Dadzie and Petit
© 2009 The Authors
, 741–750Journal compilation © 2009 European Academy of Dermatology and Venereology
job and marital prospects. However, some skin bleachers may notdesire white skin, but instead desire radiant skin.
Up until recentyears there was limited choice with regard to the types of cosmeticproducts available in Africa and Europe, especially for individualswith Fitzpatrick skin phototype VI.
In absence of such products,bleaching the skin may be perceived as an alternative method of enhancing one’s beauty, especially prior to important social events.
Other reasons cited by individuals partaking in skin bleachinginclude imitation of others and dependency on the products.
Finally, the higher prevalence of dyschromias in people withskin phototypes IV to VI may be another factor that initiates,promotes, and/or excuses this practice.
As a result of a lack of understanding about the appropriate use of depigmenting agents,coupled with negative cultural perceptions about dark skin, thesecutaneous depigmenting agents may be subsequently intentionally or inadvertently misused.
Prevalence of skin bleaching
A review of the scientific literature demonstrates that individualsfrom diverse communities around the world, including Africa,North America, Europe, Asia and the Middle East practice skinbleaching. Evidence from the non-medical press further highlightsthe global burden of this practice. Thus, scientific studies conductedon the practice of skin bleaching, as summarized in Tables 1 and2 and discussed in detail below, may only represent the clinicaliceberg of a more widespread problem.
The worldwide awareness of the cultural practice of skinbleaching originates from the work of Findlay
who in 1975first reported on the occurrence of exogenous ochronosis inSouth African women. These women had used high concentrations(3.5–7%) of hydroquinone-containing agents over the course of many years for bleaching their skin. Skin bleaching remained aproblem in South Africa and by 1986 the total sales volume of skinlighteners was an estimated 30 million pounds.
Currently, skinbleaching continues to have an impact on dermatological practicein many sub-Saharan African communities, with prevalence ratesof this practice in community and clinic settings documented tobe between 26% and 67%.
This estimate is based on descriptive
An overview of studies conducted worldwide on the cosmetic use of depigmenting agents (prevalence and types of agents used)
Reference (country oforigin and type of study)Prevalence of skinbleachingType of depigmenting agentsSite and frequency ofuse of depigmentingagentsDuration of use
(Nigeria,community study)77.3% (females, 72.4%;males, 27.6%)Hydroquinone; mercury;corticosteroids; locally concoctedsoaps/creamsNot speciﬁed in study1–3 years (46.3%) Ajose
(Nigeria, hospitalstudy)Females, 40%; males, 2%Hydroquinone; class I and IIsteroids; mercurials; phenolicscaustics; unknown chemicals andplant derivatives; combinationsNot speciﬁed in study6 months–over20 yearsFaye
(Mali, hospitalstudy)Not speciﬁed in studyHydroquinone; steroids;mercurials; unknown compositionNot speciﬁed in studyNot speciﬁed in studyDel Giudice
(Senegal, hospital study)27% active skin bleachersHydroquinone; corticosteroids;mercurials; detergents;hypochloride sodium; unknowncompositionOnce to thrice per day50.5 months (mean),range 1–240 monthsLy
(Senegal,hospital study)Not speciﬁed in studyCorticosteroids; hydroquinone;vegetable extracts; causticproducts; unknown compositionNot speciﬁed in study6.7 ± 5 years (mean),range 1–30 yearsMahé
(Senegal,hospital study)52.7% (± 5)4–8.7% hydroquinone; steroids;caustic agents; unknowncomposition; mercury iodideWhole body; once ortwice per day4 years (median)Mahé
(Senegal,maternity centre)68.7%Hydroquinone; corticosteroids;mercurialsWhole body (85.2%); atleast once per day5 year (mean), range3 month–24 yearsNnoruk
(Nigeria,hospital study)58.7%Steroids; hydroquinone;mercurials; kojic acid; alphahydroxyl acids; unknowncompositionWhole body; face; twiceper day5 years ± 1.3 yearsPetit
(France,hospital study)80%Steroids; hydroquinoneEntire body and face; atleast once per day14 years (mean),range 1–38 yearsPitché
. (Togo,community study)58.9%Mercurials; hydroquinone;steroids; unknown compositionNot speciﬁed in studyNot speciﬁed in studyTraore
(BurkinaFaso, community study)44.3%Phenolics; steroids; combinationof agents; mercurials; unknowncompositionNot speciﬁed in study1–3 years