“Healthy skin is a mirror of a healthy body” was one of the first things I was taught as a trainee dermatologist. In our society, however, having fair skin seems to be a much higher priority than having healthy skin. In fact, some of the measures people take to ensure such fairness often have some very unhealthy consequences. The reasons of this infatuation with fair skin, the emotional stress it puts on those with dark skin and the social and ethical issues with skin whitening treatments is a topic for another discussion at another time. For now I would like to share with you the problems and complications that can arise from skin whitening therapies.

The colour or complexion of human skin is mainly due to a pigment called melanin, produced by cells called melanocytes in the skin. Human skin color varies from darkest brown (type VI) to light pinkish white shades (type I). Most people in Pakistan have type III, IV or V skin tone. Various environmental, genetic and geographical factors play a role in the determination of skin colour.

It is true that many hyperpigmentary disorders of the skin are indications for seeking treatment but this blind quest for fairer skin is fraught with many pitfalls and dangers. The market for products promising gori skin is, both literally and metaphorically, a jungle. From topical applications having prices in double digits only, to imported and local gels, creams, serums, capsules and injections costing tens of thousands of rupees, there are options available for every budget. For companies, advertisers and even doctors who promise a miracle “cure” for dark skin, this is a golden opportunity for making a lot of quick bucks.

Fair skin isn’t important; healthy skin is

Firstly, let us address the home remedies that are easily available online, on television and also advised to us by our elders. The main problem with these remedies is that their preparation lacks any proper measurement of the chemicals being used. As an example, many of these use lemon juice as an essential ingredient. Lemons and other citric fruits can vary in the degree of sourness due to the amount of citric acid present in them. So a spoonful of lemon juice can contain significantly different amounts of citric acid which, when applied on the face, can also lead to variable and potentially harmful results. There is also the issue of different types of skin reacting differently to the same products / chemicals.

One such case was of a lady who used orange juice on her face, then rubbed it with an orange peel and, still unsatisfied with the results, then rubbed it with a rough towel. Needless to say, this was ill-advised as she developed cellulitis (severe infection penetrating to the deeper skin layers) on her face and required weeks of treatment and follow-ups.

Many of these products which are low cost and are advertised as rapidly acting, over the counter whitening creams, contain super potent corticosteroids and / or skin peeling agents. These products can initially cause photo sensitivity and photo chemical reaction on being exposed to the sun or heat. They are also known to cause contact dermatitis, which is a reaction of the body or skin’s immune system against the chemicals in these creams and which can cause swelling, redness, severe irritation and can even lead up to blisters and infection.

Another rather low cost but equally harmful product, frequently advised by beauty salons and barber shops as a one stop cure for all cosmetic problems from acne to melasma is a mixture of whitening agent, corticosteroid cream and peeling agent, all mixed with a “cold cream”. Even if this concoction initially gives the user their desired results it can lead to severe irritation, burning, thinning of the skin to a paper like texture and also hypersensitivity to sun, heat and chemicals. Hair growth is also a well established and troublesome side effect of this formula. These formulas also have an addictive effect on the skin. Skin looks fresh, fair and free of blemishes only till the formula is being used. With time the skin’s requirement for the formula increases and as the user tries to quit or reduce using it, the skin begins to itch, get darkened and develops acneiform eruptions.

The more high-end and expensive products are also not completely safe to use and can also cause adverse effects in susceptible individuals or with improper usage. Almost all medicines, regardless of efficacy, carry with them certain risks and possibilities of side effects. What suits one person’s skin won’t necessarily suit yours as well. If you develop irritation or redness from any topical application, immediately wash it off, discontinue its use and contact your doctor.

However, not all treatments for hyperpigmentation are essentially “fairness” oriented, many times lightening is required in cases of melasma, post inflammatory hyperpigmentation or in the cases of birth marks like Nevus of Ota etc. In these instances there is a recommendation for the treatment to be given since melasma and birth marks involving the face can lead to depression in the patients. Lasers are effective for treating certain types of birth marks and are a well established tool for dermatology treatments. With melasma their usage is still under review, especially in darker skin tones as they can cause rebound hyperpigmentation with the passage of time, but melasma can be effectively treated with topical medicines and adequate protection from sunlight.

The writer is a consultant dermatologist & cosmetologist

Twitter: @nav_derm

Email: dermadna@gmail.com

Published in Dawn, Sunday Magazine, August 23rd, 2015

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