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Open letter to the Natonal Assembly members of The Gambia

Sunday 19 July | Open Letter | Ahmed Manjang


SKIN BLEACHING, HEALTH, SOCIAL AND ECONOMIC COST


As the debate rages on over the merits and demerits of repealing the section of our constitution dealing with skin bleaching, as a concerned citizen, I felt obliged to write to you, the lawmakers of The Gambia to give specialist advice on this critical topic. I heard the Feminist proclaimed; here are a group of men again trying to legislate issues affecting women so they can exert more control over them. I beg to differ; I think skin bleaching is more than just women issue, it is more of a societal problem that carries with it host of problems including but not limited to health, social and economics. From a medical standpoint, there is no need or benefits to lighten the skin, but if one is considering skin

bleaching, it's essential to understand the risks.


Desire results are not guaranteed, and there are ample pieces of evidence that skin lightening can result in serious side effects and health complications. But the World Health

Organisation warns that skin bleaching can cause liver and kidney damage, psychosis, brain damage in fetuses and cancer (1) .


Skin bleaching or whitening is the act of brightening the skin complexion by using chemical substances that are applied to the skin or administered into the body by other means. These chemical products include bleaching creams, soaps, and pills, as well as professional treatments like chemical peels and laser therapy. The use of skin bleaching agents has its disadvantages in terms of causing harmful effects such as skin disorders like depigmentation, rashes, pimples, discolourations, kidney damaged, cancers, neurological and psychiatric complications depending on how the agents for the skin bleaching are used.


Skin bleaching used interchangeably with skin whitening, or skin lightening is the process of brightening the skin complexion using chemical substances, concoctions or physical treatments. People bleach their skins for aesthetic or cosmetic reasons to increase skin glow, radiance and vibrancy in addition to the lightening. The mechanism of skin lightening influences the amount of melanin in the skin to cause-effect. Melanin is a skin pigment produced within the skin to impart its colour as well as provide protection against ultraviolet (UV) rays of sunlight and other biological effects. Melanin is an omnipresent biological pigment, which is present in mammalian skin, hair, eyes, ears and the nervous system.


There are three main classes of melanin; eumelanin, pheomelanin and allomelanins. There is also neuromelanin, the melanin of the nervous system. Eumelanin is usually observed brownish to dark black colour of the skin and hair, while pheomelanin is reddish and yellowish. Many biological systems produce a combination of two types of melanin, red haired (ginger) people usually have pheomelanin predominantly in their hairs and skins. Many studies have shown that people with pheomelanin as the predominant pigment are susceptible to more photodamage than people with predominant eumelanin in their skin (1,2) .


Mechanism of skin bleaching


Skin bleaching slows down the production of melanin and reduces its concentration in the skin. Melanin is a dark pigment produced by cells called melanocytes. The level of melanin in one's skin is mostly determined by genetics, hormone, environmental factors, such as sunlight and certain chemicals also influence melanin production. When skin bleaching products such as hydroquinone are applied to the skin, it decreases the number of melanocytes; this can result in lighter skin and a more even appearance to the

surface.


Health effect of skin bleaching


Melanin from natural sources has been reported to possess a broad spectrum of biological activities, which include protection against UV radiation, enzymatic lysis, damage by oxidants, resistance to drugs by pathogens, protection of insects against bacteria and antiviral protection. Melanin natural ability to protect against UV rays has been utilised in the production of sunscreens in an attempt to imitate the natural role of these molecules in the skin. The protective effect of sunscreen is rated using the Sun Protection Factor (SPF) scale, and it is thought that a higher SPF value indicates a better protective capacity. All melanin lowering bleaching agents carry potential hazards by intervening in the protective activity of melanin. Mercury-containing skin bleaching agents have been scientifically proven to cause chronic kidney diseases and neurological damage and even psychiatric disorders.


Many countries across the world, including the Gambia, have put in place legislation to control sale, distribution and the use of skin bleaching products because of the dangers associated with them. I firmly believe common sense will prevail and this dangerous practice will remain banned in the Gambia. Many research had established that Skin bleaching has been associated with several adverse health effects, including but not limited to; syndrome mercury poisoning, dermatitis, kidney failure, steroid acne, whiteheads and

blackheads, and nephrotic (3,4) .


Mercury poisoning


Some skin bleaching creams made in countries with no proper regulatory mechanism have been associated with mercury poisoning. In many developed countries, mercury has been banned as an ingredient in skin lightening products. However, products made in developing countries with underregulated food and drug control policies still contain mercury. Common signs and symptoms of mercury poisoning include numbness; high blood pressure, fatigue, sensitivity to light, neurologic symptoms, such as tremor, memory loss, exogenous ochronosis and irritability.


Dermatitis


Case-control studies and research reports have strongly linked the use of skin bleaching products to contact dermatitis, an inflammation of the skin caused by contact with certain environmental stimuli. Symptoms of contact dermatitis can range from mild skin irritation to severe. They can include redness of the skin, itching, dry scaly skin, blisters, skin ulcers, hives, swelling, tenderness and burning.


Exogenous ochronosis


Exogenous ochronosis (EO), is a condition that causes blue-black pigmentation of the skin. This kind of skin disorder develops as a complication of persistent and long term use of skin bleaching chemical agents containing hydroquinone. Those who use it on large areas of the body or the entire body are more likely to develop EO.


Steroid acne


Steroid acne skin disorder develops as a result of prolonging us of skin bleaching creams that contain corticosteroids. Steroid acne mainly affects the chest area, but can also strengthen on the neck, back, arms, and other parts of the body. Symptoms of Steroid acne can include; whiteheads and blackheads, acne scars small red bumps, large, painful red lumps.


Nephrotic syndrome


Nephrotic syndrome is a kidney disorder caused by prolonged use of skin bleaching creams. This condition is characterised by impairment of the blood vessels in the kidneys that are responsible for filtering excess water and metabolic waste. This debilitating condition causes the body to excrete too much protein in the urine, causing proteinuria. Mercury, in skin bleaching creams, has been found to cause nephrotic syndrome. Symptoms of nephrotic syndrome can include swelling (oedema) around the eyes, swollen feet and ankles, foamy urine, loss of appetite and fatigue.


The social effect of skin bleaching


The culture of skin bleaching is intertwined with personal identity, self-image and racial supremacy. Colonial masters have influenced the coloured race, especially the ones colonised to believed that the white skin is an ideal colour that matches superiority and power. The perception impacted widely created obsession with the use of skin bleaching agents among the coloured race and shaped the practice of skin whitening by Negroid and other dark-skinned to emulate the fair skin Caucasians in many aspects of life, skin colour inclusive.


The western media also portrays the fair-skinned as higher and more prosperous than the black skin through adverts and other productions. The widespread use of skin bleaching agents is not without multifaceted adverse effects. In some social settings, some associated this habit with prostitution. Skin bleaching is a prevalent practise among prostitutes as a method to attract the opposite sex. Skin bleaching is widespread among prostitutes and many people who camouflage as fashion designers due to stigma associated with prostitution in our communities. It is not uncommon; some people who are already fair in complexion by nature are found to use bleaching creams to avoid anning of the skin by the sun.


The default natural texture and colour of human skin represent a trademark of beauty and nature’s protective gift to humankind so that we can adapt optimally with potential environmental insults of our natural environment. This phenomenon is a prime example of natural selection strategy at best, which needs not to be overemphasised.

Skin bleaching chemical substances contain some dangerous chemicals such as mercury, steroids, hydroquinone and host of others that have negative health implications. There is an attitude of some that fairness of skin is associated with intelligence, purity, power and success. In south Asian countries, there was a perception that the skin colour of the white race that were the colonisers was superior to the darker skin colour. Perhaps this could be the reason why some celebrities use skin bleaching creams and make their hair look straight and sometimes ridiculously blond like that of the white (1,5) .


Economic cost


Although the medical and social determinants of this phenomenon have been documented, its price is poorly defined. Hence, there is a great need to evaluate the economic cost of skin bleaching on women's income. One study conducted by Diongue and his colleagues found that 19% of the income of regular skin bleachers goes to the cost of skin bleaching agents (5) .


To conclude;

1. I will recommend youths should be empowered through the school curricular to be contented and have self-esteem and confidence with their natural skin tone.


2. The harmful effects associated with skin bleaching creams should also be mentioned and boldly emblazoned on the containers when such substances are being advertised even for medical reasons just like in the case of tobacco marketing


3. The media should stop promoting skin bleaching as a means of fostering cosmetic products for commercial purposes by making the white skin colour to sound or look superior to the others


4. The sales of skin whitening creams should be banned in the Gambia and Africa at large.


1. Darj E, Infanti JJ, Ahlberg BM, Okumu J. “The fairer the better?” Use of potentially toxic skin bleaching products. Afr Health Sci [Internet]. 2016 Jan 18;15(4):1074. Available from:

http://www.ajol.info/index.php/ahs/article/view/128269


2. Vijaya RM. Dangerous skin bleaching has become a public health crisis. Corporate marketing lies behind it. Available from:

https://www.washingtonpost.com/politics/2019/06/15/dangerous-skin-bleaching-has become-public-health-crisis-corporate-marketing-lies- behind-it/


3. Pussetti C, Pires I. A indústria do branqueamento em Lisboa: uma etnografia das práticas e produtos para o branqueamento da pele e seus riscos para a saúde dermatológica. Saúde e Soc [Internet]. 2020;29(1).

Available from:

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104- 12902020000100201&tlng=pt

4. Rao P. Paying a high price for skin bleaching. Available from: https://www.un.org/africarenewal/magazine/april-2019-july-2019/paying- high-price-skin-bleaching

5. Diongue M, Ndiaye P, Douzima P-M, Seck M, Seck I, Faye A, et al. Economic impact of skin-lightening products on household income in sub- Saharan Africa: The case of Senegal. Med Sante Trop [Internet]. 2013

Jul;23(3):308–12. Available from: http://www.john-libbey-eurotext.fr/medline.md doi=10.1684/mst.2013.0190



Ahmed Manjang,

Senior Medical Technologist,

King Fahad Medical City, Riyadh,

Kingdom of Saudi Arabia.


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