FAIRNESS CREAMS AND GLAUCOMA RISK

 

DR. JUWAIRIYA ILYAS

P.G. SCHOLAR, DEPARTMENT OF DERMATOLOGY,

NATIONAL INSTITUTE OF UNANI MEDICINE,

BENGULURU, INDIA

Skin lightening (SL) creams are currently big business world-wide. The advent of social media has brought physical beauty in increased focus, leading to increased usage of products (usually bought over-the-counter) to lighten the skin color. This artificial modification of the appearance is leading to increased usage of cosmetic products. Studies have shown that SL creams are used by 75% women in Nigeria, 60% in Senegal, 30% in Ghana, and 40% in South Korea.

61% of the skincare market in India consists of SL products. A study found 60% people using SL agents at least once in North India, and a similar number are reported from Malaysia. Similarly, 43.3% of Saudi women, and more than 60% of Jordanians reportedly use SL products. Dr. Mônica Manela-Azulay, Assistant Professor of Dermatology at the Santa Casa de Misericórdia of Rio de Janeiro, Brazil, mentioned that approximately 50% of all patients presenting to the clinic request topical treatments or procedures to lighten the skin.

In most cases patients are unaware that these products contain harmful substances such as steroids which can cause serious side-effects such as intractable glaucoma. [1, 2, 3]

Pollock et al. have performed a large International collaborative study and review of  a public health issue involving SL products. The objective of the study was to promote healthy skin and inclusive concepts of beauty in patients and society. According to the authors the risk of adverse reactions is increased when these products are used for prolonged periods of time or under occlusion. In some countries women smear creams on their bodies and wrap in dressings underneath their clothing. Individuals also may cover their skin with tight compression materials after applying creams or bathe in mixtures containing a combination of steroid agents, hydroquinone, bleach, and hydrogen peroxide. These individuals are at risk of local side effects on the skin, and also due to systemic absorption, which includes glaucoma.[4]

Dr. Neha Gupta from the famous L. V. Prasad Eye Institute in India has reported three cases of intractable glaucoma following use of fairness creams. The first case was a 19-year-old girl who reported using Pearly white skin whitening cream for 4–5 months prior to diagnosis of advanced open-angle glaucoma in both eyes. She had baseline intraocular pressures (IOP) 48- and 40-mm Hg in her right- and left-eye, respectively. As the pressures were uncontrolled with medical therapy, she underwent trabeculectomy in both eyes. The second case was a 21-year-old male who’s IOP was 42 mmHg in both eyes on presentation. He reported using Faiza skin whitening cream for 2 years. Subsequently, IOP was controlled medically. The third patient was a 29-year-old male patient who was using Pearly white (skin whitening) cream for 4 years. He underwent trabeculectomy in the left eye due to uncontrolled IOP.[5]

A Nigerian ophthalmologist, Dr Tarela Sarimiye, has been quoted as saying that indiscriminate and prolonged use of medications that contain steroids, including skin lightening creams, can affect the eyes, leading to glaucoma, the second leading cause of blindness in Nigeria.[6]

Use of steroid or bleaching creams by humans for beautification has been cited as one of the main causes of glaucoma in humans, Member of Parliament (MP) for Offinso North in the Ashanti region of Ghana, and ranking member on the Health Committee of Parliament, Collins Augustine Ntim, has stated. [7]

These reports and studies demonstrate the dark side of skin whitening or fairness creams and the necessity to regularly monitor individuals using them for glaucoma.

REFERENCES:

1. Jose, A., Ray, J. G., & Schumacher, U. (2018). Toxic content of certain commercially available fairness creams in Indian market. Cogent Medicine, 5(1). https://doi.org/10.1080/2331205X.2018.1433104.
2. Yusuf MA, Mahmoud ND, Rirash FR, Stoff BK, Liu Y, McMichael JR. Skin lightening practices, beliefs, and self-reported adverse effects among female health science students in Borama, Somaliland: A cross-sectional survey. Int J Womens Dermatol. 2019 Aug 23;5(5):349-355. doi: 10.1016/j.ijwd.2019.08.006. PMID: 31909156; PMCID: PMC6938842.
3. JC Street, K Gaska, KM Lewis, ML Wilson. Skin bleaching: A neglected form of injury and threat to global skin.  African Safety Promotion Journal, Vol. 12, No. 1, 2014
4. Pollock S, Taylor S, Oyerinde O, Nurmohamed S, Dlova N, Sarkar R, Galadari H, Manela-Azulay M, Chung HS, Handog E, Kourosh AS. The dark side of skin lightening: An international collaboration and review of a public health issue affecting dermatology. Int J Womens Dermatol. 2020 Sep 17;7(2):158-164. doi: 10.1016/j.ijwd.2020.09.006. PMID: 33937483; PMCID: PMC8072511.
5. Gupta, Neha; Senthil, Sirisha. Intractable steroid-induced glaucoma due to skin whitening creams. Indian Journal of Ophthalmology - Case Reports 1(4):p 660-661, Oct–Dec 2021. | DOI: 10.4103/ijo.IJO_3757_20
6. https://tribuneonlineng.com/skin-lightening-creams-linked-with-glaucoma/
7. https://www.peacefmonline.com/pages/local/social/201403/192575.php