Intended for healthcare professionals


Use of skin lightening creams

BMJ 2010; 341 doi: (Published 23 November 2010) Cite this as: BMJ 2010;341:c6102

High use of skin lightening creams in both male and female attenders at an inner London general practice

In her editorial, Professor Olumide highlighted the risk of mercury
exposure through the use of illegal skin lightening creams[1]. Mercury,
alongside other chemicals such as hydroquinone or corticosteroids present
in some skin lightening creams has been associated with nephrotic syndrome
and skin rashes[2]. Such creams are used widely in Africa and Asia but it
is unclear how much they are used in the UK, and whether people are aware
of possible health risks associated with them.

In December 2010, for a medical student research project, we carried
out a questionnaire survey of skin lightening cream use and knowledge of
potential health risks in consecutive attenders at a South London general
practice. Adult patients in the waiting room were given an information
leaflet by SS and asked if they were willing to complete a short
confidential questionnaire about skin lightening creams.

The response rate was 82% (100/122). The mean age of participants was
39 years (range 17-85) and 69% were female. They described their ethnicity
(n=99) as white 25%, Black Caribbean 14%, Black African 12%, Black Other
3%, Indian 20%, Pakistani 14%, Bangladeshi 4%, or other ethnic group 8%.

22% (21/97) of responders stated they had used skin lightening cream
at some point in their lives, three of whom were men. Of those using
cream, 52% (11/21) said they had used it daily. The highest use was found
in people of Black-African (58%), Indian (25%) and Pakistani origin (17%).
Of 20 users, eight (40%) had bought their skin lightening cream from
abroad (mainly India and Pakistan), where illegal skin lightening creams
containing toxic chemicals are more readily available. Eight cream brands
were detailed in the questionnaire of which two (Ambi and Avon), contain
the potentially toxic chemical hydroquinone. Of 88 responders, 59% agreed
with the suggestion that some skin lightening creams can be harmful.

We found a relatively high (one in five) rate of skin lightening
cream use among a group of multi-ethnic inner city GP attenders including
some men, alongside a lack of awareness of risks associated with cream
use. These findings clearly point to the need for further education in
ethnic minority communities in the UK about the dangers associated with
illegal skin lightening cream use. In patients of African or Asian origin
presenting with unexpected renal impairment, GPs should consider asking
about skin lightening cream use[2]. If the cream is still in use, the
Health Protection Agency recommend that GPs liaise with their local
biochemistry laboratory and Health Protection Unit about checking blood
mercury levels and analysis of the cream being used.

Supreet Sidhu -
Third year medical student
St. George's, University of London

Navreet Paul -
Locum General Practitioner
SE London

Jasmeet Sidhu -
SHO Level Locum Doctor
Dental Student, Kings College London

Pippa Oakeshott -
Reader in General Practice
St. George's, University of London


Staff and patients at: Tooting South Medical Centre,
22 Otterburn Street,
SW17 9HQ


1. Olumide YM. Use of Skin Lightening Creams. BMJ [serial on the
Internet] 2010 Nov 23. [cited BMJ 2010; 341:c6102] Available from:

2. Health Protection Agency. Mercury Exposure from Illegal Skin
Lightening Creams [document on the Internet]; updated 2010 August.
Available from:

Competing interests: No competing interests

18 February 2011
Supreet S Sidhu
Navreet Paul, Jasmeet Sidhu and Pippa Oakeshott
St. Georges, University of London