Clive Anderson - AT THE DERMATOLOGISTREADER'S FEEDBACK
Dear Dr. Anderson,
I would like to know what is the difference between bleaching and toning. Is it okay to tone one's skin.
T.M.
DERMATOLOGIST'S RESPONSE
SEVERAL STUDIES have shown that, in populations like ours, one of the commonest reasons for visiting a dermatologist is for help in removing spots from the skin. Usually, the concern is about dark spots but patients are not happy either about areas that are lighter in colour than the surrounding skin.
Any area on the skin that becomes lighter in colour than is normal is of grave concern to patients as patches of complete pigment loss, as occurs in vitiligo, can cause serious psychological trauma. There is no doubt that our skin colour is an important factor in our self-image. Dermatologists are required to not only treat the skin disorder but also to suggest ways of dealing with the spots.
The colour of our skin is due to the presence of various pigments, the chief of which is melanin. Melanin is manufactured by cells called melanocytes and shipped off to other cells in the skin. If the factory cells, the melanocytes, are absent (as in vitiligo) no melanin is produced the skin is white. If the shipping process is disrupted, as in certain skin disorders such as eczema, the skin will be paler than usual.
Conversely, if an acne bump, insect bite or other condition irritates the skin, the factory cells are triggered to produce extra pigment a spot occurs. Melasma is a dark patch of pigmented skin on the face occurring chiefly in women and associated with hormones
and sun exposure. For darker areas, after addressing the causative factors, the
following procedures are used:
Depigmenting creams these creams are some of the hottest selling items in pharmacies and on some sidewalks. They range from the relatively harmless and not very effective ones containing two per cent hydroquinone, to the illegally dispensed and harmful products containing steroids. Dermatologists prescribe safe products for use under close supervision.
Chemical peels 'physician-strength' peels exfoliate the outer layers of the skin thus removing pigment and making other products more effective.
Microdermabrasion similar to peels.
Laser resurfacing this process uses focused light to disrupt the pigment.
For lighter areas again the causes must be ascertained and treated to allow for pigment production to resume and for normal colour to return. Pigmentary disorders then are a major and quite legitimate concern for patients and several good modalities exist for their treatment.
LIGHTER SKIN
Which brings us to those persons who quite deliberately set out to lighten their overall skin colour. In most cases, the concern is not about spots or the need to regain the normal skin colour but the desire to make the skin colour lighter. Often these persons express it as 'toning the skin'. It is not unreasonable to seek to have a clearer, smoother complexion, everyone wants perfect skin and we are here to help in that quest. Cosmetic procedures have become a significant part of the practice of dermatology; skin peels, microdermabrasion, and laser resurfacing do help to produce a smoother, brighter skin tone but the skin colour is not significantly changed.
Some persons use various concoctions containing strong steroids, hydroquinone, toothpaste, curry, and so on, all over the skin to bleach. These persons sooner or later suffer the consequences of the damage done to the skin in the form of stretch marks, acne bumps, thinning of the skin, increased blood vessels, fungal and bacterial skin infections and even systemic disorders. Many of these persons recognise the damage being done to their skin but persist anyway. The benefits to them outweigh the skin damage even where the damage is irreversible. If the objective is clearer, smoother, even-toned skin see a dermatologist. If the need is for a lighter skin colour think again. Healthy skin is beautiful skin.
Dr. Clive Anderson is a dermatologist and venereologist; email: yourhealth@gleanerjm.com.
