Exogenous ochronosis. You may never have heard of it, but I am certain you have seen it. This is the darkening seen around the eyes and over the joints of someone who has been using skin lightening (aka bleaching) creams for a long period. There is a bleaching epidemic sweeping across Africa.

It is estimated by the World Health Organization that 77% of Nigerian women, 59% of Togolese women, 35% of South African women and 25% of Malian women use bleaching products on a regular basis. In Ghana, the figure stands around 30%.

This craze has come from a popular believe that light skinned women are more beautiful, more successful, more fashionable and have a higher chance of finding a husband than dark skinned counterparts. The source of this believe is still a mystery to many, but some researchers believe it is steeped in Africa’s colonial history, where white skin was considered better than black.

Interestingly, women are not the only ones who bleach. Men bleach too. Even children are being bleached by their parents, and this is abhorrent to say the least. Skin-lightening in itself is not medically prohibited; there are medical conditions in which this process is employed.

Vitiligo, in which some skin cells fail to produce the dark pigment melanin, is a case in point. To even out the skin tone in a bad case of vitiligo, the unaffected skin is lightened with prescription products.

The problem with bleaching is the use of over the counter products that contain agents that are harmful in high concentrations or ones that are toxic to the body even in small quantities. Unfortunately, these are the common and affordable ones.

Bleaching diminishes the activity of or totally destroys the cells in the skin that produce melanin, the pigment that protects us from harmful ultraviolet radiation from the sun. The effects of some bleaching agents go beyond melanin: they affect other organs, with severe complications.

The commonest agent in bleaching creams is hydroquinone. In concentrations of 2% or less, it is reportedly safe for short-term use. However, a lot of the creams on our market contain more than 4% (because that is the concentration that gives the desired effect quickly) – even when they have declared 2% on the packaging – and most people use it for many years at a stretch.

The manufacturers of such creams may attempt to deceive by giving it an alternative name like 1, 4-Benzenediol, Quinol, p-Diphenol, Hydrochinone, p-Hydroxylphenol, Hydroquinol and Tequinol. Don’t be fooled. They all mean the same thing.

Prolonged use of hydroquinone destroys the melanin-producing cells in the skin and makes the skin more susceptible to the harmful ultraviolet radiation from the sun. Sunburns and skin irritation become more common and over a prolonged period of use exogenous ochronosis occurs.

The risk for skin cancer is also increased significantly when hydroquinone-containing creams are used for long periods. These creams are also thought to be triggers for other cancers, like cancers of the blood (leukaemia), kidneys and liver.

Another bleaching agent is mercury. Though banned in most countries, including Ghana, this element is still found in some bleaching creams smuggled into the country. It is known to cause neurological defects and kidney damage, not only to the user, but also to close contacts.

Some bleaching products also contain steroids such as cortisone and clobetasol, whose long term use can have disastrous health consequences. Here is a catalogue of some of the possible complications from using these steroid-containing creams: -Thin, Easily bruised skin -Disfiguring stretch marks -Increased risk of hypertension -Increased blood sugar, with increased risk of diabetes -Gum bleeding -Increased risk of glaucoma -Cataracts -Weight gain -Insufficiency of the adrenal glands when the bleaching cream is abruptly stopped, which results in a crisis comprising dangerously low blood pressure, low blood sugar and low body temperature (hypothermia).

There are many other bleaching agents in common use, some of which are claimed to be safe. Such claims are still in contention.

Evolution has taught us that we continuously adapt to fit into our environment. You need not be a genius to realize that we need our melanin to protect us from the scorching African sun.

Some people though will always defy reason: even the litany of harmful side effects I have outlined above cannot deter them from using these harmful bleaching products.

But the Food and Drug Authority (FDA) seems to have a solution of sorts: it intends to ban the use of hydroquinone in cosmetic products from August this year. I hope they stick to their word. Then at least, these products will be out of sight and, hopefully, out of mind. It does not mean bleaching will be a thing of the past, but at least it will be less dangerous and less common.

I await a time when we will all be comfortable in our skin, be it black, brown or white.

You may have your reasons for bleaching (or toning, or highlighting- whatever you decide to call it) but bear in mind that it has adverse consequences. I cannot pretend to be an expert in cosmetology and prescribe what is beautiful or how to achieve it.

I am, however, well aware of the medical complications of your quest to be lighter than dark, and for that I can confidently say that black is beautiful. – By: K.T. Nimako (MB ChB)

Dr. Kojo Nimako is a private medical practitioner with an interest in public health. He is also the editor of healthbloggh.com and the Executive Director of Helping Hand Medical Outreach, an NGO focused on health education.