toxic serum levels have been reported within these products, and Dr Desai emphasized that just because it might claim to be mercury free, does not mean it is arsenic free. He encouraged physicians to always ask what else are patients using (whether makeup, fragrance, moisturizer, etc), especially when ordered from overseas.
Additionally, over-the-counter (OTC) skin lightening products all over the world contain many toxic agents and topical steroids. In fact, it is important to fight against topical steroid misuse as it can be dangerous, especially OTC products.
Dr Desai then led to the topic of hydroquinone safety. Under supervised use, prescription topical hydroquinone (HQ) showed no more than theoretical risk of malignancy, developing ochronosis, or other long-term safety effects. There is no substantial evidence to prove its carcinogenicity, and it remains the standard of care while non-HQ-based therapies remain second-line and/or adjunctive.
Dr Desai stressed that physicians should take time to discuss long-term use with patients in addition to toxicity risks. He encouraged dermatologists to always ask the "what" and "why" behind the motivation to use these products. It is important for physicians to work together to break down those beliefs by counselling and educating patients on dangers of skin bleaching, especially when done for nonmedical reasons. —Jessica Garlewicz
Reference:
Desai, R. Skin of color: The skin bleaching epidemic. Presented at: American Academy of Dermatology Virtual Meeting Experience 2021; April 23-25, 2021; virtual.
