Trouble Spots Got You Down? Lighten Up
By Sally Wadyka

In a country that takes pride in its multi-ethnicity, a strange-sounding beauty trend is picking up steam. Suddenly, a torrent of new face creams and gels are promising "whiteness" or "lightness."

Clinique makes Active White, Dior has DiorSnow and beginning in September, Shiseido's White Lucent line will be in stores. In the past year and a half, at least 30 such products have come on the market, according to Mintel's Global New Products Database, which tracks the cosmetics industry. Sephora stores have seen a 40 percent increase in sales of skin whitening and lightening products since the middle of last year, said Allison Slater, vice president of retail marketing for the beauty store chain.

Skin lightening may conjure images of geishas or Kabuki theater. In fact, the concept comes from Japan, where whiteners have long been top sellers. "Historically, Asian women have always been obsessed with wanting lily-white skin, which is associated with being of a higher class, as opposed to those who had to work in the field," said Dr. Min-Wei Christine Lee, a dermatologist and the director of East Bay Laser and Skin Care Center in Walnut Creek, Calif.

But the new whitening products for skin, unlike those for teeth, are not designed to actually lighten. They are meant to merely even out skin color, mainly by diminishing darker spots and blotches, like freckles, age spots and melasma (the dusky mask that sometimes shows up on a woman's forehead and cheeks during pregnancy or when she takes birth control pills). Some of the products also aim to disguise uneven coloring by making skin more luminous.

"The word 'white' is a bit of a misnomer," said Jean Bellard, who is in charge of training beauty consultants for Shiseido.
For years, dermatologists have erased, or at least dimmed, dark spots on the skin by using prescription lightening creams, chemical peels or laser resurfacing. Such treatments still offer more dramatic results than the new over-the-counter whiteners do.

Dark spots and patches on the skin occur when hormones or long-term sun exposure affect cells called melanocytes, the ones that make pigment. "Once a melanocyte is damaged, it no longer produces an even amount of pigmentation," said Elaine Linker, co-founder of Doctor's Dermatologic Formula, which makes a lightening product called Fade Gel 4.

Such melanocytes tend to produce too much color, a condition that doctors refer to as hyperpigmentation. That translates into dark spots and patches on the skin.

Because women with relatively dark skin have more pigment, they see hyperpigmentation more often than lighter-skinned women do. "If I get a zit and pick at it, I end up with a mark that's darker than the rest of my face," said Terrie Clarke, a magazine editor in New York who is African-American. She said the new over-the-counter lotions had helped even out her skin tone.

How do the whiteners work? Some contain hydroquinone, the same active ingredient used in prescription-strength spot-removing creams, like Lustra, Tri-Luma and EpiQuin Micro. Hydroquinone-works inside the melanocytes by suppressing tyrcsinase, an enzyme that is needed for the creation of melanin. Over-the-counter products like DDF's Fade Gel 4 and Philosophy's Pigment of Your Imagination contain 2 percent hydroquinone solutions, half the concentration found in prescription brands.

Hydroquinone is known to irritate some skin and to make all skin more sensitive to sunlight, however. Consumers' concerns over those side effects and over reports that the chemical may be connected to more serious health problems in laboratory animals have led many cosmetics companies to avoid using it in their whitening products.
Instead they use natural substances like licorice extract, azelaic acid, mulberry and bearberry extract, and new compounds that they say suppress melanin production without side effects. Shiseido White Lucent uses a proprietary ingredient called Spot Deacti- Complex, for example, while Dior's latest products use an antisense oligonucleotide, a melanin-suppressing plant derivative.

But some doctors question whether those ingredients work as well as hydroquinone does. "Hydroquinone is still considered to be the gold standard of treatment for hyperpigmentation," said Dr. Susan C. Taylor, a dermatologist in Philadelphia and the author of "Brown Skin: Dr. Susan Taylor's Prescription for Flawless Skin, Hair and Nails."
Secondary ingredients in whitening products include glycolic acid, retinol, lactic acids and fruit acids, which exfoliate the skin.

By making the skin sensitive to the sun, hydroquinone can render it more vulnerable to the very problems the chemicals are meant to get rid of. Doctors recommend vigilant use of sunscreen along with hydroquinone, but they also advise putting off the use of hydroquinone products until summer is over. Even then, the products should be used for only 30 to 60 days, no more than three times a year, said Ms. Linker of DDF. Products without hydroquinone are considered safe for long-term use.

"Women must be aware that any product, if used improperly, can irritate the skin and ultimately make the condition they are trying to treat worse," Dr. Taylor said. She recommends stopping use of lightening cream if there is itching, redness or inflammation.

Dark-skinned women often seek stronger whitening solutions and may be tempted to overuse them, said Dr. Rebat M. Halder, a dermatologist and the director of the Ethnic Skin Research Institute at Howard University in Washington.

"In Africa there are lotions available with up to 20 percent hydroquinone that are causing devastating results," Dr. Halder said. And these products sometimes find their way to the United States. "A rare side effect of hydroquinone is a condition called exogenous ochronosis, which is a permanent darkening of the skin. The higher the concentration, the greater the risk."

Some laboratory studies have found evidence linking hydroquinone to cancer, liver problems and tumor production in rats and mice. "Hydroquinone moves very fast through the skin and into the blood, and it has been shown to cause damage to DNA," said Tim Kropp, a senior scientist at the Environmental Working Group, an organization that analyzes the risks of chemicals used in consumer products.

But Dr. Taylor said that studies in humans had shown that hydroquinone is safe. "As physicians," she said, "we realize that there is often not a direct link between lab and animal studies and results in humans."

Women who are pregnant or taking hormone supplements (birth control pills, for example, or hormone-replacement therapies) may find whitening creams futile.

"None of these things work if you're on hormones," Dr. Lee said. "The hormones may keep making the pigmentation worse and worse, so you risk more side effects by using the products for too long."

Many doctors say the over-the-counter products are a poor substitute for medical treatments, especially for melasma, one of the most stubborn pigment problems.

Lasers, which can be used to mildly resurface the face or other areas with dark spots, have traditionally provided good results only for people with light skin. On darker skin, they can leave lines of demarcation around the areas treated. But the new Frax-el laser, which sends out a cluster of tiny beams rather than one solid beam of light, appears to work on all colors.

No matter which laser is used, doctors say it is important for women to find doctors who have worked on other patients with their skin color.
Sometimes even professional-strength lightening treatments are ineffective.

"I have fair skin and very stubborn melasma that I got from using Depo-Prov-era" birth control, said Caroline Di Giulio, 37, an advertising copywriter in Los Angeles. She tried laser treatments, but within a month the brown patches returned in exactly the same formation. Peels worked a little, as did Retin-A, which helps skin exfoliate. But now Ms. Di Giulio is pregnant, and her melasma is back with a vengeance.

"I tried everything and spent so much money," she said. "After my pregnancy I plan to go back on Retin-A and just really stay out of the sun."