Introduction

The report is about the bleaching of the skin or the whitening of the skin which is used as a process for the cosmetic processes. This is an extremely important and sensitive situation where the individuals involved in the process of using the products are exposed to wide range of chemicals and substances that can be harsh to skin (Gbetoh and Amyot 2016). This is recognized globally as a problem because it impacts the health of the individual using the products. This is because the chemicals or substances used in the product might create the problem in the skin or even had the allergy.

This report is based on Mrs Jonnes who is not a fair skinned lady and at the age of 30 she had started realizing that the she should undergo certain skin or body treatment in order to get a fairer and white skin. These processes includes the use of skin whitening procedures or bleaching mechanisms that will reduce the color of the outer epidermal skin. These processes are sometimes painful and might result in the formation of allergies or skin rashes that might even be fatal (Amponsah, Sebiawu and Voegborlo 2014). The procedure taken by Mrs Jonnes included the use of certain lightening creams and the prolonged use of that cream resulted in the further pigmentation of the skin. The use of the creams also created certain kidney problems in the patient.

Background

Skin whitening or lightening is referred to as the process of using chemicals in a way to reduce the skin color or also to provide even color of the skin by the reduction of the melanin concentration in the skin (Zhang et al. 2014). There are a number of chemicals that are shown to be effective in the whitening of the skin and on the other hand there are chances that the substances tend to be toxic to the skin and the health of the individual. It is observed that in the African countries approximately 28 to 80% of the individuals use whitening creams while in Asia, the rate of using these creams is around 40% (Saraswat et al. 2011).

All the products that are used in the lightening of the skin are illegal but a number of such creams contain chemicals that are banned in a number of countries. These chemicals involve hydroquinone and mercury that can have a greater danger with the use for a longer period of time. These adverse effects include skin damage, liver damage, kidney damage as well as poisoning of the skin (Juturu, Bowman and Deshpande 2016). The misuse of the creams that contain corticosteroids are linked with the thinning of the skin and an increased chance of skin cancer. These effects can also be supported by the further darkening of the skin. This problem was faced by MrsJonnes after she used the lightening cream for a period of one year.

After one complete year she noticed that the color of her skin did not lighten at all but there was an increase in the pigmentation of the skin, formation of excess acne and the darkening of the face skin (Agorku et al. 2016). After the patient consulted the dermatologist she came to know the actual reason for the change in her skin. She also told that there were certain problem in the functioning of the kidney. The doctor consulted her to visit a nephrologist as well as asked her to stop the medications for skin lightening.  

Literature Review

The topical corticosteroids are one of the most commonly used drugs by the dermatologists. The medical and clinical effects of such medicines are mediated by the anti-inflammatory, anti-proliferative, vasoconstrictive and the properties for immunosuppression. As most of the potential topical corticosteroids are available frequently over the medicine counter at a lower price, it has led to the misuse of the medicine generating adverse effects among the larger population (Saraswat et al. 2011). It has been noted by the use of previous literature statistics that the people using the cream might be at a greater risk. It is also noted that there might be certain cases that are not even registered to the dermatologists.

There are intensive uses of the topical corticosteroids as a skin lightener because they have a strong bleaching action. They also have an anti-inflammatory activity that can lower the risk of dermatitis whenever, they are used with the other skin lightening creams that are irritating to the skin as well. However, the lightening of the skin color is the main use of such creams (Zhang et al. 2014). The adverse effect of the cream is associated to the potential of the topical corticosteroids. This includes the effect on the epidermis or the top layer of the skin as well as the dermis. This is usually affected by the systemic absorption of the cream to the skin layer.

Research has shown that the misuse or prolonged use of the creams with hydroquinone or corticosteroid can create several health issues like tinea incognito, perioral dermatitis, infantile gluteal granuloma and impetigo incognito have been identified. Along with this, bacterial infections, cellulitis, fungal infections, skin atrophy, acne and the skin pigmentation are also detected (Amponsah, Sebiawu and Voegborlo 2014). Currently a lot of research has been used that show that there is a rebound of erythema, scaling and burning sensation on the face of the individual who earlier used the cream and is now attempting for cessation.

The process of skin bleaching involves application of hydroquinone to certain parts of the body. This is dangerous as there is involvement of mercury and thus, it can lead to mercury poisoning. Mercury is a metal in the human body that is toxic and non-essential (Saraswat et al. 2011). Mercury is omnipresently dispersed in the setting, expressed in the natural products, as well as widely found in everyday items. There are three types of mercury,which includes elemental or metallic mercury, inorganic and organic mercury. Inorganic mercury substances are soluble in water after ingestion with a bioavailability of 7% to 15%; they are also irritants and cause symptoms of the gastrointestinal tract (Agorku et al. 2016).

Upon reaching the body, inorganic mercury compounds are stored mainly in the kidneys, causing damage to the kidneys. Human exposure to elemental mercury, on the other hand, is mainly by inhalation, accompanied by the rapid absorption and dissemination in all the major organs (Juturu, Bowman and Deshpande 2016). The brain and kidney are the primary target organs of elemental mercury. Elemental mercury is soluble in lipid and can penetrate the blood-brain barrier, while the inorganic mercury compounds are not soluble in lipid, making it impossible to cross the blood-brain barrier. Elemental mercury can also penetrate the brain through the olfactory pathway from the nasal cavity.

The highest inorganic mercury concentration is found in the kidney, which is a major inorganic mercury target organ (Amponsah, Sebiawu and Voegborlo 2014). Inorganic mercury salts are not soluble in lipid; therefore, they do not cross the blood-brain or blood-placenta barrier easily. Mainly in urine and feces are excreted inorganic mercury salts. The rate of excretion is biphasic as well as dependent on the dose, accompanied by a sluggish excretion later by an initial rapid period of excretion. The biological half-life is estimated at approximately 60 days (Peltzer, Pengpid and James 2016).

As antiseptics, inorganic mercury creams and ointments were used. Recently, however, cosmetic soaps and creams have been manufactured in several countries, including inorganic mercury compounds. Mercury and mercury salts such as ammonized mercury, mercury iodide, mercury chloride, mercury oxide, and mercury chloride were generally found in these products (Rice et al. 2014). Young women use skin lightening products and cosmetics to lighten their skin and anti-skin effects. Research has shown that inorganic mercury is one of the ingredients in the skin lightening creams.

Inorganic mercury is absorbed into the body by bringing mercury through the epidermis, as well as through sebaceous glands, sweat glands, and the hair follicles. The Mercury salts prevent the production of melanin by interacting in tyrosinase with copper contributing to skin lightening (Maneli et al. 2016). Research has shown that in US, there were around 317 women who had used a cream that are noted to have a self-reported prevalence of symptoms linked with the poisoning of mercury (Zhang et al. 2014). There were a number of other symptoms that included fatigue, irritability, nervousness, headache, loss of memory, insomnia, loss of limb strength, depression, tremors, burning sensation or high amount of mercury in the urine. Thus, it is important to stop the additional exposure of mercury in the cosmetic products. This can be done by the assessment of the products to find out the contamination of mercury, and also by educating the public about the effect of mercury on the health (Agrawal and Mazhar 2015).

In summary, while direct mercury poisoning is rare, due to the wide distribution and persistent pollution of mercury from natural and manmade sources, the risk to human health remains a major public concern. Currently, the health effects of mercury exposure in individuals are not entirely clear. As a preventive measure in public health, it is strongly recommended that the use of mercury products in industry and medicine be eliminated as completely as possible (Gbetoh and Amyot 2016).

Discussion

The mechanism for the skin lightening creams is that they reduce the concentration as well as the production of the melanin that is present in the skin. The skin lightening procedures can result in the adverse side effects and can result in the complication of the health of the individual exposed to the cream (Michalek et al. 2019). There is a high trend that the individuals with a darker skin tone tend to buy skin creams without any prescription. The individuals are not aware of the ingredients that are present in these creams. Especially hydroquinone, mercury or corticosteroid are generally not prescribed by the doctors as these are banned items as they are able to cause serious side effects (Matsumoto et al. 2014).

The cost of the lightening creams are also very high and thus, this is an additional burden on the health and the medical condition of the individual. There are populations of the individual who can fall prey to cancer just by the use of the creams (Askari et al. 2013). In the above case study, it was discussed that the patient started having skin rashes and kidney problems. This was due to the fact that the cream used by the patient had hydroquinone that removes the top skin layer. This makes the top layer of the skin exposed to the oil, dirt and dust that creates additional pollution to the skin (Elhag, Osman and Dahab 2015). This creates extra problem to the patient as she had sensitive skin and the pollution made the skin prone to acne and additional damage.

The patient also had a problem in the kidney function and that was also due to the skin cream was used by the patient. Along with this, the skin cream used by the patient also contained mercury that can cause great damage to the liver and the kidney of the patient. This might be the probable reason for the kidney problems faced by the patient (Dey 2014).

Recommendation

Apart from using the skin lightening creams that are found in the market the patient should use natural home-made recipe in order to make her skin look healthy and also to get a natural glow (Jha, Sinha and Prasad 2016). The dermatologist should also ensure that the patient receives proper prescribed medicine for the use in the skin. The doctor should also ask the patient to attend the motivational classes that will help the patient to accept her own skin and will also educate her on the greater harm of using such creams (Saraswat et al. 2011). The doctor should also advise her to take proper diet in order to correct her kidney problems.

Conclusion

Therefore, it can be concluded that the use of cream that are involved in skin whitening and lightening should be used after proper advice from the doctors. The individuals using the cream should consult the doctors about the ingredients and should check that whether the mentioned ingredients have any kind of allergy problems or not. This will help the individuals to decide whether the cream is suitable for use or not. The report also suggest that the individuals should always opt for healthy natural recipes for the skincare and that the education about the adverse effects of such creams is very necessary. If any person faces any kind of problem then they should visit the doctor immediately.

References

Agorku, E.S., Kwaansa-Ansah, E.E., Voegborlo, R.B., Amegbletor, P. and Opoku, F., 2016. Mercury and hydroquinone content of skin toning creams and cosmetic soaps, and the potential risks to the health of Ghanaian women. SpringerPlus, 5(1), p.319.

Agrawal, S.S. and Mazhar, M., 2015. Adulteration of mercury in skin whitening creams–A nephrotoxic agent. Current Medicine Research and Practice, 5(4), pp.172-175.

Amponsah, D., Sebiawu, G.E. and Voegborlo, R., 2014. Determination of amount of mercury in some selected skin-lightening creams sold in the Ghanaian market. International Journal of Engineering Research, 3(6).

Askari, H., Sajid, A., Faran, Z. and Sarwar, S.Z., 2013, February. Skin-lightening practice among women living in Lahore: prevalence, determinants, and user’s awareness. In 3rd International Conference on Business Management.

Dey, V.K., 2014. Misuse of topical corticosteroids: A clinical study of adverse effects. Indian dermatology online journal, 5(4), p.436.

Elhag, D.E., Osman, H.O. and Dahab, A.A., 2015. Investigation of mercury content in cosmetic products by using direct mercury analyzer. American Journal PharmTech Research, 5(5), pp.205-212.

Gbetoh, M.H. and Amyot, M., 2016. Mercury, hydroquinone and clobetasol propionate in skin lightening products in West Africa and Canada. Environmental research, 150, pp.403-410.

Jha, A.K., Sinha, R. and Prasad, S., 2016. Misuse of topical corticosteroids on the face: A cross-sectional study among dermatology outpatients. Indian dermatology online journal, 7(4), p.259.

Juturu, V., Bowman, J.P. and Deshpande, J., 2016. Overall skin tone and skin-lightening-improving effects with oral supplementation of lutein and zeaxanthin isomers: a double-blind, placebo-controlled clinical trial. Clinical, cosmetic and investigational dermatology, 9, p.325.

Maneli, M.H., Wiesner, L., Tinguely, C., Davids, L.M., Spengane, Z., Smith, P., Van Wyk, J.C., Jardine, A. and Khumalo, N.P., 2016. Combinations of potent topical steroids, mercury and hydroquinone are common in internationally manufactured skin‐lightening products: a spectroscopic study. Clinical and experimental dermatology, 41(2), pp.196-201.

Matsumoto, M., Masumori, S., Hirata-Koizumi, M., Ono, A., Honma, M., Yokoyama, K. and Hirose, A., 2014. Evaluation of in vivo mutagenicity of hydroquinone in Muta™ mice. Mutation Research/Genetic Toxicology and Environmental Mutagenesis, 775, pp.94-98.

Michalek, I.M., Benn, E.K., dos Santos, F.L.C., Gordon, S., Wen, C. and Liu, B., 2019. A systematic review of global legal regulations on the permissible level of heavy metals in cosmetics with particular emphasis on skin lightening products. Environmental research, 170, pp.187-193.

Peltzer, K., Pengpid, S. and James, C., 2016. The globalization of whitening: prevalence of skin lighteners (or bleachers) use and its social correlates among university students in 26 countries. International journal of dermatology, 55(2), pp.165-172.

Rice, K.M., Walker Jr, E.M., Wu, M., Gillette, C. and Blough, E.R., 2014. Environmental mercury and its toxic effects. Journal of preventive medicine and public health, 47(2), p.74.

Saraswat, A., Lahiri, K., Chatterjee, M., Barua, S., Coondoo, A., Mittal, A., Panda, S., Rajagopalan, M., Sharma, R., Abraham, A. and Verma, S.B., 2011. Topical corticosteroid abuse on the face: A prospective, multicenter study of dermatology outpatients. Indian Journal of Dermatology, Venereology, and Leprology, 77(2), p.160.

Zhang, L., Liu, F., Peng, Y., Sun, L. and Chen, C., 2014. Nephrotic syndrome of minimal change disease following exposure to mercury-containing skin-lightening cream. Annals of Saudi medicine, 34(3), pp.257-261.