Skin lightening practices: an epidemiological study of South African women of African and Indian ancestries

Background Cutaneous adverse sequelae of skin lightening creams present with myriad skin complications and affect dermatology practice, particularly in sub-Saharan Africa where such products are widely used, with a prevalence of 25-67%. Objectives To examine the skin lightening practices of both African and Indian women living in South Africa. Methods A cross-sectional survey was undertaken in the general outpatient departments of two regional university hospitals in Durban, South Africa. All consenting African and Indian women aged 18-70 years were recruited and asked to complete a questionnaire. Results Six hundred women completed the questionnaire, of whom 32.7% reported using skin lightening products. The main reasons cited were treatment of skin problems (66.7%) and skin lightening (33.3%). Products were purchased from a variety of sources. Twenty-five percent reported using sunscreen. Conclusions The use of skin lightening cosmetics is common among darkly pigmented South African women, including those of both African and Indian ancestries. Despite more than 20 years of governmental regulations aimed at prohibiting both the sale of cosmetics containing mercury, hydroquinone and corticosteroids, and the advertising of any kind of skin lightener, they are far from having disappeared. The main motivations for using these products are the desire to treat skin disorders and to achieve a lighter skin colour. Television and magazine advertisements seem to influence womens' choice of these products and, thus, would be efficient channels for raising public awareness about the dangers of using uncontrolled skin lighteners.