Fatal beauty: which cosmetics are your glaucoma patients using?

Colorism refers to the difference in social treatment between light-skinned and dark-skinned people. This sociological concept is a result of colonialism and slavery during which natives and slaves with lighter skin tones generally received preferential treatment. [1],[2] Social pressure based on skin tone unfortunately still persists within some communities, mainly among people of African descent but also in Asians as well as Latino-Americans. [2],[3] This is exploited by the cosmetics industry, which advertises various skin-lightening (SL) treatments, easily available over the counter and containing ingredients that can cause systemic and ocular harm.[4] Indeed, they most commonly include hydroquinone, mercury, arsenic and corticosteroids. [3],[4] Topical corticosteroids being the most likely to cause intraocular pressure (IOP) elevation [5], people chronically using SL creams or lotions containing them may develop steroid response and, ultimately, steroid-induced glaucoma. Hence the importance of leading a thorough anamnesis in glaucoma patients, including their cosmetic routine, especially if they originate from at-risk communities. This should be coupled to a clinical examination targeting clues of chronic use of SL treatments (for example the well described hydroquinone-related exogenous ochronosis [3]), as they often contain a combination of noxious compounds.

References

1. Reece RL. Genesis of U.S. Colorism and Skin Tone Stratification: Slavery, Freedom, and Mulatto-Black Occupational Inequality in the Late 19th Century. Rev Black Polit Econ. 2018;45(1):3-21. doi:10.1177/0034644618770761
2. Banala M, Mamidipaka A, Ogunleye T. Skin-Lightening Product Use Among South Asian Americans: Cross-Sectional Survey Study. JMIR Dermatol. 2023 Nov 2;6:e49068. doi: 10.2196/49068.
3. Ladizinski B, Mistry N, Kundu RV. Widespread use of toxic skin lightening compounds: medical and psychosocial aspects. Dermatol Clin. 2011 Jan;29(1):111-23. doi: 10.1016/j.det.2010.08.010.
4. Parente JBM, Silva GS, Gotschall JW, Ferreira AL, Grant-Kels JM. Cosmetic Skin Lightening: Contextualizing Biomedical and Ethical Issues. Clin Dermatol. 2024 Apr 12:S0738-081X(24)00058-0. doi: 10.1016/j.clindermatol.2024.04.001.
5. Phulke S, Kaushik S, Kaur S, Pandav SS. Steroid-induced Glaucoma: An Avoidable Irreversible Blindness. J Curr Glaucoma Pract 2017;11(2):67-72.

Contributor: Artémise Dugauquier MD; Department of Ophthalmology, UZ VUB (Universitair Ziekenhuis Brussel), Brussels, Belgium

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