Creams marketed to lighten skin tone are being sold illegally on British high streets, including in butchers and specialist food shops. It is an unsettling discovery, but perhaps not a surprising one. Demand for these products is real and the profits are significant. But the ingredients that make them effective are also what make them dangerous.
Healthy human skin comes in a wide range of diverse tones. These can change over time because of illness, hormones, sunlight or ageing. Some people want to lighten their overall skin tone, and “colourism” – discrimination or prejudice that favours lighter skin tones over darker ones – may contribute to psychological distress among people of colour. Others want to fade darker patches.
Acne, eczema and other inflammatory skin conditions can leave areas darker or lighter than the surrounding skin. This is known as hyperpigmentation (darkening) or hypopigmentation (lightening). Hormonal changes can also disrupt pigment, and scars can permanently alter skin colour.
Often, the skin will gradually return to its natural tone. But this can take months or even years. The desire to speed up that process has led to the development of chemicals that reduce or block melanin – the pigment that gives skin its colour.
Some of these chemicals have a powerful effect. Because of the risks, their sale is tightly controlled. Yet concern is growing about products sold in the UK that contain banned ingredients. These include mercury, hydroquinone and strong steroid drugs.
Mercury – sometimes called quicksilver – is a liquid metal once used in thermometers and in hat making. On the skin, it blocks an enzyme needed to produce melanin, which can make the skin appear lighter.
But mercury is highly toxic. It can damage the skin directly and be absorbed into the body, harming the kidneys, liver, lungs, nerves and brain.
Hydroquinone also reduces melanin production in the outer layer of the skin. In the UK it is available only on prescription and can be used to treat conditions such as melasma, a common form of facial pigmentation.
But it must be used carefully. It can irritate the skin and, in some cases, cause a long-term grey-blue discolouration known as ochronosis.
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Steroid creams are widely prescribed for inflammatory skin conditions. Stronger forms are available only on prescription because of well-known side-effects, including thinning of the skin and absorption into the bloodstream. There is also increasing concern about “topical steroid withdrawal”, a condition where the skin flares badly after stopping prolonged use of these creams.
Potent steroids can lighten skin quickly by narrowing blood vessels and, over time, by affecting the cells that produce pigment. They are sometimes added to skin-lightening products to reduce irritation from other ingredients. But long-term use can cause acne, stretch marks, diabetes and osteoporosis. In the UK, stronger corticosteroids are only available with a prescription.
The legal products
Not all skin-lightening products are illegal. Some cosmetics are designed to gently reduce dark spots. These may contain antioxidants such as vitamin C, which can reduce pigmentation, or niacinamide (a form of vitamin B3), which can help even out skin tone over time. Others contain retinoids – vitamin A-related compounds – including retinol and retinal. These can gradually improve pigmentation.
There are also prescription-only retinoids, such as tretinoin, which doctors use for acne and certain pigment problems. But all retinoids can irritate the skin. However, irritation itself can trigger further darkening, known as post-inflammatory hyperpigmentation. In other words, a product meant to lighten the skin can sometimes make patches darker.
Under UK law, cosmetic products must list the manufacturer or importer, provide an address and include a full ingredient list. If this information is missing, alarm bells should ring.
Enforcement action has been taken before, with retailers brought to justice. Still, illegal products continue to surface in places that seem safe and familiar.
If a cream promises dramatic lightening, especially at a low price, it is worth asking why. When it comes to skin, safer and slower is usually better than fast and risky. But the message is clear: colourism and unrealistic beauty standards that fuel demand for skin lightening products pose harm for all in our society.
Sara Brown currently receives funding from the Wellcome Trust, UKRI/MRC, British Skin Foundation, Rosetrees Trust, Stoneygates Trust and anonymous donations from people living with eczema. Sara is a medical adviser for Eczema Outreach Support and the Ichthyosis Support Group.
