Skin Lightening Cream: How Does It Work?

Skin lightening creams, also known as skin brightening creams, are designed to lighten skin color. The creams are often used to spot-treat dark areas of the skin, such as age spots or acne scars. They are sometimes used to lighten the complexion overall.

While these creams can be prescribed for specific skin conditions, they can have side effects. The risks can be serious, especially with over-the-counter creams that may not be tested for safety.

This article discusses how skin lightening creams work. It also covers the conditions they can treat and the risks of using them.

What Are Skin Lightening Creams?

Skin lightening creams are products designed to bleach and lighten the skin. They target skin cells to decrease the level of melanin. Melanin is a pigment produced by skin cells. It determines how light or dark our skin appears.

Skin lightening products can come in the form of creams, lotions, oils, and serums. Creams and oils are usually heavier and better for dry skin. If your skin tends to be on the oily side, you may want to opt for a lighter serum. Your dermatologist can advise you on which kind is best for your skin type.

Several varieties of skin lightening creams are available online and over the counter (OTC). However, it’s best to talk with your healthcare provider before using skin lightening creams. Prescription products are regularly tested for safety and efficacy, unlike OTC products, which could contain dangerous ingredients. 

How Do Skin Lightening Creams Work?

Skin lightening creams contain ingredients that work to decrease your body’s production of melanin. Melanin is made by cells called melanocytes. Skin bleaching products work by lowering the number of melanocytes in your skin. 

Many skin lightening creams contain hydroquinone, which is known to decrease melanocytes.

Vitamin C, also a common ingredient in skin lightening creams, is an antioxidant that is known to lower melanin production in our cells.

Glycolic acid, which is also found in many skin brightening creams, works as an exfoliant. It helps to brighten the skin by clearing away dead cells. 

Retinoids, products derived from vitamin A, can also be used to lighten dark spots. They work by speeding up the turnover of surface skin cells. They can include retinol, adapalene gel, tazarotene, and tretinoin.

What Skin Conditions Do Skin Lightening Creams Treat?

Skin lightening creams may be used for various conditions that cause discoloration. These include:

• Age spots
• Freckles
• Acne scars
• Melasma
• Post-inflammatory hyperpigmentation (PIH)
• Hormonal imbalances
• Addison's disease

Melasma and post-inflammatory hyperpigmentation (PIH) are both conditions that cause dark, blotchy areas. Common areas include parts exposed to the sun, like the forehead and cheeks.

PIH leads to a darker complexion in areas inflamed because of injury to the skin. For example, scarring may cause darker areas, or severe acne can leave dark spots after it resolves.

Hormonal imbalances and endocrine conditions like Addison's disease can also lead to darkening of the skin. 

With Addison's disease, the adrenal gland doesn't produce enough of certain hormones. Those with Addison's disease produce a high level of adrenocorticotropic hormone, which stimulates the melanocytes to produce more melanin, resulting in skin darkening.

Risks of Skin Lightening Creams

In 2020, OTC products containing hydroquinone were removed from the market. This was because the Food and Drug Administration (FDA) classified them as "not generally recognized as safe and effective." Even though hydroquinone products were removed from store shelves, they're still available by prescription.

Hydroquinone has been linked to exogenous ochronosis, a disorder that makes the skin appear black and blue. This condition is difficult to treat and can result in permanent skin discoloration. Discoloration may be more common when applying hydroquinone over a large skin area or in higher concentrations.

Because many skin lightening creams contain corticosteroids, steroid acne is also a possible side effect. It can also lead to skin breakdown and leave users with open sores and scarring.

Milder side effects have also been reported, including dermatitis and skin irritation.

Mercury Poisoning

Mercury is a heavy metal that is toxic even in small amounts. The FDA has limited the amount of mercury in cosmetic products to trace amounts not exceeding 1 part per million (ppm).

However, in a 2014 study, researchers tested 549 skin lightening products for their mercury content. They found that 6% contained mercury levels above 1,000 ppm, while some had mercury levels as high as 10,000 ppm. Of the U.S. products, 3.3% had mercury levels over 1,000 ppm.

Though products from the United States were somewhat safe, it can be difficult to determine the country of origin of products purchased online. 

Avoid any product with mercury as an ingredient. Look for: “Hg” (the chemical symbol for mercury) or the word “mercury,” mercuric iodide, mercuric chloride, mercurous chloride, ammoniated mercury, calomel, mercurio, amide chloride of mercury, or mercury oxide.

Being exposed to mercury over time can cause symptoms like:

• Numbness
• Tingling
• Dizziness
• Forgetfulness
• Headaches
• Depression

More severe symptoms include:

• Confusion
• Muscle weakness
• Trouble breathing
• Changes in vision
• Difficulty walking

Mercury exposure can also cause kidney damage over time. Users of skin brightening products have been diagnosed with nephrotic syndrome after using the cream for months. Nephrotic syndrome is a kidney disorder that causes the body to excrete too much protein in the urine.

Symptoms of nephrotic syndrome include:

• Severe swelling
• Fluid retention
• Foamy urine
• Fatigue
• Loss of appetite

Nephrotic syndrome is treatable, however, and will resolve once the mercury exposure stops.

More research is needed to determine the long-term effects of using skin-lightening products. The chemicals in skin lightening creams have not been studied over long periods, so it's unknown if they will lead to long-term conditions. 

Skin Cancer

The use of skin lightening products over long periods has been linked to an increased risk of skin cancer, particularly squamous cell carcinoma (SCC). When using lightening products, always apply sunscreen.

Check With Your Healthcare Provider

If you are being treated for any medical condition, are pregnant or breastfeeding, always check with your healthcare provider before using any skin lightening product.

If you suspect that you have been exposed to mercury (especially over a long period), or have symptoms of mercury poisoning, consult your healthcare provider.

Summary

Skin lightening creams may be used to spot-treat dark areas of the skin or lighten skin overall. They may be prescribed for specific skin conditions, such as melasma and post-inflammatory hyperpigmentation.

However, these creams can have serious side effects. Those with hydroquinone can cause a disorder called exogenous ochronosis, which causes the skin to become black and blue. Some skin lightening creams may contain mercury, which can lead to mercury poisoning or a kidney disorder called nephrotic syndrome.