Dr Ebitsam Elghblawi discusses the dangers of using over-the-counter products to treat pigmentary issues without consulting a dermatologist.

Skin is the most voluminous structure of the body, and one of the most researched aspects in the cosmetic business. It is not only presupposes a physiological duty, but embodies a ‘social interface’ among the individual and others. There is a growing interest both from the doctors as well as patients to seek resolutions towards maintaining and attaining perfect skin.

In some countries, in order to reach this goal, skin-lightening cosmetics are widely used, including Libya, where the concept of having a fair skin complexion has become to be considered trendy and desirable. Libyan women tend in the summer time to keep away from the sun and deprive their skin of the magical benefits of the sun and vitamin D synthesis.

Such patients have likely tried everything, both at home and also in other clinics – and on occasion spending what amounts to a fortune on products and treatments that have little or no effect at all.

The dangers

Hyperpigmentation disorders and skin lightening treatments have a significant impact on the dermatological, physiological, psychological, economic, social, and cultural aspects of life. Raising patient awareness is vital to avoid such irreversible complications.

The active ingredients in these cosmetic products are mainly hydroquinone, mercury and corticosteroids in higher concentrations. Several additives are used to enhance the bleaching achievement. Nowadays glutathione has surfaced as antioxidant, despite the warnings.

I have personally observed high demands of lightening agents and the self-administration of super potent steroids, which is striking with huge irreversible drawbacks. What is more, such products are easily accessible through pharmacies without a physician prescription. Patients are only motivated to visit a doctor when complications occur.

Since most of these products are used mostly for longer period, on a large body surface area, and under hot moist circumstances, the per-cutaneous absorption is boosted. Thus the complications of these products are very detrimental and are sometimes can be deadly.

The misuse of over-the-counter cosmetic and bleaching agents must be restricted and there should be some legislation directed at pharmacies to not sell such products without a prescription, and to encourage consultation with a dermatologist beforehand. Usually patients in Libya attain such topical products by unregulated bodies including pharmacies.

Such patients usually presented particularly complex medical problems, where they are desperate for a solution and willing to pay anything.

Nowadays, some people access unscrupulous supplies via the Internet to avoid the costs of professional consultation. Many women, including Libyan women, have access to social media, where marketers promote their business themselves without any regulation and legislation. They just post advertisements and ask clients to contact them about the price and delivery. This marketing model is effective, and many women buy them without any prior consultation.

However, self-administration is dangerous and fraught, not least due to the lack of information about the product’s name, exact formulations and safety, which is neither provided nor approved by the regulatory bodies.

What can we do?

In dermatology communities, a discussion on the safety of bleaching agents including hydroquinone should offer an occasion to raise consciousness and understanding about skin bleaching risks and mandate careful consideration and selection.

We need to educate people with pigmentary problems to request early dermatological consultation for their dermatoses, rather than to self-medicate with over-the-counter or illegally obtained cutaneous depigmenting bleaches. This will help to avoid complications, which can potentially impact the patients on sociological and psychological levels.

There is a need for appropriate public health prevention campaigns to raise awareness to combat illegal trafficking of lightening products.

There is a need for rigorous scientific studies, especially in Arab world where such studies remain scarce, to critically evaluate the burden and adverse health effects associated with skin lightening.