Shades of Pale

One of the most controversial topics in aesthetic medicine in South Africa today is the trend of skin bleaching and lightening. Unfortunately, many patients have not been educated on the differences of these procedures, creating a huge amount of uncertainty – while making way for illegal products to infiltrate the market. Dr Alistair McAlpine gives us the low-down.
Published by A2 Aesthetics Magazine, written by Dr Alistair McAlpine.


The use of skin bleaching creams has been common practice in South Africa. In isiXhosa, it is known as ukutsheyisa, which means to chase beauty. In isiZulu, it is known as ukucreamer, referring to the application of creams on the skin. The controversy of skin bleaching and skin lightening has recently been highlighted in the media (especially social media), as these procedures have been used by various South African and international celebrities. This has created a huge illegal market for skin lightening products (due to high demand), and has led to non-medical and even medical practitioners pushing boundaries – all to provide patients with their desired result for maximum financial gain.

From the outset, it is important to differentiate between skin bleaching and skin lightening. The distinction between these two completely different treatments has been blurred, which has led to patients making uninformed decisions due to the vast number of treatment options available – along with the incorrect information being supplied to patients.


Skin bleaching

Skin bleaching involves depigmenting the skin, by obliterating melanosome granules produced by melanocytes (cells that produce pigment), thus causing significant changes to the pigment concentration of the skin in a short period of time. This is dangerous, as it predisposes the skin to harmful long-term damage caused by UV radiation from the sun. Skin bleaching can be achieved by using substances such as hydroquinone, arbutin, monobenzone and cortisone. Some of the illegal skin bleaching products contain a mixture of these substances, with added illegal products such as mercury. Depigmenting the skin to achieve skin bleaching can cause serious side effects, some of which could be potentially life-threatening. Why should patients avoid skin bleaching? Skin bleaching creams consist of a host of chemicals, including hydoquinone, monobenzone, corticosteroids and even mercury. These are extremely aggressive products, which, if abused for the purposes of skin bleaching, can lead to the following side effects:

  • hyperpigmentation
  • ochronosis (blue/black discolouration of the skin)
  • photosensitivity (increased sensitivity of the skin to the sun)
  • burning sensation of the skin
  • severe allergic reactions
  • thinning of skin
  • nausea
  • liver damage
  • renal (kidney) damage.


Skin lightening

Skin lightening involves the use of antioxidants, namely glutathione and vitamin C, to stop the production of darker eumelanin. This aids in an overall lightening/brightening of the skin, as the antioxidants block the enzymatic pathway involved with the production of eumelanin (dark melanin/pigment). Skin lightening is not permanent and doesn’t affect the production of pheomelanin (lighter melanin/pigment). This process is gradual, requires maintenance, and may not give patients the desired result they wish to achieve, but the patient will achieve some degree of lightening. One of the main positive attributes of this treatment is that it is safe, provided it is carried out by a trained medical professional. The other positive attributes of receiving antioxidants for skin lightening are the anti-ageing benefits, prevention of a host of chronic conditions, improving the immune system and reducing fatigue. One of the most effective ways of providing this treatment is intravenously.

However, the increase in popularity of skin lightening has caused a surge in the market of substandard products, especially tablets and powdered vials imported from the Far East. This has caused consumers to be misled into buying and using inferior products, which may not have the active ingredients that are advertised. These substandard products can cause serious side effects and leave patients out of pocket without any result. Also, a large number of these products are supplied by non-medical personnel who do not perform the necessary history check and examinations in order to ensure that these patients are suitable candidates.

The reality is that skin lightening is a treatment choice that will continue to be popular, and patients will indeed continue to seek alternatives. It is important that the public is informed about all the treatment options that are available, as well as the side effects associated with these treatments. It is also advisable that patients should seek treatment from reputable clinics and practitioners to ensure they receive the best quality treatment, in order to get the best possible results – with minimal or no adverse effects.