title: Skin diseases associated with the cosmetic use of bleaching products in women from Dakar, Senegal.
abstract: BACKGROUND
  The cosmetic use of bleaching products is considered a common practice in dark-skinned women from sub-Saharan Africa. However, there are few studies on this subject.
  
  
  OBJECTIVE
  To increase the knowledge about the dermatological consequences of this practice in Dakar, the capital of Senegal.
  
  
  METHODS
  A representative sample of 368 adult women presenting at our dermatological centre was selected. Each woman was questioned about her cosmetic use of bleaching products. Next, the following data were recorded in 425 women who used bleaching products: names and types of products used; modalities of the skin bleaching practice; skin diseases motivating the dermatological visit, with recording of their clinical features; and results of a full skin examination. The active substances of the bleaching products were determined mainly by reading the indications on their packages; with products of unknown composition, a pharmacological analysis of samples was done. A statistical analysis was performed.
  
  
  RESULTS
  Of the 368 women questioned, 194 (52.7%) were current users of bleaching products. Concerning the 425 users enrolled, products were applied on the whole body in 92% of users, with a median duration of use of 4 years. The active principles used included hydroquinone (used by 89% of users), glucocorticoids (70%), mercury iodide (10%) and caustic agents (17%); 13% of users used products of unknown composition. In the samples that were analysed, hydroquinone was found at concentrations of between 4% and 8.7%. Concerning steroids, superpotent (class 1) glucocorticoids predominated. The main skin complaints in bleaching products users included dermatophyte infections (n = 105) and scabies (n = 69), both often unusually extensive and severe; acne (n = 42), often severe; eczema (n = 41); irritant dermatitis (n = 14); and dyschromia (n = 26, including 14 cases of exogenous ochronosis). The skin examination noted features apparently disregarded by users: striae (noticed in 39% of users), and macular hyperchromia involving the face, mainly the periocular area (33%). The statistical analysis showed that glucocorticoid use was associated with the presence and severity of infectious skin diseases, and of acne.
  
  
  CONCLUSIONS
  More than half of the adult women presenting at our dermatology centre were using bleaching products. Most skin diseases observed in bleaching products users appeared to be induced, aggravated or modified by this practice. Superpotent topical glucocorticoids appeared to be the main agents responsible for the observed complications. The cosmetic use of bleaching products therefore has a major impact on our current dermatological practice.
authors.affiliation: Department of Dermatology, Institut d'Hygiène Sociale, Dakar, Senegal. mahe@refer.sn
authors.forename: A
authors.initials: A
authors.lastname: Mahé
authors.forename: F
authors.initials: F
authors.lastname: Ly
authors.forename: G
authors.initials: G
authors.lastname: Aymard
authors.forename: J M
authors.initials: JM
authors.lastname: Dangou
mesh_terms: D000152:Acne Vulgaris / Q000139:chemically induced; D000293:Adolescent; D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000008:administration & dosage / Q000009:adverse effects; D002424:Caustics / Q000008:administration & dosage / Q000009:adverse effects; D003358:Cosmetics / Q000008:administration & dosage / Q000009:adverse effects* / Q000737:chemistry; D003877:Dermatitis, Contact / Q000209:etiology; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000737:chemistry; D003881:Dermatomycoses / Q000139:chemically induced; D004485:Eczema / Q000139:chemically induced; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006873:Hydroquinones / Q000008:administration & dosage / Q000009:adverse effects; D017669:Mercury Compounds / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D010859:Pigmentation Disorders / Q000139:chemically induced; D012532:Scabies / Q000139:chemically induced; D012675:Senegal; D012871:Skin Diseases / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000975:Antioxidants; D002424:Caustics; D003358:Cosmetics; D003879:Dermatologic Agents; D005938:Glucocorticoids; D006873:Hydroquinones; D017669:Mercury Compounds; C031927:hydroquinone