You look in the mirror and frown. You’ve been taking good care of your skin, but you still see dark spots, splotches, and patches that mar your appearance. This discoloration seems to stick with you no matter what you do, and you’re getting desperate.
Should you try one of those skin bleaching creams?
Here’s why that might not be a good idea, and what you can do instead to fade dark areas and feel better about your complexion.
What Is Hyperpigmentation?
Hyperpigmentation is a common condition in which certain areas of the skin become darker than the surrounding skin. The darkening occurs when melanin, which is the pigment in skin that produces its color, becomes too concentrated in certain areas.
There are many different types of hyperpigmentation, including the following:
- Age spots: Also called liver spots or sun spots, these are small darkened patches that form on the face and sometimes also the hands and other areas of the body. These are caused by long-term exposure to the sun’s damaging ultraviolet (UV) rays, such as that which occurs after years of being outside. These may be brown or gray and are usually bigger than freckles.
- Freckles: These are small, concentrated spots that typically occur in clusters and vary in color from brown to tan to red. Those people with fair complexions are most likely to have them. They are caused by the sun and tend to run in families.
- Melasma: This is a condition triggered by hormonal changes such as those that occur during pregnancy or when women take birth control pills. Thyroid dysfunction can also be a factor. It creates a mask-like appearance ― also called “pregnancy mask” or “butterfly mask” ― with larger, splotchy dark areas on the cheeks, nose, forehead and sometimes the upper lip. Because hormones are involved, treatment is more difficult as the condition affects the deeper layers of the skin. Sun exposure, stress and some medications can make the condition worse.
- Post-inflammatory hyperpigmentation (PIH): Traumas and injuries to the skin, such as acne, burns, friction or aggressive treatments, cause this type of hyperpigmentation. The skin responds to the injury by becoming inflamed and the dark area is left behind as it heals. These type of spots usually fade on their own with time.
All of these types of hyperpigmentation get worse with exposure to the sun. When UV rays reach the skin, they trigger the production of melanin, which is why you get a tan after sunbathing. In areas of hyperpigmentation where there is already too much melanin, sun exposure makes those areas darker and more pronounced.
Why Skin Bleaching Creams Aren’t the Safest Option
If you go out looking for a solution to your dark spots, you’re likely to come across several terms, including:
- Skin whitening
- Skin bleaching
- Skin lightening
- Skin brightening
In general, the first two are essentially the same and refer to a more drastic process of actually “whitening” the skin. It’s popular in other countries where whiter skin is prized and usually involves aggressive ingredients and treatments meant to block the production of melanin so that the entire surface of the skin becomes lighter or several shades “whiter.”
Skin lightening typically refers to a less aggressive but still serious approach to lightening dark areas of the skin while skin brightening is more about increasing glow and radiance. Whether the treatments are safe for your skin depends on the ingredients used. Below are those that have been linked with dangerous side effects.
This is the most popular skin whitening or lightening ingredient because it is effective. In the United States, it’s available up to a 2 percent concentration over-the-counter and at 4 percent or higher in prescription skin products.
When you apply hydroquinone to the skin, it blocks the action of an enzyme needed to make melanin. Over time, as there is less melanin for the skin to use, the dark areas fade. Results take time. Most users can tell the difference in about four weeks, but it can take up to 90 days.
When used over a short period, hydroquinone seems to be well tolerated by most people. The U.S. Food and Drug Administration (FDA) classifies it as safe at low concentrations. It can, however, cause side effects like irritation, dryness, itching, reddening and allergic contact dermatitis. For this reason, it’s typically not recommended for dry or sensitive skin.
When used for an extended period, hydroquinone has been linked with the development of a rare skin condition called “ochronosis,” particularly in African Americans. This disease causes a blue-black speckled and diffuse pigmentation over the face, neck and other areas exposed to the sun. In 2012, researchers reported on a 50-year-old woman who developed the disease after prolonged use of topical hydroquinone.
The problem is that it’s difficult not to use hydroquinone long-term. As long as you’re using it, you can keep the dark spots at bay. However, once you stop, the melanin resumes its production, and you can be back where you started.
There is also some concern that there could be a link between hydroquinone and cancer. Some animal studies have shown an association but, so far, there are no human studies suggesting an increase in any types of cancer in those using the product. Animal studies showed that the ingredient, when ingested (not applied topically), could induce benign growths of tissue in the kidneys. Laboratory studies have also shown that hydroquinone can cause cancerous changes in cells, particularly bone marrow cells, but this is when the ingredient was injected into the cells.
The International Agency for Research on Cancer (IARC) states that hydroquinone is not classifiable as to its carcinogenicity to humans because of a lack of evidence. We don’t know yet as we don’t have enough studies on the issue. That’s not exactly reassuring.
Finally, the ingredient can create what is called “halo spots,” as it lightens whatever skin it’s applied to. You may find that your dark spots fade, but you develop lighter skin around those spots too.
Because of these and other issues, hydroquinone is banned in Europe for over-the-counter formulations.
In 2011, the Minnesota Department of Health warned state residents to stop using some types of skin lightening products because they were found to contain dangerous levels of mercury.
The FDA also warned about the issue, alerting consumers to the fact that some skin creams and lotions could contain mercury. State officials discovered numerous products with the ingredient, and there were cases in which people exposed to those products developed mercury poisoning or elevated levels of mercury in their bodies.
Mercury is a powerful and effective whitening agent, but it’s also very dangerous. It can cause kidney and nerve damage, vision problems, muscle weakness and more, depending on the level of exposure and is particularly dangerous to children as it can harm developing brains.
To determine if your product contains mercury, look for ingredients like calomel, cinnabaris, hydrargyri oxydum rubrum, quicksilver, mercuric amidochloride, mercury oxide, mercurio or mercury salts. Products containing these ingredients are usually manufactured abroad and sold illegally in the U.S., often in shops catering to the Latino, Asian, African or Middle Eastern communities as well as online.
In 2011, researchers reported that skin lightening creams are promoted extensively online and in the media and that they can contain potentially toxic ingredients like hydroquinone, mercury, and steroids. They tested 33 different brands and found corticosteroids above safe limits in many of them. One type of steroid called cortisone was found above safe limits in 13 and another called dexamethasone was found above safe limits in three.
Steroids are used in skincare formulas to treat certain skin conditions like psoriasis, dermatitis, eczema, and rashes, mainly because these ingredients help tame inflammation. They are not recommended for long-term use, however, as they can cause health problems.
In a 2014 study entitled “Misuse of topical corticosteroids: A clinical study of adverse effects,” researchers found that women were using the steroids to lighten skin color and treat melasma. Negative effects included acne and a condition called “telangiectasia,” which causes threadlike red lines or patterns on the skin.
Although short-term use of these ingredients isn’t likely to cause serious issues, long-term use can result in “skin atrophy.” This causes thinner, more fragile skin, tenderness, increased photoaging and more visible blood vessels. Steroids can also increase the risk of acne, rosacea, perioral dermatitis (facial rash around the mouth), delayed wound healing and other issues.
Whitening or lightening creams with steroids in them typically claim to give “faster and better results,” and are typically imported from other countries and found in ethnic shops. In the U.S., only very low-potency topical steroids are available over the counter and are typically found in anti-itch and anti-inflammatory creams like Cortizone 10, not in lightening creams.
For Skin Lightening, Choose Safer Options
Fortunately, you can still help fade those dark spots by using safer ingredients from reputable brands. Some of the best lightening ingredients include:
- Arbutin: A natural derivative of hydroquinone found in plants like bearberry and blueberry, this ingredient can significantly lighten the skin without the dangers of hydroquinone.
- Ellagic acid: This natural substance comes from fruits like berries and pomegranates and helps inhibit the enzyme used for melanin production.
- Kojic acid: An antioxidant that comes from a fungus, it breaks down melanin in the skin and also prevents its production in the future.
- Licorice: These are derived from the licorice root and may help lighten skin. It also helps to inhibit the enzyme needed to produce melanin.
- Lignin peroxidase: It comes from a fungus found in wood pulp and helps break down melanin in the skin.
- Niacinamide: This is a form of vitamin B that inhibits the transfer of melanin cells into the skin’s upper layer. It helps to prevent additional pigment from coming to the surface of the skin.
- Vitamin C: This vitamin, when applied topically, increases cell turnover in the skin, getting rid of surface cells and allowing younger cells to rise to the top more quickly, which can help lighten darker areas as new skin comes into place.
- Retinol: A form of vitamin A, it helps to treat skin aging by stimulating the production of new cells, and it can also help to fade dark spots.
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AAD. (n.d.). Dermatologist shines light on natural ingredients used in new topical treatments for hyperpigmentation | American Academy of Dermatology. Retrieved from https://www.aad.org/media/news-releases/dermatologist-shines-light-on-natural-ingredients-used-in-new-topical-treatments-for-hyperpigmentation
Abraham, A., & Roga, G. (2014). Topical steroid-damaged skin. Indian Journal of Dermatology, 59(5), 456. doi:10.4103/0019-5154.139872
Al-Saleh, I., Elkhatib, R., Al-Rouqi, R., Al-Enazi, S., & Shinwari, N. (2012). The dangers of skin-lightening creams. Toxicological & Environmental Chemistry, 94(1), 195-219. doi:10.1080/02772248.2011.631925
AOCD. (n.d.). Hyperpigmentation – American Osteopathic College of Dermatology (AOCD). Retrieved from https://www.aocd.org/page/Hyperpigmentation
Dey, V. (2014). Misuse of topical corticosteroids: A clinical study of adverse effects. Indian Dermatology Online Journal, 5(4), 436. doi:10.4103/2229-5178.142486
FDA. (2016, July 26). Mercury Poisoning Linked to Skin Products. Retrieved from https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm294849.htm
Gandhi, V., Verma, P., & Naik, G. (2012). Exogenous ochronosis after prolonged use of topical hydroquinone (2%) in a 50-year-old Indian female. Indian Journal of Dermatology, 57(5), 394. doi:10.4103/0019-5154.100498
Maneli, M. H., Wiesner, L., Tinguely, C., Davids, L. M., Spengane, Z., Smith, P., … Khumalo, N. P. (2015). Combinations of potent topical steroids, mercury and hydroquinone are common in internationally manufactured skin-lightening products: a spectroscopic study. Clinical and Experimental Dermatology, 41(2), 196-201. doi:10.1111/ced.12720
McGregor, D. (2007). Hydroquinone: An Evaluation of the Human Risks from its Carcinogenic and Mutagenic Properties. Critical Reviews in Toxicology, 37(10), 887-914. doi:10.1080/10408440701638970
MDH. (2011). Skin Lightening Products Found to Contain Mercury. Retrieved from http://www.health.state.mn.us/topics/skin/