title: Combinations of potent topical steroids, mercury and hydroquinone are common in internationally manufactured skin-lightening products: a spectroscopic study.
abstract: BACKGROUND
  The topical steroids betamethasone (BM) and clobetasol propionate (CP) are illegal in cosmetics. Hydroquinone (HQ) and mercury (Hg) are either illegal or allowed only in limited concentrations (2% and 1 ppm, respectively).
  
  
  OBJECTIVE
  To investigate active ingredients and countries of origin of popular skin-lightening products available in Cape Town, South Africa.
  
  
  METHODS
  In total, 29 products were examined; of these, 22 products were purchased from informal vendors, and 2 products (out of a total of 29) were purchased over the counter. HQ, Hg(2+) and steroids were quantified by high-performance liquid chromatography-ultraviolet spectrophotometry, inductively coupled plasma-mass spectrometry and liquid chromatography-mass spectrometry, respectively.
  
  
  RESULTS
  Of the 29 products, 22 (75.9%), all imported and bought from informal vendors, contained illegal or banned ingredients: 13 (44.8%) contained steroids (9 CP, 4 BM), 12 (41.4%) contained Hg (30-2300 ppm), and 11 (37.9%) contained HQ. Sequentially, the products originated from Italy (27.3%, n = 6), India (22.7%, n = 5), the Democratic Republic of Congo (DRC) (22.7%, n = 5), Cote d'Ivoire (9.1%, n = 2), USA (9.1%, n = 2), UK (4.5%, n = 1) and France (4.5%, n = 1). Two products, one from India and one from the DRC, contained all four ingredients (HQ, Hg, BM, CP). Of the 12 products containing Hg, 10 also contained HQ and/or a steroid, yet none listed Hg as an ingredient. A significant proportion of the steroid-containing products (76.9%) also contained at least one other skin-lightening agent. Not all internationally available products were tested, which is a limitation of the study.
  
  
  CONCLUSIONS
  In spite of a European Union ban on skin lighteners, a third of the products tested were from Europe. Combinations of Hg and ultrapotent steroids were prominent. International law enforcement and random testing is needed to encourage industry compliance and help protect consumers.
authors.affiliation: Division of Dermatology, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: M H
authors.initials: MH
authors.lastname: Maneli
authors.affiliation: Division of Clinical Pharmacology, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Wiesner
authors.affiliation: Department of Geological Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Tinguely
authors.affiliation: Department of Human Biology, University of Cape Town, Cape Town, South Africa.
authors.forename: L M
authors.initials: LM
authors.lastname: Davids
authors.affiliation: Division of Dermatology, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: Z
authors.initials: Z
authors.lastname: Spengane
authors.affiliation: Division of Clinical Pharmacology, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: P
authors.initials: P
authors.lastname: Smith
authors.affiliation: Division of Dermatology, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: J C
authors.initials: JC
authors.lastname: van Wyk
authors.affiliation: Department of Chemistry, University of Cape Town, Cape Town, South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Jardine
authors.affiliation: Division of Dermatology, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: N P
authors.initials: NP
authors.lastname: Khumalo
mesh_terms: D001623:Betamethasone / Q000032:analysis; D002851:Chromatography, High Pressure Liquid; D002990:Clobetasol / Q000032:analysis; D006873:Hydroquinones / Q000032:analysis*; D013058:Mass Spectrometry; D008628:Mercury / Q000032:analysis*; D011753:Pyrones / Q000032:analysis; D062327:Skin Lightening Preparations / Q000737:chemistry*; D013019:South Africa; D013056:Spectrophotometry, Ultraviolet; D013256:Steroids / Q000032:analysis*
chemical_list: D006873:Hydroquinones; D011753:Pyrones; D062327:Skin Lightening Preparations; D013256:Steroids; C011890:kojic acid; D001623:Betamethasone; D002990:Clobetasol; D008628:Mercury; C031927:hydroquinone