Hypothalamo-hypophyseal-adrenal hypofunction caused by the use of bleaching cosmetics in Senegal]

Cosmetic use of bleaching agents to clear skin is widespread among black West African women. In Dakar, most products used for whole body applications contain highly potent corticosteroids. Whereas cutaneous adverse effects are well described, little is known about possible systemic consequences. In order to assess transcutaneous absorption of glucocorticoids, hypothalamo-pituitary-adrenal axis functionality can be tested. We measured plasma cortisol concentration at 8 h and 1 h after intramuscular injection of 250 micrograms of cosyntropin (Synacthen) in 12 women with a more than 10 years use of bleaching agents. Cortisol at 8 H was also measured in 9 non exposed women without disease or treatment able to disturb glucocorticoids metabolism. All controls had 8 H cortisol concentration (mean = 521 +/- 113 nmol/l) above the minimal normal level considered by our laboratory. The 8 H cortisol concentrations were under the minimal normal level in 9 exposed women and the overall mean value was significantly lower than the one observed in controls (264 +/- 81 nmol/l; p < 0.001). After cosyntropin, cortisol concentrations were elevated among all exposed women (469 +/- 196 nmol/l), and less so in 3 of them. Most of the bleaching agents users present a functional inertia of hypothalamo-pituitary adrenal axis. While there is no absolute evidence for risk of stress-induced adrenal insufficiency, our results show conclusively that an excessive corticosteroids charge among users who could be exposed to systemic adverse effects.