Fragrance, Sunscreens, Botanicals, and Potential Allergens in Bestseller 'Fairness' Creams in the Indian Market: A Consumer Exposure Study.

BACKGROUND: The skin lightening industry has seen exponential growth in India. Consumers often present to the dermatologist with adverse cutaneous reactions to these 'fairness' (skin lightening) creams. The composition of these creams has not received sufficient attention.
OBJECTIVE: To identify fragrance, sunscreens, botanicals and potential allergens in the bestseller 'fairness' creams available in the Indian market.
METHODS: Twenty fairness (or whitening or lightening) creams were selected based on the 'bestseller' creams of one of the largest electronic commerce websites in India, and availability in local stores and unlabelled brands were excluded. Fragrance, sunscreens, botanicals and potential allergens were identified from the ingredient labels.
RESULTS: Twenty bestseller fairness creams were included. The number of the listed ingredients in the fairness creams ranged from 6 to 49 (mean = 32.2). The most frequently listed ingredients included water, fragrance or parfum, glycerin, tocopherol/tocopherylacetate and titanium dioxide. Hydroquinone, monobenzyl hydroquinone, corticosteroids, tretinoin and mercury were not listed in any of the creams. Unspecified fragrance was listed in 19 (95%) creams and linalool (8,40%) was the most frequent specified fragrance. Titanium dioxide (14, 70 %) was the most common inorganic sunscreen and ethylhexyl methoxycinnamate (12 creams or 60% of creams) was the most common organic sunscreen. Twenty-seven botanicals were identified. Eight ingredients were potential allergens according to the Indian Cosmetic and Fragrance Series. The cost of the creams ranged from 95 to 1,095 in Indian rupees (mean 300.5).
CONCLUSIONS: Consumers are exposed to a vast range of compounds in the quest for a lighter skin tone. Several potential allergens, particularly fragrance allergens, are present in addition to the eight allergens that were identified with the Indian Cosmetic and Fragrance Series. Increased awareness of the composition of skin lightening creams available in the market and strict regulation of these creams is needed. Copyright:

Introduction

Skin lightening creams are a multi-million-dollar booming industry in India. The skin 'fairness' industry represents 50% of India's skin care market.[1] 'Fairness' is marketed as a desirable trait, and fairness creams are extensively promoted in print and audio-visual media.[2] Indian dermatologists often face patients giving a history of application of fairness creams or patients presenting with adverse cutaneous reactions to fairness creams. However, the composition of the fairness creams available in the Indian market has not received sufficient attention.

Objective

To identify fragrance, sunscreens, botanicals and potential allergens in the bestseller 'fairness' (skin lightening) creams available in the Indian market.

Methods

No ethics approval was needed for the study, as the Institutional Ethics Committee does not require review for studies not involving human subjects. Fairness (or whitening or lightening) creams were selected based on the 'bestseller' creams on of one of the largest electronic commerce websites in India.[3] The online search was done under the 'Creams and moisturizers' category at 2.55 pm on 5/10/2018. Creams targeted to both genders were included. Creams which did not have an ingredient label, and could not be procured from local stores in Puducherry, were excluded from the study. The ingredients listed on the labels were entered in Microsoft Excel™. Ultraviolet filters/absorbers and fragrances were identified using the Cosing database (European Commission database for information on cosmetic substances and ingredients).[4] The ChemIDplus database was used to identify the synonyms of the cosmetic ingredients.[5] The potential allergens according to the Indian Cosmetic and Fragrance Series (INC-1000 Chemotechnique®; Chemotechnique Diagnostics, Sweden) approved by the Contact and Occupational Dermatoses Forum of India (CODFI).[6]

Results

Twenty bestseller fairness creams were included. The number of the listed ingredients in the fairness creams ranged from 6 to 49 (mean = 32.2). The most common ingredients present in 50% or more of the creams screened are given in Figure 1. Hydroquinone, monobenzyl hydroquinone, corticosteroids, tretinoin and mercury were not listed in any of the creams. The specified fragrances listed in the creams are given in Table 1. The ultraviolet (UV) filters and UV absorbers present in the creams are given in Figure 2. The botanicals listed in the creams are given in Table 2. Other natural products listed in the creams included diamond powder (3, 15%), milk enzymes (2, 10%), milk lipids (1, 5%), xanthan gum (1, 5%), honey (1, 5%) and a semi-precious stone called tourmaline (1, 5%). The potential allergens according to the Indian Cosmetic and Fragrance Series are given in Figure 3. The cost of the creams ranged from 95 to 1095 in Indian rupees (mean 300.5).

Figure 1

Most common ingredients in fairness creams, % (n = 20)

Table 1

Specified fragrance in the fairness creams, n=20

Specified fragrance	Frequency	(%)
Linalool	10	50.0
Alpha-isomethyl ionone	9	45.0
Citronellal**	8	40.0
Hexyl cinnamal**	8	40.0
Benzyl salicylate	8	40.0
Limonene	8	40.0
Geraniol*	7	35.0
Butylphenyl methylpropional	7	35.0
Benzyl alcohol	4	20.0
Hydroxyisohexyl 3-cyclohexene carboxaldehyde**	3	15.0
Cinnamyl alcohol*	1	5.0
Eugenol*	1	5.0
Citral**	1	5.0
Coumarin**	1	5.0

*Components of fragrance mix I 8% petrolatum. **Components of fragrance mix II 14% petrolatum

Figure 2

UV filters/UV absorbers present in fairness creams, n = 20

Table 2

Botanicals listed in the fairness creams, % (n=20)

Botanicals	Frequency	(%)
Lemon fruit extract	4	20.0
Morus alba root extract, mulberry extract,Morus bombycis, mulberry phenylflavones	3	15.0
Almond oil/Prunus amygdalus	3	15.0
Glycyrrhiza glabra (licorice) extract	3	15.0
Aloe barbadensis leaf extract	2	10.0
Zingiber officinale (ginger) root extract	1	5.0
Triticum vulgare (wheat germ) oil	1	5.0
Arctostaphylos uva-ursi (bearberry) extract	1	5.0
Camellia sinensis (green tea) extract	1	5.0
Symphytum officinale (comfrey root) extract	1	5.0
Epigallocatechin (saxifraga) extract	1	5.0
Vitis vinifera (grape) extract	1	5.0
Coix lacryma-jobi ma-yuen seed extract	1	5.0
Gentiana lutea root extract	1	5.0
Nariyal (Coco nucifera water)	1	5.0
Dudhal (Taraxcum officinale)	1	5.0
Manjishta (Rubia cordifolia)	1	5.0
Vetiveria zizanioides extract	1	5.0
Ricinus communis seed oil and hydrogenated castor oil	1	5.0
Hedychium spicatum	1	5.0
Alpinia galanga rhizome	1	5.0
Vateria indica bark extract	1	5.0
Bombax malabaricum bark extract	1	5.0
Rheum emodi root extract	1	5.0
Hydrolyzed soy protein	1	5.0
Lepidium sativum	1	5.0
Olea europea (olive oil)	1	5.0

Figure 3

Potential allergens according to the Indian Cosmetic and Fragrance Series, % (n = 20)

Discussion

Fair skin is linked to power, beauty, success, superiority and better marriage prospects in South Asia. Multinational cosmetic giants of Indian and South Asian companies play important roles in the Indian fairness industry.[2] Fairness creams are a part of the daily skin care regime for several Indian women (personal observation). Potent skin lightening agents such as hydroquinone, corticosteroids, tretinoin and monobenzyl hydroquinone (with the exception of mercury) are commonly used by dermatologists to treat disorders of hyperpigmentation. These require supervision and have potential for severe adverse effects.[7] They were not listed in any of the fairness creams screened in the study. Niacinamide was a common skin lightening agent present in 13 (65%) creams. Desmedt et al.[7] reported its presence in skin lightening agents in the European Union.

Consumers are being exposed to several undisclosed and several specified fragrances. Fragrance (or parfum) was listed in 19 (95%) creams. Some of these undisclosed fragrances may be potential allergens or may have toxicological or ecotoxicological relevance.[8] Three of the fragrances (geraniol, eugenol and cinnamyl alcohol) in our study are components of fragrance mix I 8% and five (citral, coumarin, citronellal, hexyl cinnamal and hydroxyisohexyl 3-cyclohexene carboxaldehyde) are components of fragrance mix II 14% petrolatum. Four fragrances in our study (alpha-isomethyl ionone, benzyl salicylate, hydroperoxides of linalool and hydroperoxides of limonene) are additional non-mix fragrances included among the 26 fragrances that require mandatory labelling in the European Union if their concentration in cosmetic leave-on products exceeds 10 ppm.[9]

Linalool (10, 50%) and alpha-methyliso ionone (9, 45%) were the most frequent specified fragrances in our study. Uter et al.[10] reported linalool and limonene as the most frequent fragrances in cosmetic creams tested in Germany. Linalool and limonene are common fragrance terpenes with low sensitizing potential. However, their hydroperoxides, produced on exposure to air, are potent sensitizers. Limonene was present in 8 (40%) creams. However, lemon fruit extracts were listed in 4 (20%) creams. Limonene occurs naturally in lemon, orange, bitter orange, lemongrass, peppermint, laurel and eucalyptus essential oils.[11] Botanicals may be used for their medicinal properties, and their essential oils may be used as fragrances. When a fragrance has other additional properties, it is often not labelled as a fragrance.[12] Thomson et al.[13] reported misleading labelling in cosmetics as plant essential oils were not labelled as fragrances. Thus, patients with fragrance allergies also have to be made aware of the botanical fragrances in creams.

Ten sunscreens [Figure 2], both organic and inorganic, were listed in the creams. The presence of sunscreens and possibly the opacifying effect of inorganic sunscreens such as titanium dioxide and zinc oxide may contribute to the perceived efficacy of these creams. Several Indian women apply a fairness cream followed by talc application to look fairer (personal observation). Some consumers may prefer fairness creams with claims of UV-protection. However, consumers often have misconceptions about the important attributes of sunscreens.[14] Thus, consumers may receive inadequate UV-protection. The presence of sunscreens also makes consumers at risk for the adverse effects of sunscreens which include irritant, allergic, phototoxic and photoallergic contact dermatitis.[15]

Several botanicals [Table 2] were listed along with milk products (milk enzymes and milk lipids), xanthan gum, honey and stones (diamond powder and tourmaline). Consumers may have concerns about the safety of chemicals such as parabens, phthalates and fragrance in personal care products. Natural products are popular and are often perceived to be safer and environment friendly.[8] There was inconsistent labelling of the botanical products in our study. The binomial Latin names were not used for some botanicals (e.g., mulberry extract, almond oil, lemon fruit extract). Some botanicals such as aloe (Aloe barbadensis), bearberry (Arctostaphylos uva-ursi), white mulberry (Morus alba), black mulberry (Morus nigra), citrus fruit flavonoid-hesperidin, grapeseed (Vitis vinifera), licorice (Glycyrrhiza glabra), saxifrage (Pimpinella saxifraga), soy (Glycine soja, Glycine max) are lightening/brightening botanicals, and some such as grapeseed (Vitis vinifera), green tea (Camillia sinensis) and olive (Olea europea) are photoprotective botanicals.[16] The botanicals are multiconstituent with potential for multiple interactions, and their toxic constituents are often excluded from labelling.[8] Their composition and efficacy variable based on extraction technique, part of plant used, environmental conditions etc.. and cross-reactions with other herbs may occur. Botanicals cannot be always presumed to be safe as contact dermatitis, hepatotoxicity and teratogenicity have been reported with topical Chinese herbal medicines.[16]

Eight [Figure 3] of the listed ingredients were potential allergens according to the Indian Cosmetic and Fragrance Series. Components of the paraben mix (butyl/ethyl/methyl/propyl) were the most common potential allergens. Several constituents, including fragrances, sunscreens and botanicals might be responsible for allergic contact dermatitis. Thus, extended testing for fragrances, sunscreens, and the suspected creams may be needed to identify the potential allergen.

Limitations

Our study was a cross-sectional study done on a limited number of bestseller creams in one specified hour. It provides a snapshot of the sales. However, the creams included in the study were also easily available in the local stores, and thus, represented popular creams available in the Indian market. The actual composition of the creams may vary from the listed ingredients. Sahu et al.[17] reported the presence of mercury in 44% of the 32 fairness creams tested in India. Gbetoh et al.[18] reported inaccurate labelling of mercury, hydroquinone and clobetasol propionate in skin lightening products in West Africa and Canada. This highlights the need for strict regulation of the ingredients in the 'fairness' cream industry. Our study provides data on a topic that has received insufficient attention in India. Awareness of the composition of fairness creams is important in evaluating and counselling patients with facial dermatoses.

Conclusions

Indian consumers are exposed to a vast range of compounds in the quest for lighter skin. The presence of sunscreens may contribute to the perceived benefits of these creams. However, consumers are being exposed to several potential allergens including fragrances. Several botanicals are commonly included in the fairness creams. Increased awareness of the composition of skin lightening creams available in the market and strict regulation of the contents of these creams are needed.

Financial support and sponsorship

The study was partially funded by the research funds of Sri Manakula Vinayagar Medical College and Hospital.

Conflicts of interest

There are no conflicts of interest.