Non-FDA approved skin fair creams could be hazardous
Eminent Author, Medical Biochemist and Scientist, Technical Education consultant.
AGD Biomedicals (Pvt) LTD. Andheri East, Mumbai.
Use of fairness cream for improving fairness of skin has become a part of the daily routine of many individuals. Salon and beauty parlour visits by customers have doubled over the past decade, despite the high prices charged by them (Ref. Q2). The main risk associated with these products is the content of mercury, hydroquinone, and clobetasol propionate (Ref. Q2) According to several latest research-findings, reports and surveys from India and all over the world, a series of cases suffering from severe kidney disease have been linked with long-term use of fairness creams, that contained very high levels of mercury (Refer Case study). Latest-devised IVD Body profile tests advised by the family physicians; could be useful to diagnose long-term skin-fair cream use related early stage of kidney disease and timely treatment (Ref. Q3).
Case study
ANS: An 18-year-old girl was admitted to a Municipal corporation hospital in Mumbai (April 2024); with edema on face and feet, lethargy, headache and generalized weakness. Her blood pressure was 165/105. On examination, from the case history it was found out that she was using skin-fair cream provided by a private beauty parlour for past eight months. Random urine examination showed the presence of proteins (+++). Her other laboratory test reports indicated; very low glomerular filtration rate (iGFR), very high serum urea and creatinine, and very low serum total proteins and albumin. On examination, from the case history, it was found out that she and her mother were using skin-fair cream provided by a private beauty parlour. After a week, her 45-year-old mother was also admitted in the same hospital with symptoms and laboratory findings indicating kidney disease.
Q1. What are the observations of latest surveys on the increased use of skin-fairness creams?
ANS: According to a latest survey (2014-2024), 20% of men and 22% of women aged 18-34, had a facial at a salon. A recent World Health Organization report (WHO), indicate, half of the population in Korea, Malaysia, and the Philippines uses some kind of skin-lightening treatment. Use of skin-fair cream is even higher in India (60%) and African countries, such as Nigeria (77%). In a survey, 28% of Koreans and 50% of Philippians say that they use skin whitening products. Use of skin-lightening creams is also significantly high in US and European countries.
Q2. Which ingredients in the skin-fair cream are responsible for fairness of skin? And what type of risk is associated with their continued use?
ANS: The main risk associated with these products is the content of mercury, hydroquinone, and clobetasol propionate. Melanocytes present in the skin are responsible for the production of melanin which makes skin dark. Mercury and hydroquinone are added in the skin-fair creams, that significantly inhibit melanocytes and decrease melanin production and skin looks fair. Acceptable range of mercury in blood is less than 20 micrograms per liter of blood. Toxic blood level of mercury is more than 150 micrograms per liter of blood. Concentration higher than the acceptable range could be harmful to the kidneys. Hazardous skin lightening products that are not in line with cosmetics legislation (non-FDA approved) are available on the world market. Home-based cream makers often knowingly use very high levels of mercury and hydroquinone, often more than 100 times the acceptable range.
Q3. What are the latest innovations in IVD that enabled total body profile tests to include blood and urine levels of mercury and other harmful ions?
ANS: A 21st century new analytical methodology liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) has been used by the latest automated clinical chemistry analyzers, which could determine microgram quantities of mercury and other harmful heavy metals and report could be available in a day. Several super-specialized clinical laboratories offer complete body profile test package, which include blood and urine mercury tests and also kidney functions tests such as serum urea, creatinine, uric acid, iGFR, serum total proteins, albumin, globulins with routine urine examination. It is suggested to regular salon and beauty parlour visitors to undergo complete body profile tests, twice a year as per the advice by their respective physicians.
References
(1) Lihua Zhang, Mengru Du, Yuanmao Tu, Dandan Liang, Xiaomei Wu, Honglang Xie. Clinicopathological features and long-term prognosis of glomerular diseases associated with mercury-containing cosmetics. J Nephrol (2023), Jun;36(5):1401-1407.
(2) “NYC Health Dept. Warns Against Use of ‘Skin-lightening’ Creams Containing Mercury or Similar Products Which Do Not List Ingredients”. January 27 (2005). Archived from the original on May 24, 2007.
(3) Counter SA, Buchanan LH (2004). “Mercury exposure in children: a review”. Toxicology and Applied Pharmacology. 198 (2): 209–230.
(4) Mahaffey KR (2005). “Exposure to Mercury in the Americas”. Dynamics of Mercury Pollution on Regional and Global Scales. Springer. pp. 345–384.
