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Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Patients and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

Objective  This study aims at describing the clinical characteristics of patients with acne using skin bleaching (SB) products.

Patients and methods  This is a prospective study conducted over 8 months in three dermatology departments and one private clinic. All patients examined for acne were included in the study.

Results  The study included 119 patients examined for acne from March to October 2010. Among them 48 (40.7%) did SB. Hydroquinone was the first product used for SB (26 of 48), followed by topical corticosteroids (17 of 48). The elementary lesions were papules (99.2%), comedos (36.1%), pustules (63.9%), pigmentation (26.1%), scars (21%), and nodules (20.2%). The extent of acne on the face was observed in all patients (100%). The lesions were extensive among 43.7% of the patients. The extent of acne lesions was not statistically associated with SB. Other body areas concerned were the chest (20.2%), back, and shoulders (41.2%). The relative risk of having lesions on the back and/or shoulders when the patient practiced SB was 2.71 (CI: 1.08–6.84), which is significant.

Conclusion  The study suggests that the back and shoulders can be the main areas for acne lesions associated with the practice of SB. The influence of different types of product is unclear.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Patients and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

Acne is the main cause of dermatological consultation in Lomé and sub-Saharan Africa.1,2 Skin inflammatory processes and pigmentary sequels are distinctive features/the peculiarities of acne in people with black skin.3 Induction of acne is well documented, including from the use of skin bleaching (SB) in sub-Saharan Africa.2,4,5 SB is a social phenomenon in Togo.6 Although the clinical characteristics of induced acne are well known, those related to acne due to SB products (hydroquinone, topical corticosteroids, and mercury derivatives) remain sparsely documented. The aim of our study was to describe the clinical characteristics of acne in patients using SB.

Patients and methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Patients and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

This was a prospective study over 8 months (March–October 2010). All patients examined for acne were included; they were outpatients consulting for acne at the dermatology department in Tokoin and Campus teaching hospitals, as well as at Gbossimé Dermatology Center, and in one private dermatology clinic. The diagnosis of acne was clinical, and data on skin product use were collected by interview and examination of samples of products brought by the patient. Acne that spread was considered when the elementary lesions were located on more than two of the following sites: face, chest, and back/shoulder. Evaluated products included soaps, ointments, creams, and body lotions. Other signs and complications of SB were investigated by physical examination. We considered all patients as a cohort, and we calculated relative risks by taking SB as a risk factor.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Patients and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

In total, 119 patients aged from 11 to 49 years (average age 23.4 years ± 6.4) were examined. We noted a female predominance: 96 were female (80.7%) and 23 male (19.3%) patients. The average age of women (23.6 years) was slightly higher than that of men (22.7 years). This difference was not significant.

Among the 119 patients, 48 (40.7%) practiced SB. Among the latter, 21.7% had used SB for less than 3 months, 41.3% from 3 to 12 months, and 37% over 12 months. The use of SB was statistically associated with females (P < 0.0005). Among the 48 patients who practiced SB, 46 were female versus two males.

image

Figure 1  Facial acne aggravated by the use of clobethasone in a young man. (Picture from dermatology department of Pr Tchangaï-Walla).

Hydroquinone was the first product used for SB (26 of 48 cases), followed by topical corticosteroids (17 of 48 cases). Products containing the two active ingredients were used by four patients.

The extent of acne on the face was observed in all patients (100%). The lesions were extensive in 43.7% of patients. The extent of lesions was not statistically associated with SB. The other body areas with acne were the chest (20.2%), back, and/or shoulders (41.2%). The relative risk of having acne lesions on one’s back and/or shoulders when the patient practiced SB was 2.71 (CI: 1.08–6.84). This relation was significant (P = 0.02694).

image

Figure 2  Acne on the chest of a 17 year-old girl using betamethazone. (Picture from dermatology department of Pr Tchangaï-Walla).

Other noticeable complications of SB were pigmentation disorders (five cases), stretch marks (four cases), and skin atrophy (two cases); one case of exogenous ochronosis and one of infection were also observed.

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Patients and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

The use of SB products is a social phenomenon among black people in Africa. The results of a survey on 910 women in Lomé showed that 58% used SB.5 The results from our study are congruent with those from this investigation.

The occurrence of acne during the practice of SB is often reported. Acne was the main reason for consultation due to SB in Brazzaville2 and it represented 29% of complications in a study carried out in Bamako.7 The occurrence of acne on SB-treated skin areas, particularly the face, and related unaesthetic condition, prompt patients using SB to ask for medical advice about the cause of acne and obtain dermatologist instructions for proper treatment to get rid of it.

Historically, induced acne was said to be caused by oily vehicles such as vegetable oils or Vaseline contained in so-called comedogenic products. However, in the case of SB, acne is assumed to be due to topical corticosteroids, which can provoke or aggravate lesions.8 However, in our cohort, there was no association between the type of product used and observed acne lesions. A case–control study is needed to assess the role of different SB products in the onset and clinical characteristics of acne.

image

Figure 3  Acne on the back for the same patient. (Picture from dermatology department of Pr Tchangaï-Walla).

Although only indicative, our results showed that the relative risk of having acne lesions on the back and shoulders when the patient used SB was significant. The upper back and shoulders are the typical areas affected by acne lesions. The application of SB products on these areas, which are usually covered can cause or aggravate acne by occlusion phenomenon.

Our study confirms that SB is used mainly, but not exclusively, by females. Hydroquinone and corticosteroids are the most used SB products.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Patients and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

The results of our study suggest that the back and shoulders can be the main areas affected by acne lesions associated with the practice of SB. A case–control study on a large cohort would assess the influence of different types of bleaching products on the clinical characteristics of acne.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Patients and methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References