Aesthetic problems associated with the cosmetic use of bleaching products

The use of skin bleaching products for cosmetic purposes is a frequent practice (25-96%) in women from sub-Saharan Africa. The dermatologic complications associated with this practice have been comprehensively reported. The aim of this work was to study the epidemiologic, clinical, and cosmetic aspects of these complications in order to produce better therapeutic guidelines for their management.

This was a prospective, descriptive study performed over a 6-month period. All women aged between 15 and 50 years, who consulted a dermatologist (Le Dantec Hospital or Institute of Social Hygiene), experienced a complication associated with artificial depigmentation, and agreed to take part in the study, were included. The data were input and analyzed using Epi info version 6.0.

Eighty-six female patients were included, with a mean age of 29.34 years (range, 16-49 years). The breakdown by level of education was as follows: primary (48.8%), secondary (18.3%), and higher (8.5%) education. Twenty-two per cent of our population had not attended school. The mean monthly cost of skin bleaching products was 6.22 euros. The initial skin tone before using skin bleaching products was black in 41.5% of patients, light in 32.9%, and intermediate in 25.6%. The mean duration of exposure was 6.7 +/- 5 years (range, 1-30 years). The breakdown by skin bleaching products showed that topical corticosteroids were the most frequently used (78%), followed by hydroquinone (56%), products based on vegetable extracts (31.7%), caustic products (8.5%), and, finally, products of unknown composition (41.4%). Two components or more were frequently combined (86.5%). The aesthetic complications of artificial depigmentation were the reason for consulting a dermatologist in 10 patients (12%). Nineteen types of aesthetic complication were reported in our sample. Hyperpigmentation of the joints was the most frequently found complication (85.4%), followed by striae atrophicae (72%) and skin atrophy (59.8%). The number of aesthetic complications found in the patients varied from one to nine. Patients frequently presented (71.9%) with other complications associated with artificial depigmentation.

Aesthetic complications associated with artificial depigmentation are common, but rarely the reason for consulting a dermatologist. In the absence of suitable therapeutic agents, prevention, based on informing women of the damaging effects of artificial depigmentation, is the only way forward.