SKIN BLEACHING AGENTS IN LEGAL AND ILLEGAL MARKET. THE USE OF SOME DEPIGMENTING COSMETICS OUT OF THE RULE, ILLEGALLY IMPORTED AND CONSUMED IN ITALY FROM FOREIGN PEOPLE

Morrone A.

9th ISCD International Congress
Wellness and Beauty outside in: East & West working together
Rome, 21-23 October 2009

Aldo Morrone MD: Director General- National Institute for the promotion of Migrants' health and the control of Poverty-related diseases – NIMHP- Rome, Italy
The bleaching products usually contain drugs and substances able to inhibit or prevent the synthesis of melanin.
According to the mechanism of action, they are dived in:
- inhibitors of the synthesis of tirosinase (such as the heavy metals),
- inhibitors of the activity of tirosinase (such as the anti-oxidants, that bind to the O i.e: idroquinone ,
arbutin and glycolic acid) – the most popular
- agents with selective cytotoxicity towards the melanocytes
- inhibitors of the transfer of melanosomes to keratinocytes (cytochines)
- agents able to keep the melanin in the reduced form, making it clearer (peroxides)
The bleaching agents include hydroquinone, hydroquinone derivatives (hydroquinone monobenzylether and monomethylether), strong steroids, mercurials (mercuric odide 1–3% or mercuric chloride 6–8%), kojic acid, alpha hydroxyl acids, plant-derived products (that may contain active agents such as arbutin) and even hydrogen peroxide.
Skin bleaching agents are marketed as cream, lotion, oil, gel, soap or pomade formulations and are typically obtained from non-medical sources, including open markets and beauty stores. Sometimes, various ingredients from the domestic environment (toothpaste, washing liquid, washing soda, hair straighteners, sand, cement and even battery fluid) may be mixed in homemade concoctions that are used for their caustic effect. The unregulated trade in cutaneous depigmenting agents involving non-medical individuals has fuelled an international trafficking business, which needs to be curtailed. Moreover, the risk of side-effects occurring with skin bleaching depends on the nature and concentration of products used. This is complicated by the fact that these products may contain a higher concentration of active agents than stated on their packages. Additional contributory factors for the development of side-effects with skin bleaching include the concurrent use of several active principles, application of products over widespread areas of the body and for prolonged periods (months to years) and lack of sunscreen application.
The current focus within the dermatological community on the safety and regulation of hydroquinone presents a unique opportunity to raise awareness on the occurrence and dangers of skin bleaching. Aesthetic and systemic side-effects of skin bleaching not only remain a public health problem in most parts of sub-Saharan Africa (but not only), but also may increasingly impact many other communities around the world. It is also important that we educate individuals that use the legal formulation of these drugs for the treatment of pigmentory problems to seek dermatological care for their dermatoses, in order to avoid the self-medicatation or use illegally obtained cutaneous depigmenting agents.
However, this would not be enough to reduce the global burden of skin bleaching. Instead, a multifaceted approach is required. Some studies in the field of human sciences, to consider the sociological and psychological factors that are responsible for the search of a lighter complexion (which may vary among different communities) are required to guide the development and implementation of appropriate public health prevention campaigns. In addition, international cooperation between governmental, nongovernmental and medical agencies is required to decrease the international trafficking of illegal depigmenting agents. Continued rigorous scientific studies, especially in Western, Arab and Asian countries where such studies remain scarce, are required to critically evaluate the global burden and adverse health effects associated with skin bleaching, Finally, more research directed towards the development of alternative safer agents for the inhibition of skin pigmentation is required.