Thousands of women risk developing cancer from skin-lightening products – freely available on the informal market, despite being regulated – according to a study collaboration between a South African university and a Senegalese one, which highlights a new danger from the use of the products.
Head of the University of KwaZulu-Natal (UKZN) Dermatology department Professor Ncoza Dlova said the study they are writing up points to more than 50 cases of squamous cell carcinoma, a skin cancer commonly seen in white people and those with albinism, which is believed to be a result of the use of skin-lightening products that contain a combination of hydroquinone, mercury and corticosteroids.
News24 reports that the research raises a warning for South African consumers, with local dermatologists saying they see various damaging side effects in people using the creams.
Dermatologist Dr Suretha Kannenberg, from Stellenbosch University’s Division of Dermatology, said the products remove the skin’s natural protection provided by pigmentation.
“The pigmentation sits inside the cell and forms a little umbrella over the nucleus, which contains the chromosomes. But if we don’t have that little umbrella, the sun can get to the chromosomes and cause abnormalities. And that’s when you get skin cancers,” she said.
While many ingredients in the products, such as hydroquinone, are used by dermatologists to treat various skin conditions, they must be administered in small doses and under medical supervision, Kannenberg added.
“In very high doses, there is the potential for cancer. One of the other ingredients we find in some skin-lightening products is mercury, which can be neurotoxic,” she said.
She said cancer was not the only complication from the products.
Ochronosis
“We have seen steroid rosacea and burns. Some people develop a type of ochronosis where their skin goes completely black and you can’t get rid of it at all.”
Dlova’s research has revealed that of the black and Indian South Africans who use skin-lightening products, a third are using them to lighten their skin, while the rest use them to treat dermatological conditions like post-inflammatory hyperpigmentation (PIH), melasma, and acne.
Around 30% of her patients request skin-lightening treatments, “purely for the desire to appear lighter”.
Skin-lightening has been a common practice in Africa for 70 years. Researchers estimate that up to 75% of women in Nigeria, 60% in Senegal, 50% in Mali, and 30% in Ghana use the creams regularly.
South Africa has a lower rate of use than other African countries, probably due to the anti-skin-lightening messages broadcast on television for decades and regulations preventing the sale of products containing harmful ingredients.
Dlova said the first case of ochronosis, which is a permanent darkening and irreversible damage to the skin caused by hydroquinone, was reported in SA in 1975, leading to the country becoming among the first to regulate the products and ban the use of hydroquinone in cosmetic and over-the-counter products.
Rwanda, Côte d’Ivoire, Tanzania, Kenya and Ghana have since introduced stricter regulations.
“However, if the rules are not enforced, if there’s no rigorous oversight, our borders will continue to be porous and flooded with illegal creams from other countries, in addition to the locally available banned products. Patients buy these products from street vendors, markets, and spice shops,” Dlova said.
“In fact, one of the street vendors told us she gets the products from the pharmacist and sells them for a commission. Many patients buy the corticosteroid-containing creams without even seeing a doctor, so we know there are unscrupulous and unethical healthcare physicians out there.”
Global warning
The International League of Dermatological Societies has issued an alert about the dangers of misuse and called for better regulations. Dlova, who leads this global committee, pointed out that cancer cases recorded in Senegal are due to the use of hydroquinone, mercury and corticosteroids, with longer-term use of around 20 years.
The National Cancer Registry’s (NCR) Dr Judith Mwansa-Kambafwile said that data from the pathology-based cancer registry showed that around one in every 100 000 black women will be diagnosed with melanoma skin cancer in South Africa, but that this was lower than the overall rate for all South African women (three out of every 100 000), and significantly lower than that of white women (19 out of every 100 000).
“The low figure for black females might be due to less access to diagnostic services or lack of health-seeking behaviour and, therefore, late presentation,” added Mwansa-Kambafwile.
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