Ochronosis in black South Africans who used skin lighteners

Skin-lightening preparations containing hydroquinone are used extensively by black South Africans. In some instances these preparations produce severe and irreversible cutaneous damage. Clinically, the deleterious effects begin with darkening and coarsening of the skin, followed by a hyperpigmented papular condition. Histologically, there is increased basophilia of the collagen, followed by the formation of yellow fibers. These yellow fibers swell and break down to form an amorphous eosinophilic material. Electron microscopy shows that the changes arise from a breakdown of normal collagen.