The Harmful Trifecta of Skincare in African and Asian Populations: Triple Action Creams, Skin‐Lightening Creams, and Antiseptic Soaps

Certain skincare products are widely used and marketed as solutions for common skin problems in African and Asian populations, but cause or aggravate dermatological conditions [1-3]. They include fixed-dose combination creams containing corticosteroids, skin-lightening products, and antiseptic soaps, and their cumulative harm is often overlooked by both patients and healthcare providers [1-3]. Fixed-dose combination creams, often referred to as “triple-action creams,” contain potent corticosteroids (e.g., clobetasol propionate or betamethasone dipropionate), an antibiotic (neomycin or gentamicin) and a low-dose antifungal (0.5% clotrimazole or 1% ketoconazole) [2]. Widely available over the counter in many African and Asian countries, they are commonly misused for eczema, acne, and superficial fungal infections, and even for skin lightening, including on infants and children [2, 4, 5]. Misuse occurs through self-medication or inappropriate prescription by health workers [2, 4, 5]. Reported adverse effects include skin atrophy, telangiectasia, striae, steroid dependence and allergic sensitisation from neomycin or gentamicin [1, 2, 5]. In addition, combining a potent steroid with a low-dose antifungal may contribute to antifungal resistance and complex clinical scenarios [4-6]. Skin lightening or bleaching is a public health concern in Africa and Asia, with reported prevalence ranging from 30% to 80% [1, 7]. Skin-lightening products commonly contain potent corticosteroids, high concentrations of hydroquinone or resorcinol, and heavy metals such as mercury or arsenic [1, 7, 8]. Complications of use include dyspigmentation, exogenous ochronosis, skin atrophy, skin infections, premature skin ageing, and squamous cell carcinoma of the skin, while systemic sequelae such as hypertension, diabetes, renal dysfunction and adrenal insufficiency have also been documented [1, 7, 8]. Societal pressures linking lighter skin to social and economic advantage (colourism), aggressive marketing, particularly unregulated claims on social media, sustain widespread use despite adverse effects [1, 7, 8]. The global skin-lightening market is a multibillion-dollar industry, valued at USD 9.37 billion in 2024, dominated by the Asia-Pacific region (55.6%), and projected to reach USD 16.42 billion by 2032 [9]. Antiseptic soaps and liquids are widely marketed and used with the belief that they prevent infection [3, 6]. However, studies show they offer no advantage over plain soap and water and may instead pose additional health risks [3]. Excessive use of these antiseptic formulations can disrupt the skin microbiome, aggravate inflammatory conditions, and contribute to antimicrobial resistance and fungal overgrowth [3, 6]. Many contain agents that are banned or restricted in the EU and US (e.g., triclosan and triclocarban) due to concerns about endocrine disruption and antimicrobial resistance with their use [3]. When used together, these products form a “toxic trifecta” that amplifies individual harms. Driven by cultural acceptance, ease of access, marketing, and even official endorsements from medical associations, they are commonly used together [1-3, 6]. Their use often persists among immigrant populations in Europe and North America via informal importation from their countries of origin [1, 7, 8]. Table 1 provides examples of these products, their active ingredients and dermatological sequelae. Figure 1 illustrates some cutaneous complications of this harmful trifecta. Triple-action creams (fixed-dose steroid–antifungal–antibacterial combinations) E.g., Skineal, Funbact-A, Visita Plus, Endix G, Epiderm; Tydineal; Quadriderm, Betnovate-N, Tenovate, Panderm Plus, Lobate GM, Zole-F, Candid-B, SKderm, Gentrisone Potent corticosteroid (Clobetasol propionate, Betamethasone dipropionate, Fluocinolone acetonide, Triamcinolone acetonide); Low-dose antifungal (Clotrimazole, Ketoconazole, Econazole, Miconazole); Antibiotic (Neomycin, Chlorocresol, Gentamicin, Ofloxacin, Fusidic acid)- concentrations vary in each combination Skin-lightening/bleaching creams E.g., Caro tone, Bronzetone, Movate, Peau Claire, Top Gel, Fair & White; Fair & Lovely/Glow & Lovely, Melacare, Skinlite, Demelan, Clearmin, Clairliss, Antiseptic soaps & liquids E.g., Dettol, Savlon, Delta, Safeguard, 2Sure, Tetmosol, Family, Rungu, Tura Dermatologists and healthcare professionals must be aware of their widespread use in African and Asian populations and the additive adverse effects [3, 5, 7]. Clinicians should routinely inquire about their use when assessing patients from these regions presenting with chronic, recalcitrant, or complex skin conditions. Public education, community engagement and stricter regulation are necessary to curb misuse, promote safer formulations, and address societal drivers [1-3, 7]. Marketing and sale of these products should be regulated in a manner similar to tobacco control. The Zero Mercury Working Group has urged global action to eliminate the use of toxic mercury at its source, and the International League of Dermatological Societies recently cautioned against the misuse of topical corticosteroids [7, 10]. In conclusion, triple-action creams, skin-lightening products, and antiseptic soaps, though intended to treat skin concerns, have profound long-term adverse effects on skin health among African and Asian populations, and these effects may be amplified when used together. Recognising and addressing this harmful skincare trifecta is necessary to promote safe skincare practices, reduce preventable skin morbidity and advance equitable dermatological care worldwide. Olufolakemi Cole-Adeife: conceptualization, original manuscript draft. Monisha Madhumita: original manuscript draft. Doreen Mapunda: original manuscript draft. Daudi Mavura: manuscript revision. Fatimata Ly: manuscript revision. Fatimata Ly is the senior author. All authors read and approved the final manuscript. The authors have nothing to report. Written informed consent was obtained from patients for clinical photographs. The patients in this manuscript have given written informed consent to publication of their case details. As a perspective article, ethical approval was exempted. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.