MOHAP warns against the use of prescription medicines based

The Ministry of Health and Prevention, MOHAP, has warned the public against the hazards of using some facial skin care whitening creams without consulting a physician, particularly products marketed on social media, as they could pose grave health hazards and permanent damage to the skin, including facial bleaching and occurrence of dark spots.

Dr. Amin Hussain Al Amiri, Assistant Under-Secretary of Public Health Policy and Licensing at MOHAP, said there is a growing demand among teenage girls to use skin whitening products which has led some social media influencers who have a considerable following to promote creams that should be administered by medical prescription or in which chemicals should be used only after consulting with specialists.

"These influencers present their personal experiences in videos they publish to their followers and encourage them to do the same," Dr. Al Amiri explained, adding that such information dissemination, whether or not it was done in good faith, could lead some manufacturing companies or local distributors to contract social influencers or ‘fashionistas’ to promote their products to increase sales. Such actions have prompted the Ministry, particularly the Health Empowerment and Compliance Department, to put a system of monitoring the content of these social media accounts and form a team to track some of the suspected accounts on social media, he explained.

Dr. Al Amiri cited the video of a GCC lady who showcased her skin whitening experience after mixing three creams, the first one is Dermovate, a preparation that contains a cortisone derivative ‘Corticosteroid’ used to treat symptoms such as skin inflammation, itching, which occur in some skin diseases such as Psoriasis, some allergies and superficial dermatitis. These types of creams should be dispensed by a medical prescription and under the supervision of a specialist, he explained.

Corticosteroids have side effects which usually occur after prolonged use or high dose or lack of medical supervision such as skin numbness, skin atrophy, burning, itching, skin stinging, acne-like pimples, hypopigmentation, skin perspiration disorder, and secondary skin infections including bacterial, fungal, and viral and some skin lesions, which render the skin thin and easily bleed.

The second cream in the video is Differin Gel, it contains Vitamin A and is a gentle exfoliator used to treat acne, and other skin conditions such as facial peeling, and protecting the skin from ageing, and overexposure to sunlight. The cream could cause some adverse effects including dryness and allergy, and it must be applied at night time because it reacts with sunlight. It should be used under medical supervision, and it could cause skin irritation on initial use.

The third skin care brand, Hi-Queen, is an unregistered product which contains 4 percent Hydroquinone, a widely-used chemical substance available in the form of cosmetics, particularly prescribed for skin whitening, Dr. Al Amiri continued.

"Initially, users of hydroquinone creams may see whitening in their skin, however, when exposed to the sun, adverse effects will soon occur leading to the tanning of the skin and the occurrence of dark spots which leads to an extended use of the product and a higher risk of occurrence of the adverse drug reactions including dark spots, painful sensation and inflammation, as well as acne."

Very long-term use of these type of creams could lead to skin cancer, in addition to liver disorders resulting from the substance absorbed through the skin. Some European countries have banned the use of Hydroquinone due to its side effects and the risks associated with its misuse.

The World Health Organisation, WHO, has reported that Hydroquinone is a hazardous substance and could cause side effects leading to ochronosis, the accumulation of melanin pigments in some tissues such as joints and cartilages, apart from skin allergies in most cases. MOHAP has published a circular on the hazards of using Hydroquinone and mandated the administration under specialist supervision; the product should not be mixed with other substances as this might lead to acute toxicity.

Dr. Al Amiri urged the public to dismiss misleading advertisements which promote some skin whitening creams without medical consultation unless the ad was approved by the Ministry of Health and Prevention and after having verified the content and accuracy of the ad. He went on to say that many ads on social media are incorrect, misleading and not medically proven and it is not licensed and issued by people who are not medical specialists. Such actions have significant negative impact on the health and safety of the consumer.

The Assistant Undersecretary also noted that many of these products are typically sold online without prescription, and are illegally marketed to people. Some of these ads are being marketed as a new and unknown medical and pharmacological innovation, he added.

As part of its efforts to ensure safety for everyone in the country, MOHAP discourages any unchecked use of these products or any other products before they are medically verified and approved.

Dr. Anwar Al Hammadi, Head of Dermatology Society in the Emirates Medical Association, said, "The pull of social media, coupled with the growing interest of many people to apply cosmetics have led to a misuse among teenage girls following the advice of social media celebrities or the so-called ‘influencers or fashionistas’. This is an irresponsible action where those influencers post their experiences using some cream preparations on their social accounts. Among the shocking developments, we came to notice in the video that was posted by a lady was her use of a facial skin whitener containing Dermovate cream which is the most potent corticosteroid used in the market to treat cases of eczema and severe psoriasis.

Dr. Al Hammadi explained, "I would like to stress that Dermovate was by no means used for facial skin, nor has it ever been an over-the-counter drug; which means that it cannot be dispensed unless with a prescription from the dermatologist. Moreover, pharmacists are prohibited from dispensing it without the doctor's prescription as diagnosis should be provided for its application. The problem is exacerbated because this product cannot be used for the treatment of acne, which has other treatment pathways. The worst part is ‘influencers’ demonstrate to their followers their experiments, and with a vast segment of followers ranging from children to teens, it becomes a more extensive medical issue when followers indiscriminately flock to pharmacies and buy these products to copy what these influencers did."

He said that applying Dermovate cream to the face leads to skin scarring and atrophy, in addition to vitiligo-like bleaching and the protrusion of blood vessels, which when it occurs could lead to permanent damage to the skin. He added that these cases are an act of deception and misguidance including the video which featured the Hydroquinone cream for skin whitening. It can cause skin darkness when used for prolonged periods of time and could develop dark blemishes; this has been medically proven.

"I appeal to those influencers to avoid posting anything outside their speciality. In the same manner that makeup artists or fashion experts should only post the content related to their line of business, and avoid medical products. Such acts could be worse if some physicians themselves would post content beyond their specialities to get the attention of others which could cause confusion and extreme fascination and overuse of beauty products to lighten their skin. I urge the public, particularly the followers and fans of some influencers not to blindly yield to those influencers to avoid severe implications that we see in many dermatology clinics. I hope there would be legislation to incriminate those who misuse medicines particularly when children and teens sustain damage," Dr. Al Hammadi continued.

Dr. Hessa Ali Mubarak, Director of the Empowerment and Medical Compliance Department, said that a lot of the traditional preparations and whitening creams sold without authorisation are usually prepared with pharmacological compounds and lotions that contain Hydroquinone and Corticosteroids, and Vitamin A products, which cause a compounded effect that exceeds the melanin to affect the overall cells and increase the likelihood of the emergence of the side effects of the Hydroquinone and Corticosteroids. It is important to know that such preparations have a high concentration of ‘sulfate’ compounds which in turn cause skin irritation, allergy, and contact eczema that counter the benefit of the medication. Also, the overuse of this medication without follow-up with the supervising dermatologist might lead to the emergence of unusual symptoms such as hyperpigmentation of the skin without the knowledge of the patient, which is hard to treat by topical cortisone.

Dr. Mubarak advised that among the general precautions that should be taken upon usage of skin whitening treatment is to avoid sun exposure to prevent hyperpigmentation as well as not applying it close to the eye region, close to the wounds, or lesions. It should not be used after shaving to lower the side effects as much as possible. Neither should it be used during pregnancy or breastfeeding due to lack sufficient information about the likely side effects. It is advisable, when used for the first time, to apply sparingly to the skin for the entire day for two or three times to make sure that it does not cause any allergy before using it regularly.

She emphasised that the medication should be tapered and reduced by degrees, particularly that the most of these medicines are composed of cortisone, and gradual and slow reduction is advisable to avoid the adverse effects of the cortisone.

MOHAP emphasised the importance of avoiding the distribution of any medical information not validated by the ministry of health or by the local health authorities, and requires members of the public to report to the ministry any misleading or suspicious advertisement through the numbers 80011111 or on the Ministry’s website via the portal ‘Tameny’; or to report to any government healthcare authority.