Skin Toning can cause hypertension and more

Creams Offering Lighter Skin May Bring Risks

For years, Allison Ross rubbed in skin-lightening creams with names like Hyprogel and Fair & White. She said she wanted to even out and brighten the tone of her face, neck and hands. Mrs. Ross, 45, who lives in Brooklyn, also said that she used the lightening creams “to be more accepted in society.”

Tim Sharp/Associated Press (left); Eric Jamison/Associated Press

Sammy Sosa, the former baseball slugger, in 2007, left, and 2009. He said a cream to “soften” his skin had bleached it, too.

Yana Paskova for The New York Times

Allison Ross used creams for years to lighten her skin. She developed several severe side effects.

After months of twice-a-day applications, her skin was not only fairer, it had become so thin that a touch would bruise her face. Her capillaries became visible, and she developed stubborn acne. A doctor told her that all three were side effects of prescription-strength steroids in some of the creams, which she had bought over the counter in beauty supply stores.
“I never read the labels,” Mrs. Ross said. Instead, she took her cues from friends, many of them, like her, from the West Indies. “Once somebody told me Fair & White was the one they were using, I’d go to the Korean store and ask for it,” she said.
Dermatologists nationwide are seeing women of Hispanic and African descent, among others, with severe side effects like Mrs. Ross’s from the misuse of skin-lightening creams, many with prescription-strength ingredients, which are sold in beauty shops and bodegas and online.
Hyprogel, made in Germany, contains the powerful steroid clobetasol propionate and includes a warning to use only as directed by a doctor. Fair & White, from France, normally contains no steroids, but counterfeit versions with undisclosed ingredients have turned up in stores.
No major studies have focused on the use of such creams in this country. But dermatologists with practices that cater to darker-skinned women say adverse effects are on the rise. Ethnic beauty supply stores, where clerks often shrug at selling prescription creams over the counter, report that sales are strong.
Dr. Erin Gilbert, a chief resident in dermatology at the State University of New York Downstate Medical Center in Brooklyn, said that she or a colleague saw a case of severe side effects from skin-lightening creams at least once a week. Dr. Gilbert attributed the frequency, which she called surprising, to the fact that the hospital served an “amazingly international cross section of women of color.”
Users are not necessarily immigrants, said Dr. Eliot F. Battle Jr., who has a dermatology practice in Washington, where he treats side effects from lightening creams “not only containing corticosteroids, but mercury,” a poison that can damage the nervous system. The patients are “Ph.D.’s to women from corporate America, teachers to engineers — the entire broad spectrum of women of color,” Dr. Battle said.
For years misuse was on the decline, Dr. Battle said, but now “it’s happening more because the Internet has been a great source for these patients to get physician-strength or prescription-strength products.”
Some users are seeking to lighten dark spots caused by acne or brown patches known as melasma, which are triggered by pregnancy, menopause or birth control pills.

But many others seek to lighten their entire face or large swatches of their body, a practice common in developing countries as disparate as Senegal, India and the Philippines, where it is promoted as a way to elevate one’s social standing. A small percentage of men in such countries also use the creams.
In November, some fans of Sammy Sosa, the former Chicago Cubs slugger, were surprised when photographs from the Latin Grammy Awards ceremony showed his face as uniformly lighter. Online critics accused him of wanting to be white. Mr. Sosa, a Dominican-born American citizen, told a reporter from ESPNDeportes.com that he had used a cream nightly to “soften” his skin and that it had bleached it, too. “I’m not a racist,” he said in the interview. “I live my life happily.”
Evelyn Nakano Glenn, a professor of gender and women’s studies at the University of California, Berkeley, said it was wrong to assume that skin-lightening was a cultural anachronism or an effort to negate one’s racial heritage.

“In fact, it’s a growing practice and one that has been stimulated by the companies that produce these products,” she said. “Their advertisements connect happiness and success and romance with being lighter skinned.”
Moreover, it is not as if dark-skinned women are imagining a bias, said Dr. Glenn, who is president of the American Sociological Association. “Sociological studies have shown among African-Americans and also Latinos, there’s a clear connection between skin color and socioeconomic status. It’s not some fantasy. There is prejudice against dark-skinned people, especially women in the so-called marriage market.”
There was an echo of the issue recently in comments by the Senate majority leader, Harry Reid, Democrat of Nevada, as reported in a new book, that he had urged Barack Obama to run for president because the country was ready to accept a “light skinned” African-American.
In the aisles of ethnic beauty supply stores on Flatbush Avenue in Brooklyn, dozens of skin lighteners are for sale, most manufactured abroad. Prescription creams with clobetasol propionate were available recently for as little as $3.99.

“Clobetasol is the most potent topical steroid we make in dermatology,” said Dr. Gilbert, who works nearby. “There’s almost no indication where you’d use it on the face. And it’s basically provided to people as cosmetic products. It’s illegal.”
A salesman at Blessing Beauty Supply, who would give only his first name, Monroe, said the secret to one best-selling cream, L’Abidjanaise, was that “it has steroids in it.” Asked why he sold prescription medications illegally, he declined to answer.
A spokeswoman for the Food and Drug Administration, Rita Chappelle, would not say whether the agency was pursuing such violations. “As a matter of policy, we do not discuss enforcement actions,” Ms. Chappelle wrote in an e-mail message.
Long-term use of a whitening cream with topical steroids can lead to hypertension, elevated blood sugar and suppression of the body’s natural steroids, doctors said. Some side effects, like stretch marks, may be permanent.
Some doctors also identified hydroquinone as a culprit in misuse cases. At a strength of 4 percent or higher, it is prescribed for short-term use to lighten skin blemishes like sun spots. Over-the-counter versions like Fair & White contain 1.9 percent hydroquinone, but bootleg versions are being sold with 4 percent to 5 percent, said Dominique Tinkler, the manager of product development for Fair & White’s American distributor, the Mitchell Group.
“We see it in New York, Miami, Chicago,” Ms. Tinkler said. “I mean it’s everywhere now.”
One unusual side effect of misusing hydroquinone is a blue-black darkening of the skin. Dr. Battle said he never used to see such cases, but in the last five years his Washington practice had treated them monthly.
The food and drug agency has been considering a ban on over-the-counter sales of hydroquinone since 2006, and it is already banned in England and France.
Doctors said some consumers wrongly assumed that all ingredients were disclosed on labels.
“There’s a basic assumption that there’s some truth in labeling,” said Dr. David McDaniel, a dermatologist in Virginia Beach and a director of the Skin of Color Research Institute at Hampton University. “That’s a false assumption for the skin-lightening market.”
Mrs. Ross of Brooklyn, who described herself as a onetime “queen of bleaching creams,” is recovering now with the help of her dermatologist from Kings County Hospital Center.
“I went through a terrible depressed phase,” she said. “I wanted to go back to use the creams a couple of months back. I just decided to ride it out with my dermatologist.”