The International Society of DermatologyInternational Journal of Dermatology
del Giudice and Pinier
Use of skin lightening creams in Senegal
In addition, in some Asian countries, suchas Vietnam and the Malawi, Philippines, similar practiceshave recently been reported.
The expected result of “xessal” in Senegal is to clear theskin to obtain the so-called “
,” which is supposed to“improve appearance” and is considered by women as astandard of elegance, beauty, and higher social level.
Thispractice is widespread in Senegal: we found that 27% of women questioned were regular users. In Mali, a neighboringcountry, Mahé
found similar results, with 25% of women from the general population using bleaching creams,and, in Togo, Pitche
found an even higher rate of 59%.In Senegal and Mali, the main products are corticosteroidsand hydroquinone, used in combination in most topical prep-arations;
however, in Togo, Pitche
reported a higherrate of the use of mercurials (31%). Mercurials were popularas depigmentation agents until they were recognized as toxic,and their use was banned in some countries, such as SouthAfrica. These products are used in soaps or creams. They havebeen shown to be nephrotoxic via the absorption of mercurythrough the skin following repeated applications. In our experi-ence, mercurials were rarely used; however, the use of mer-curials has been reported in the past in Senegal, and we cannotexclude the possibility that the women questioned deniedtheir use.
Hydroquinone was the major skin lighteningagent used in our study population. High concentrations of hydroquinone-containing bleaching creams have been associ-ated with ochronosis, and may produce contact dermatitisresulting in a secondary postinflammatory hyperpigmentation.
Corticosteroids were the second most common productsused. As reported in Mali by Mahé
topical steroids aresuspected to be responsible for most cutaneous adverse effects.Other products used included detergents, sodium hypochlo-ride, lemon juice, salicylic acid, and others. A high proportionof women (25%) used products of unknown composition.The mean duration of use was 50.5 months; a few womenhad used “xessal” for longer periods, e.g. 20 years. The pos-sible result of such extensive use is the occurrence of cutane-ous adverse effects. Cutaneous diseases were present in62.5% of women (similar results were found in Togo andMali with 69% and 70%, respectively). Facial acne, presentin 36%, was the main adverse effect (Fig. 1). Facial acne andother frequent cutaneous adverse effects, such as atrophy,hypertrichosis, and stretch marks, are probably a result of theuse of topical steroids as previously reported.
It can beargued that, in the absence of a control group, it is not possi-ble to associate cutaneous diseases with the practice of using“xessal;” however, a rate of facial acne above 30%, whateverthe age group, is not usual. The usual rate of facial acne in thegeneral African adult population is low (< 5%). In addition,facial acne has been reported to be a frequent adverse event insubjects using topical steroids for cosmetic reasons in Viet-nam,
Togo, and Mali.
Stretch marks seen in women using“xessal” were unusual in location, intensity, and number(Fig. 2). No cases of ochronosis were found. No true cases of leukomelanoderma were found, as reported with the use of the monobenzyl ether of hydroquinone in South Africa, butrather the association of hypopigmentation contrasting withpostinflammatory hyperpigmentation in the same area (Fig. 3
Stretch marks on the upper part of the body
Pigmentary disorder: hypo–hyperpigmentation