Intended for healthcare professionals


Use of skin lightening creams

BMJ 2010; 341 doi: (Published 23 November 2010) Cite this as: BMJ 2010;341:c6102
  1. Yetunde M Olumide, professor of medicine (retired)
  1. 1University of Lagos, Lagos Nigeria
  1. mercyolumide2004{at}

Lack of recognition and regulation is having serious medical consequences

Skin lightening (bleaching) cosmetics and toiletries are used to lighten the colour of darker skin. The practice, which is fuelled by racial prejudice, stems from the misconceptions that black skin is inferior and that someone with a fair skin is more attractive.

Seyllou/AFP/Getty Images

By definition, cosmetics are meant to improve the appearance of the skin or enhance the attractiveness of users, not to alter the basic structure of the skin. Skin lightening creams alter the chemical structure of the skin by inhibiting the synthesis of melanin and should therefore be regulated as drugs not cosmetics.

The active ingredients include hydroquinone, mercury, and highly potent fluorinated corticosteroid ointments and creams such as fluocinonide, betamethasone valerate, and clobetasol propionate. The list of ingredients has expanded because some manufacturers have introduced new chemicals of unknown safety—such as niacinamide, oxybenzone, and triethanolamine—to circumvent the efforts of government regulatory agencies that prohibited the use of the above chemicals in cosmetics and toiletries.1 Some products do not have ingredient labelling or place of manufacture,2 3 and inadequate regulation has provided users with easy access to cheap, substandard, and misbranded toxic products.

These products are associated with serious and life threatening complications because they are used for long periods on a large body surface area and often under hot and humid tropical conditions, which promote percutaneous absorption. Complications such as exogenous ochronosis and colloid milium were initially reported in people with coloured …

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