The cosmetic use of skin-lightening products during pregnancy in Dakar, Senegal: a common and potentially hazardous practice

Abstract

Many women of childbearing age from sub-Saharan Africa use topical skin lighteners, some of which present a risk of toxic systemic effects. The goals of this study were to evaluate, in this environment, the frequency of this practice during pregnancy, as well as eventual consequences on pregnancy. Ninety-nine women from 6 to 9 months pregnant were randomly selected among those attending a standard maternal centre in Dakar for a prenatal visit. Investigations consisted of questions about the use of skin lighteners, a standard clinical examination, follow-up until delivery and a morning blood sample for plasma cortisol levels. Sixty-eight of the 99 selected women used skin lighteners during their current pregnancy, the main active ingredients being hydroquinone and highly potent steroids (used by 64 and 28 women, respectively). No difference in the main outcomes of pregnancy were found between skin-lightener users and the others; however, women using highly potent steroids, when compared with those who did not, had a statistically significant lower plasma cortisol level and a smaller placenta, and presented a higher rate of low-birth-weight infants. Skin lightening is a common practice during pregnancy in Dakar, and the use of steroids may result in consequences in the mother and her child.

"The fairer the better?" Use of potentially toxic skin bleaching products.

“…Mahé et al, reports from Senegal that the cosmetic use of hydroquinone and corticosteroids were extensively prevalent among pregnant women and with negative impact on birth and placenta weights 3 . Skin bleaching is motivated by complex psychological, economic and social factors.…”

“…We encourage continued research into the multiple dimensions and implications of skin bleaching such as motivating factors for the use of these products, toxicity, sale, purchase and trade and identify effective alternative skin bleaching agents. Information on the potential adverse health effects is needed 29 , and studies of the health implications for infants, has to be carried out in a country where cosmetic skin bleaching is more commonly used than in Sweden 3 . As bleaching products are sold and used in Sweden, this knowledge is important to advocate for changes to the deeply-rooted and more insidious factors, such as racism, and to challenge widespread associations between fairer complexions, social status and beauty.…”

“…Such products can be prescribed to treat hyperpigmentation disorders 1 , but are more frequently used intentionally to lighten skin complexion. The regular and sustained use of skin bleaching products has been practiced in African and Asian contexts for decades, with prevalence estimates from 25% to 96% [2][3][4][5][6] . Skin bleaching continues to affect communities "of colour" disproportionately 6 , but has extended beyond the African and Asian continents [7][8][9][10][11] .…”

“…While effective in lightening skin colour, the products are also associated with health risks, such as dermatitis, impaired wound healing and adrenal suppression 12,16 . Mercury is associated with adverse neurological, psychological and renal effects and organic mercury compounds also have the ability to cross the placenta with toxic effects for the foetus 3,12,15,[16][17][18][19] .…”

Le refus du blanchiment de la peau, l’autre versant du xessal

“…C'est un fait bien connu que l'éclaircissement de la peauconstitue une pratique courante pendant la grossesse à Dakar, Sénégal et que l'utilisation de stéroïdes pendant cette période peut se traduire par des conséquence nocives pour la mère et son enfant. Dans une étude, Mahé, et al 8 ont observé que soixante huit des 99 femmes sélec-tionnées avaient utilisé des éclaircissants de la peau pendant leurs grossesses, les principaux agents actifs étant l'hydroquinone et des stéroïdes très puissants. Les effets indésirables constatés chez les femmes utilisant des corticostéroïdes étaient des niveaux plasmatiques de cortisol plus faibles et des placentas plus petits, avec des différenc-es statistiquement significatives (P < 0.05).…”