Updated Position Statement Advocates for Improved Patient Protection and Education

The International League of Dermatological Societies (ILDS) has released an updated position statement on the Safe and Appropriate Use of Tropical Corticosteroids, raising alarm over their misuse in skin-bleaching products.

Professor Ncoza Dlova, Head of Dermatology at UKZN and former Dean of the School of Clinical Medicine, has contributed to several local and international studies advocating against skin-bleaching.

The ILDS statement identifies skin-bleaching as a growing global public health crisis requiring urgent action. The practice is prevalent in parts of Africa, Asia, South America, and the Caribbean, driven by socio-cultural pressures favouring lighter skin tones.

This demand has fuelled rapid growth in the global skin-bleaching industry, which is projected to reach $US15.5 billion by 2032.

In many countries, facial skin-bleaching products – often containing potent or super-potent corticosteroids – make up a significant portion of the skincare market.

Alarmingly, these products are frequently sold without medical oversight, posing severe risks to public health. The misuse of corticosteroid-based bleaching agents may be linked to:

• Treatment-resistant fungal infections
• Irreversible skin damage
• Systemic side effects
• Negative impacts on mental health.

The ILDS outlines several key recommendations to combat the misuse of corticosteroids and the dangers of skin-bleaching:

• Stricter regulation and enforcement of regulations that prohibit the use of monotherapy and/or fixed-dose combinations, containing potent or super potent corticosteroids without a prescription from an appropriately trained healthcare professional
• Clearer guidelines to protect patients and the public from the risks of overuse and misuse of potent topical corticosteroids
• Clearer guidelines to protect patients and the public from the misuse of topical corticosteroids
• Increased advocacy for safe dermatological practices globally.

A contributor to the updated position statement, Dr Ramesha M Bhat, Professor of Dermatology and Head of Research, Father Muller Medical College, Kankanady, Mangalore, India, said: ‘The widespread misuse of skin-bleaching creams containing corticosteroids and sold over the counter is a serious public health concern. It is exacerbated by the misapplication of combination creams, containing potent corticosteroids, antifungals, and antibiotics, as antifungal treatments. Used in this way, they provide temporary relief but ultimately worsen the condition by suppressing the patient’s immune response.’

He added: ‘Unregulated access and misleading marketing are fuelling this crisis, particularly in communities where lighter skin is preferred culturally. We hope the updated ILDS position statement will encourage national governments to enforce stricter regulations, promote the rational use of corticosteroids, and ban potent topical corticosteroid combinations marketed as skin-lightening or antifungal treatments.’

Fellow contributor, Dlova, added: ‘Skin-bleaching is reaching epidemic levels and, for the first-time cases of squamous cell carcinoma are being reported, which is a serious concern. The dermatology community must work together to address this problem, both through education and by tackling the socio-political influences on this practice.’

ILDS position statements offer evidence-based guidance for healthcare professionals, regulatory authorities, and public health organisations. The updated statement is available online.

ILDS President, Professor Henry W Lim, said: ‘As the leading global advocate for skin health, the ILDS is dedicated to advancing education, clinical care, and research to address the pressing dermatological challenges we face.

‘Our updated position statement underscores the growing concerns raised by our member societies about the misuse of corticosteroids in skin-bleaching products. It also outlines key recommendations to combat this serious public health crisis.

‘We are delighted that more than 50 of our member societies from different regions of the world have already reaffirmed the updated position statement and look forward to working with them, our wider membership and other stakeholders to bring about the changes necessary to promote the safe use of topical corticosteroids worldwide.’

Words: NdabaOnline

Photographs: Supplied