Skin Bleaching

and
Complications

By
Dr Anyamele Ibuchim
Introduction
Epidemiology
Anatomy
Basic Biochemistry
Bleaching Agents
Effects of Skin Bleaching
Complications
Conclusion
 Introduction

 Refers to the use of substances to lighten

skin colour
 Also known as skin whitening, Depigmentation
etc
 An Age-long practice

 Done to improve appearance and perceived

attractiveness
Initially arose out of racial prejudice
Perception that white skin is superior/more attractive

However, reasons have evolved with time

But fundamentally, done to improve appearance/

attractiveness/acceptability

Practice can also suggest underlying issues with

self esteem and self worth

Males and females involved, but females

disproportionally affected
Millions of dollars spent yearly worldwide on
various bleaching products

Practice unregulated in many developing nations

Even in developed countries, enforcement of

regulation is often unsatisfactory
Multiple sources of procurement

Herbal extracts

Off-label use of medications etc

There’re legitimate reasons to bleach the skin

Specific zones of hyperpigmentation may be depigmented

to match the surrounding skin
In extensive vitiligo, areas with normal skin colour may be
depigmented to give a more uniform appearance

However, unregulated skin bleaching can cause

multiple health problems, both local and systemic

Such problems range from striae, increased

susceptibility to infections, ochronosis, poor wound
healing, to nephrotic syndrome, chronic kidney
disease and malignancies
Epidemiology
Basic Anatomy
The epidermis is made up of different cells

Keratinocytes

Melanocytes

Immune cells
The keratinocytes are the most numerous

They are produced at the basal layer and migrate

upwards until they are shed off
The melanocytes are located at the basal epidermis

They send dendritric processes which interact with

the keratinocytes

They contain melanosomes, where melanin is formed

The melanin now travel through the dendritic

processes to the outer keratinocytes, giving the skin
its colour
The interaction between melanocytes and
keratinocytes is also important in the control of
melanogenesis
Melanin is mostly responsible for skin colour

Other factors influencing skin colour include

Skin thickness

Content of carotenoids in the skin

Amount of blood in blood vessels

Skin with little or no melanin is almost white

 Biochemistry of skin bleaching

Three types of melanin

 Eumelanin
 Pheomelanin
 Neuromelanin

Eumelanin is most common, and comes in black

and brown forms
Pheomelanin is a cysteine derivative containing
polybenzothiazine portions

It is largely responsible for the colour of red hair

The melanins are efficient light absorbers, and are

able to dissipate over 99.9% of absorbed UV light
Protects skin cells from UV-B damage

High Ultraviolet radiation stimulates melanogenesis

Small amounts of black eumelanin in the absence
of other pigments causes grey hair

Small amounts of brown eumelanin in the absence

of other pigments causes yellow/blond hair

As the body ages, it continues to produce black

eumelanin but stops producing brown eumelanin,
resulting in the grey hair typically seen in the elderly
 Bleaching Agents
1. Tyrosinase inhibitors
 Kojic acid, available as kojic clear soap and
cream
 Benzene 1,4-diol. Constituent of many skin
lightening soaps and creams. Banned in
european countries, but available in the USA
prescription. Animal studies have demonstrated
carcinogenic potential.
Exposure of bleached areas to UV light will result
in repigmentation due to upregulation of the
tyrosinase enzyme, possiby causing ochronosis

Should be used with a sunscreen

2. Competitive antagonist of enzyme cofactors

 Mercury salts, which serve as an antagonist of

copper, an essential cofactor for tyrosinase

Have been banned due to mercury poisoining,

including nephrotoxicity.

However, available in many developing countries