Background: Skin-lightening products are increasingly common in European cities. These products may contain substances that are banned under EU regulations as they can induce adverse effects, including cutaneous and systemic reactions (e.g., mercury, hydroquinone and topical corticosteroids). Objectives: To assess the knowledge, attitudes and practices of women regarding skin-lightening products and to quantify the potentially harmful substances in the products used. Methods: We performed a cross-sectional study among 82 non-Italian women visiting an outpatient facility in Rome, Italy. The women completed a questionnaire on product use, side effects and risk awareness. We performed patch tests among a subgroup of 48 women who presented with contact dermatitis. We also quantified the allergenic and toxic substances in the 14 products reported, using dynamic reaction cell inductively coupled plasma mass spectrometry for metals and high-performance liquid chromatography for hydroquinone and topical corticosteroids. Results: Out of the 82 women, 33 used skin-lightening products; about one fourth of these women were aware of potential risks. Three cosmetic creams and two soaps contained high concentrations of metals (Cr, Ni and Pb); hydroquinone was found in three creams and one oil. The only topical corticosteroid detected was dexamethasone, in one product. More than half of the women in the clinical evaluation had irritant contact dermatitis (i.e., negative response to patch test). Conclusions: Among immigrant women in Rome, the use of skin-lightening products seems to be fairly common, and some of these products contain potentially hazardous substances. Consumers must be informed of the potential risks, and EU regulations must be more strictly enforced.

Ladizinski B, Mistry N, Kundu RV: Widespread use of toxic skin lightening compounds: medical and psychosocial aspects. Dermatol Clin 2011;29:111-123.
de Souza MM: The concept of skin bleaching in Africa and its devastating health implications. Clin Dermatol 2008;26:27-29.
Lin CH, Sheu JY, Wu HL, Huang YL: Determination of hydroquinone in cosmetic emulsion using microdialysis sampling coupled with high-performance liquid chromatography. J Pharm Biomed Anal 2005;38:414-419.
Petit A, Cohen-Ludmann C, Clevenbergh P, Bergmann JF, Dubertret L: Skin lightening and its complications among African people living in Paris. J Am Acad Dermatol 2006;55:873-878.
Topping DC, Bernard LG, O'Donoghue JL, English JC: Hydroquinone: acute and subchronic toxicity studies with emphasis on neurobehavioral and nephrotoxic effects. Food Chem Toxicol 2007;45:70-78.
Mahé A, Perret JL, Ly F, Fall F, Rault JP, Dumont A: The cosmetic use of skin-lightening products during pregnancy in Dakar, Senegal: a common and potentially hazardous practice. Trans R Soc Trop Med Hyg 2007;101:183-187.
AlGhamdi KM: The use of topical bleaching agents among women: a cross-sectional study of knowledge, attitude and practices. J Eur Acad Dermatol 2010;24:1214-1219.
Regulation (EC) No 1223/2009 of the European Parliament and of the Council of 30 November 2009 on cosmetic products.
Council Directive of 27 July 1976 on the approximation of the laws of the Member States relating to cosmetic products (76/768/EEC).
Regulation (EC) No 1272/2008 of the European Parliament and of the Council of 16 December 2008 on classification, labeling and packaging of substances and mixtures, amending and repealing Directives 67/548/EEC and 1999/45/EC, and amending Regulation (EC) No 1907/2006.
Wilkinson DS, Fregert S, Magnusson B: Terminology of contact dermatitis. Acta Derm Venereol 1970;50:287-292.
Gagliardi L, Amato A, Cavazzuti G, Chimenti F, Bolasco A, Tonelli D: Identification and quantification of hydroquinone and some of its ethers in cosmetic products by reversed-phase high-performance liquid chromatography. J Chromatogr 1987;404:267-272.
Gagliardi L, De Orsi D, Del Giudice MR, Gatta F, Porrà R, Chimenti P, Tonelli D: Development of a tandem thin-layer chromatography-high-performance liquid chromatography method for the identification and determination of corticosteroids in cosmetic products. Anal Chim Acta 2002;457:187-198.
Harada M, Nakachi S, Tasaka K, Sakashita S, Muta K, Yanagida K, Doi R, Kizaki T, Ohno H: Wide use of skin-lightening soap may cause mercury poisoning in Kenya. Sci Total Environ 2001;269:183-187.
Peregrino CP, Moreno MV, Miranda SV, Rubio AD, Leal LO: Mercury levels in locally manufactured Mexican skin-lightening creams. Int J Environ Res Public Health 2011;8:2516-2523.
Gao W, Legido-Quigley C: Fast and sensitive high performance liquid chromatography analysis of cosmetic creams for hydroquinone, phenol and six preservatives. J Chromatogr A 2011;1218:4307-4311.
López García P, Rocha Miritello Santoro MI, Kedor-Hackmann ER, Kumar Singh A: Development and validation of a HPLC and a UV derivative spectrophotometric methods for determination of hydroquinone in gel and cream preparations. J Pharm Biomed Anal 2005;39:764-768.
Panusa A, Ottaviani M, Picardo M, Camera E, Gagliardi L, Chimenti P, Granese A, Tonelli D: Analysis of corticosteroids by high performance liquid chromatography-electrospray mass spectrometry. Analyst 2004;129:719-723.
Momtaz S, Mapunya BM, Houghton PJ, Edgerly C, Hussein A, Naidoo S, Lall N: Tyrosinase inhibition by extracts and constituents of Sideroxylon inerme L. stem bark, used in South Africa for skin lightening. J Ethnopharmacol 2008;119:507-512.
Gaudiano MC, Lucente D, Antoniella E, Bertocchi P, Muleri N, Manna L, Bartolomei M, Alimonti S, Valvo L, Rodomonte AL: ‘For export only' medicines come back to Europe: A RP-LC method for the screening of six glucocorticoids in illegal and counterfeit anti-inflammatory and lightening creams. J Pharm Biomed Anal 2010;53:158-164.
Pellegrini M, Marchei E, Pacifici R, Rotolo MC, Pichini S: Advances in the analysis of non-allowed pharmacologically active substances in cosmetic products. J Pharm Biomed Anal 2011;55:842-847.
Balaguer A, Salvador A, Chisvert A: A rapid and reliable size-exclusion chromatographic method for determination of kojic dipalmitate in skin-whitening cosmetic products. Talanta 2008;75:407-411.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.