Depigmentation for cosmetic purposes: prevalence and side-effects in a female population in Senegal

Background. Use of depigmenting agents by black women for cosmetic purposes is a long-standing practice. Most depigmenting agents contain topical ster oids and hydroquinone. The purpose of this study was to clarify prevalence data on use of depigmenting agents in a female population in Senegal and to report the incidence and main features of adverse skin reactions in additi on to possible associations with diabetes, hypertension and renal insuffici ency. Patients and methods. A cross-sectional study was made in a representative sample Of 147 hospitalized women aged from 15 to So years. The incidence of adverse skin reactions, diabetes, hypertension and serum creatinine in 41 women admitting use of depigmenting agents was compared to those found in 8 5 women who maintained they had never used depigmenting agents. Two patient s who refused to participate in the study and ig others who did use depigme nting products and had stopped their use for at least 3 months were exclude d from the analysis. Results. The prevalence of use of depigmenting agents was 27.9% (47/147). A dverse skin reactions were significantly more frequent among these patients . Effects observed were similar to those reported For prolonged use of topi cal steroids but also included periorbitary dyschromia, exogenous ochronosi s, infectious dermatosis, and, in particular, extended dermatophytosis and necrotizing cellulitis, contact eczema, and certain hyperpigmentation when depigmenting agents were discontinued. Presence of relative hyperpigmentati on of the dorsal phalanges identified use of depigmenting agents with a 100 % specificity. Prevalence of diabetes and hypertension was significantly hi gher among the group of women using depigmenting agents (46.3% and 8.2%, ve rsus 34.1% and 8.2% respectively). There was no difference for renal insuff iciency. The risk increased independently of age depending on whether durat ion of use was less than 10 years or not with a relative risk that rose fro m 3.63 (1.2-10.47) to 6.47 (3.41-12.32) for diabetes and from 1.34 (0.45-3. 96) to 2.65 (1.27-5.51) for hypertension, clearly suggesting a possible dos e effect. Discussion. The prevalence of use of depigmenting agents in this first publ ished hospital series confirms the widespread nature of this phenomenon in Senegal. While certain patent skin signs are similar to those described in the literature, and excluding specific features related to the hospital set ting, this is the first report of a dose-effect between use of depigmentati on agents and diabetes and hypertension, probably via the effect of topical steroids.