Partner: Ministry of Climate Change, GoP
Location: Main cities of Pakistan
Team: Dr. Mahmood A. Khwaja (email@example.com) & Dr. Zaigham Abbas
The use of mercury (3rd most hazardous chemical) in various cosmetic products, particularly for its skin whitening effects, has been in practice since the nineteenth century and such products continue to be easily accessible in open markets and are most commonly used all around the world including many developing countries. The obsession for fair skin in the subcontinent is believed to have emerged with the introduction of the cast system according to which fair complexion was considered as the domain of the upper ruling class, whereas dark complexion was associated with the lower working class. It is also suggested that the migration of Aryans who were much fairer than the local population may also have influenced the dark skinned population’s desire for fair complexion. Living under the regime of various colonial legacies for more than two centuries could have further influenced the local population to perceive white skin as a sign of power and superiority. Presently, preference for a fair skin has also been intensified by the fairness cream industries through extensive electronic & print media campaigns. The most unfortunate exaggerations in some advertisements can even reach to the extent that they project fair skin as an essential prerequisite for success in both professional and personal matters.
Very few investigations on mercury added products and their use by consumers have been carried out in South Asia, including Pakistan. This brief report (full report with details would soon be accessible at www.sdpi.org) focuses on the findings of our recently completed study, to investigate the health threats and challenges due to the use of Skin Whitening Creams (SWCs) in some selected main cities (Peshawar, Islamabad Rawalpindi) of Pakistan.
The study was carried out in two parts. First, the sampling and analyses was carried out for the determination of total mercury contents in SWCs, sold and purchased by the consumers from the open market. In the second part, contacts were made, in person, with 50 dermatologists/skin specialists (male & female) in 29 hospitals and 14 private clinics of the three cities and through a questionnaire, their opinion/recommendations on SWCs related issues were sought. Samples of 20 SWCs different brands were purchased from the retail shops in the open markets in the three selected main cities. For SWCs assay, acidic digestion of the homogenized SWCs samples was followed by total mercury content measurements by flow injection mercury system – FIMS-CVAAS.
In the 20 SWCs brands analyzed, total mercury content was found to be in the range 0.13 – 26,500 ppm. Mercury content in one sample seems to be less than 0.1ppm. Eight samples showed mercury content less than 1ppm (requirement of Minamata Convention on Mercury). On the basis of the observed total mercury content in the studied samples and the health risk due to mercury exposure, the studied SWCs brands were categorized in four major groups as (a) most hazardous with Hg content > 10,000 ppm (5 samples), (b) highly hazardous Hg content > 5000 ppm (4 samples), (c) moderately hazardous Hg contet < 5000 ppm (3 samples) and (d) least hazardous with Hg content < 1ppm (8 samples). It is evident from the above these analytical results that SWCs users are exposed to alarminglyÂ high levels of mercury in SWCs which may result in mercury being absorbed, inhaled or ingested, thus causing adverse health impacts (to consumers health directly and children’s indirectly) which are well known and established. These include effects on neurological development, growing brain, nervous system, lungs and kidneys.
The summarized overall findings, from the survey/interviews with the dermatologists/skin specialists (n=50) in Peshawar, Rawalpindi & Islamabad, regarding SWCs users reasons for changing complexion, their level of awareness about SWCs, number, frequency of visiting patients, their age & gender and other mercury/SWCs related issues, are given below:
Among various factors considered for an individual’s reason to go for complexion change, according to the majority of dermatologists (78%) interviewed in the 3 main cities, seems to be social and not at all professional (91%). (51%) of the dermatologists thought, it could also be personnel. As a result, people use products such as SWCs to lighten their skin tone and thus put their health in significant risk. These social pressures for acquiring fair complexion are mostly directed through advertisements and TV shows that strongly suggest the viewers with exaggerated benefits of having a fair skin tone. There is consensus among all respondents that such advertisements and programs (including morning shows) should be banned immediately.
One of the reasons for the extensive use of SWCs in Pakistani population is due to the lack of awareness of the hazardous contents/ingredients of SWCs and their possible health risks among the public, as agreed by all respondents. However all the dermatologists claim that they very strongly caution their patients about the adverse health effects of these products such as SWCs that may contain high levels of toxic chemicals such as mercury.The overall flow of patients with skin disease has been found to be high as more than 70% dermatologists informed, they received more than 50 patients per week. This indicates the prevalence of skin related issues among the population of the 3 selected cities of Pakistan. The current study reveals that 23% of the patients received by dermatologists are male the remaining 77% patients females. Majority of patients (45%) visiting skin care centers are of age between 25-40 years. There’s unanimous support (100%) of all dermatologists interviewed for awareness raising, regulating the manufacturing and sale of SWCs and display of full information regarding the ingredients and their amounts in the products, on labels of SWCs products.
91% support the review and revision of current MBBS curriculum/syllabus and to include mercury related information.
(98%) support banning the manufacturing and sale of SWCs with mercury content higher than 1ppm, as pointed out in Minamata convention on mercury.
Additional information/comments received from the visited dermatologists in Islamabad, Rawalpindi and Peshawar, regarding health effects, popular SWCs brands and alternatives for skin care are summarized below:
According to dermatologists/skin specialists regarding the types of health conditions/ailments commonly observed among the patients who have a history of SWC use, are, formation of wrinkles, rosacea, melanosis, acne, telangiectasia, aczema rash, scaring, webbing, hypersensitivity and sometimes, dermatitis, erythema, ocronosis, skin abscess, hirsutism and even fungal infections & allergy. In addition to this almost all dermatologists pointed out that SWCs users also develop conditions such as skin sensitivity, thinning, peeling & atropy, acne formation, hyperpigmentation, including melasma, dark spots and freckles. SWCs that are most commonly used among the patients are Fair and lovely, Due whitening cream, Faiza beauty cream, Golden pearl, Stillman’s freckle cream, Arche cream, Face fresh, Gipsy Amazing cream and also Betnovate.
Some alternative treatments are also prescribed by the dermatologists for skin lightening effects, such as vitamins (C D & E), zalic acid, Derma glow, betnogenotic, Sefraderm, 1% hydrocortizone, and other hydroquinone and kojic acid based products. On patients demand, a few dermatologists also administer Glutathione injections. Patients are also advised larger intake of dietary supplements such as fruits & vegetables, avoiding excessive sun exposure, wearing proper clothing and using umbrella/sunblock when going out in the sun.
From the literature survey, results of analyses of 20samples of SWCs and the opinions expressed by 50 dermatologists/skin specialists, it is very evident that with the continued use of mercury containing SWCs, the skin is affected, becomes unhealthy and ugly looking. Besides, mercury absorbed through the skin, causes adverse health problem to human health. Such SWCs brand need not be used at all. There is dire need of public awareness raising (through social, print & electronic media), regarding the high level of hazardous mercury & other chemicals contents in SWCs and their effects both to the skin and human health. People need to understand that â€œHealthy? skin is beauty, not its Complexion? and people should not hunt for SWCs which use lead to unhealthy and ugly looking skin.
At present, there does not seem to be an effective check and balance in place for the direly needed assessment of chemicals in consumer products. Ministry of Health/health department, Pakistan medical & dental council (PMDC), Pakistan national accreditation Council (PNAC) through joint efforts by Specific regulations need to be developed and implemented, especially regarding standards for chemicals content in consumer products, including cosmetics/SWCs. All products need to be have proper labels (Mandatory), clearly indicating the amount of the chemicals added to the products, with updated contacts/address of the manufacturer. Consumer products, containing excessive amount of chemicals be banned for use/sale/manufacturing. EPAs may also be involved in view of environmental pollution caused by chemicals use and resulting releases/wastes. It is also recommended that higher education commission (HEC) looks into MBBS syllabus/curriculum for the needed additional information about cosmetics, especially SWCs, to be included for dermatology specialization.
WE strongly recommend ban on the production/use of skin lightening creams with total mercury content above one ppm as per the requirement of Minamata convention on Mercury.