Author Archives: Ashlynn nguyen

Laughing Gas – No Laughing Matter

Laughing gas (LG) and its associated health consequences can be unpredictable, especially in young people who abuse LG for recreational uses.

LG, commonly known as whippets, funky balloon, or hippy crack, is a colourless, odorless, sweet-tasting NO2. Dentists and medical professionals routinely use NO2 as an inhalational anaesthesia during minor medical procedures, childbirth, and ambulances for its anaesthetic properties, including pain-relieving effect and anti-anxiety effects. They are typically mixed with oxygen in a 2:1 or 1:1 oxygen:NO2 ratio to prevent oxygen starvation from high dosage or pure NO2 usage without supplemental oxygen, which is the case in recreational uses. The gas readily displaces air in the lung from reaching into the bloodstream, reducing the oxygen content in tissues and brain (hypoxia), causing suffocation (asphyxiation), heart attack, or unconsciousness that can lead to sudden death or severe brain damage. These risks increase drastically in people with a history of cardiac and respiratory diseases.

For non-medical uses, NO2 typically comes in small, finger-length steel canisters that users can purchase separately at any local grocery store as a propellant for whipped cream bottles (Figure 1). Nightclubs will use industrial tanks (Figure 2) that can fill up about 200 balloons and sell each for $5-$10. A clubber who wished to keep his identity anonymous said his friends can easily spend anywhere from $1,000 to $10,000 per night solely on NO2 balloon. One inhalation of NO2 can lead to lightheadedness, tingling in the arms and legs, drug-induced psychoactive effects, including brief euphoric high, temporary distortion of visual and sensory perceptions, and lack of coordination, all of which subsides after a few minutes of discontinuing.

Figure 1: A box of whippets with sealed ends that users can puncture to release gas. Source: Wikimedia

Figure 2: Industrial Tanks of Nitrous Oxide mixed Oxygen In Dentistry. Source: Wikimedia

The 2014 Global Drug Survey reported about 64% out of over 6800 NO2 users consumed five or less balloons per session. The majority of responders reported using less than 3 balloons per session, followed by 4-10 balloons, 11-50 balloons, and over 100 balloons (Figure 3). To maintain the short-lived rush of euphoric high, Garakani et al. reported a small number of abused NO users can go through 75 -125 whippets per session.

Figure 3: Summary of responses on the number of balloons consumed per session from a survey of 6800 people.

Recreational users inhale NO2 by releasing the gas from a whippet into a balloon, and directly inhaling it through the mouth. Short-term NO2 exposure via balloons is still relatively safe, but several fatal cases reported in NO2 users who tried other methods. For example, inhaling the gas directly from the canister delivers the freezing NO2 gas directly to the internal tissue, causing frostbite to the mouth, lungs, or vocal cord. Excessive, continuous inhaling of NO2 while placing a plastic bag over their head, can lead to severe hypoxia and eventually asphyxial deaths. The short-lived euphoric high and easy access of whippets together contribute to the growing popularity in recreational NO2 misuse in many countries, most prominently in the UK.

Is Hair Dyeing Harmful?

Hair coloring (HC) is a beauty practice that changes one’s natural hair colour using chemicals to remove pigments in the hair shaft, melanin, by oxidizing the pigments, and replacing them with other pigments of choice. HC comes in different types, depending on how long a person wants the colour to last by changing the concentration of hydrogen peroxide (HP), ammonia, and paraphenylenediamine (PPD). Ammonia causes the swelling of the hair shaft, opening hair cuticles so HC pigments can penetrate into hair. HP oxidizes melanin in the hair strand, removing its natural colour to create a canvas. Finally, PPD complexes with HP to form a colourful complex, which then binds to our hair to give it a new colour.

Health concerns relating to hair colouring practice.

It is undeniable that HC improves the appearance drastically if you choose the right colour, but the harm of “forcing” hair to change color to health is extremely harmful that not many people are aware of. Several studies reported a possible correlation between certain chemicals in many oxidative-type HC products to a few sub-categories of cancer. Ames et. al. founded that the oxidation reaction between HP and each of the three main chemicals in oxidative-type hair colouring products – PPD, 2,5-diaminotuluene (TDA), and 2,5-diaminoanisole – yield a mutagen Bandrowski’s base. They conducted a facial absorption test on rats and found that this compound is a carcinogen to rats. Some HC users reported experiencing allergic reactions after using an at-home HC product or obtaining HC services from salons. Several hairdressers experienced frequent incidents of hand dermatitis from long-term exposure to HC products. This is because PPD, TDA, and other chemical compounds in many HC products are strong and extreme sensitizing compounds that lead to contact dermatitis (Figure 1) in many people who directly come in contact with the chemicals.

Figure 1: Contact dermatitis occurs when skin comes into contact with a substance that causes our body to elicit one or several allergic reactions. Source: Wikimedia

Why do people still choose to dye their hair?

Despite health concerns surrounding chemical compounds in HC products, HC remains a popular beauty practice these days among all ages, either to change their natural hair colours or to cover up grey hairs. For many people, HC not only improves their appearance and boosts their self-confidence if they choose a colour that matches their complexion but also a way to express their personality. To avoid the harmful effects that come from strong concentrations of HP and other compounds in HC products, experts from the US Food and Drug Administration recommend people to opt for temporary or semi-permanent HC, which contains the same chemical formula in permanent HC products, but at lower concentration. In addition, hairdressers always wear gloves, and some would wear masks to avoid inhaling the fume, while handling HC products. However, HC users and hairdressers should consult dermatologists or health experts if they experience any reactions or health concerns after using HC products to avoid the risk of having cancer.

Exposing the Dark Side of The Skin-Lightening Industry

Skin colour has long been the social-economic benchmark in many countries, predominantly in Asia-Pacific, where individuals often affiliate lighter complexions with attractiveness and more career opportunities. Skin lightening products (SLPs), the practice of lightening complexion by reducing the skin’s natural pigments, is often the solution to this dilemma. This growing demand created the lucrative business of skin-lightening products (SLPs), which was valued at US$8.8 billion in 2020.

Skin beauty is very important to many people by enhancing users’ self-esteem and confidence. Oftentimes, people reported wanting a lighter, radiant, and youthful skin, an indicative symbol of beauty and youth.

Some active ingredients in SLPs shown results in correcting the effects of age, stress, UV exposure, pollution, and poor eating. They also help maintain a luminous skin by preventing skin dryness, reducing oxidative damage, and balancing skin tone. SLPs coat the skin’s surface and act as a protection layer, thereby preventing issues like tanning and sunspots.

For most people, the utility that SLPs offer are essential to maintaining their beauty and confidence.

However, a major concern when it comes with SLPs is the uncontrolled concentrations of these active ingredients and their negative side effects.

Hydroquinone, a potent SL agent for hyperpigmentation treatments, causes blue-black facial discoloration (Figure 1) or skin thinning with high-dosage applications, said Dr. Desai, a board-certified dermatologist at the University of Texas Southwestern Medical Center. This condition is hard to treat, and can result in permanent discoloration of the skin.

Figure 1: Discoloration from long-term usage of hydroquinone-containing products. Source: Wikimedia

Mercury, another dominating ingredient in many unregulated SLPs, inhibits skin pigmentation production to reveal a lighter complexion. The well-documented report from the Pan American Health Organization list of associated risks from mercury poisoning does not look so pretty.

Risks from prolonged exposure to mercury ranges from multiple major organ failures to psychological issues such as psychosis, depression, anxiety, and early-childhood development issues.

Minnesota Department of Health revealed that most SLPs contain mercury ranging from 135 to 33,000 parts per million (ppm). This level is much higher than the recommended level of 1 ppm by the US Food and Drug Administration (FDA).

Additionally, the high levels of corticosteroids in most SLPs have resulted in steroid-dependent reactions (SDRs) – the tell-tale signs of chronic misuse of corticosteroids over an extended period (FIgure 2). Rashes, skin sensitivity to sunlight, and infections occur when SDR patients withdraw from topical steroids.

Figure 2: Steroid-Dependent Reactions. Source: Wikimedia

While these active ingredients in SLPs are effective in brightening consumers’ skin complexions along with providing additional skin care benefits, they pose significant and unwarranted health risks. Personally, the turmoil from experiencing side effects of some over-promising SLPs that are constantly promoted on social media is not worth sacrificing the highly-appraised fair skin. Not to mention the society that pressures those who are chasing after a fairer skin might be the first to criticize the consumers if SLP’s side effects arise. It is therefore crucial to pressure the SLPs’ manufacturers to move away from these dangerous compounds and towards safer ingredients.

Exposing the dark side of the skin-lightening industry

Minnesota Department of Health warns consumers to steer clear from skin-lightening products (SLPs). Their recent investigation on SLPs revealed dangerously high concentrations of unlisted ingredients that can harm users’ health.

Skin lightening refers to the practice of lightening complexion by reducing the skin’s natural pigment, melanin. Dermatologists prescribe patients products with low concentrations of active ingredients to treat certain pigmentary conditions and post-inflammatory hyperpigmentation. However, due to potential adverse complications, many countries either banned or strictly regulate these ingredients.

Skin colour has long been the social-economic benchmark in many countries, predominantly in Asia-Pacific, where individuals often affiliate lighter complexions with attractiveness and more career opportunities. A survey of 667 participants revealed that appearing lighter was the most common reported reason for using SLPs, followed by to appear more attractive, regular skincare products, social influences, and others (Table 1).

Figure 1: Summary of users’ reasons for using SLPs from 667 participants.

These growing demands created the lucrative business of SLPs, which was valued at US$8.8 billion in 2020.

Unsurprisingly, most toxic SLPs remain accessible in local markets and promote on social media. Some go undercover by omitting harmful ingredients or using counterfeit labels.

Hydroquinone, a potent SL agent for hyperpigmentation treatments, causes permanent blue-black facial discoloration (Figure 1) or skin thinning with high-dosage applications, said Dr. Desai, a board-certified dermatologist at the University of Texas Southwestern Medical Center.

Figure 2: Discolouration from long-term usage of hydroquinone-containing products. Source: Wikimedia

UK-based optometrists recently diagnosed three patients with corneal degeneration. This condition leads to a loss of vision over time, most likely from using hydroquinone-containing products for years, as the patients reported.

Corticosteroid, a widely-used topical steroid for skin inflammation conditions, is also a potent bleaching agent. Steroid-dependent reactions (SDR) are the tell-tale signs of chronic misuse of corticosteroids over an extended period (Figure 2). Rashes, skin sensitivity to sunlight, and infections occur when SDR patients withdraw from topical steroids.

Figure 3: Steroid-Dependent Reactions. Source: Wikimedia

Mercury, another dominating ingredient in unregulated SLPs, inhibits melanin production to reveal a lighter complexion. The well-documented list from Pan American Health Organization on associated risks from mercury poisoning does not look so pretty.

These risks range from multiple major organ failures – kidney, liver, etc. – to psychological issues – psychosis, depression, anxiety, and early-childhood development issues.

Moreover, determining factors when assessing a patient’s health on the severity of mercury exposure include the product’s concentration, period of exposure, other compounds changing mercury’s chemical properties, etc. The complex nature of different coexisting factors raises another problem for proper diagnoses, as indicative symptoms of mercury poisoning may not always manifest equally.

While mainly mercury poisoning from SLPs occurs via skin absorption, inhalation of mercury vapours is not off-limit. Simply put, users put not only themselves at risk of mercury poisoning, but also the whole household.

So how should buyers go on from here?

“Consumers should always check the ingredients of their skin creams, be suspicious of low prices which are likely to indicate the lotion is fake and potentially harmful, and never use a product containing hydroquinone,” said Simon Blackburn, chairman of Local Government Association’s Safer and Stronger Communities.

Ashlynn Nguyen

Exposing the dark side of the skin-lightening industry

Healthcare experts are warning consumers to steer clear from skin-lightening products (SLPs) for the safety of their health. The 2020 CNN investigation on SLPs revealed dangerously high concentrations of some unlisted ingredients that can have detrimental complications to their users.

Hydroquinone, a potent skin-lightening agent used for hyperpigmentation treatments, can cause permanent blue-black facial discoloration or skin thinning with high-dosage application, said Dr. Desai, a board-certified dermatologist at University of Texas Southwestern Medical Center.

Figure 1: Blue-black discoloration from long-term usage of hydroquinone-containing products. Source: Taylor & Francis Online

Recently, optometrists at two corneal clinics in the UK had diagnosed three patients with corneal degeneration – a condition which leads to a loss of vision overtime, most likely from using hydroquinone-containing products for the past 3 to 15 years.

Corticosteroid, the most popular topical steroid for skin-inflammation conditions, also has a very potent bleaching effect. Chronic misuse of corticosteroid over an extended period of time at any dosage results in steroid dependent reactions – rashes, increased skin sensitivity to sunlight, and infections occur when a patient discontinues using topical steroid.

Figure 2: Topical Steroid Dependent Face (TSDF). Source: CNN

Mercury, another dominating ingredient in many unregulated skin-lightening products which inhibits the production of skin pigmentation to reveal a lighter complexion. And in a note from the Pan American Health Organization, the well-documented list of associated risks from mercury poisoning does not look so pretty.

Prolonged exposure to mercury ranges from organ failures such as kidney, liver, brain, and eyes, to psychological issues such as psychosis, depression, anxiety, and early-childhood development issues.

Moreover, the determining factors when assessing a patient’s health on the severity of mercury exposure include the product’s concentration, period of exposure, other compounds changing mercury’s chemical properties, etc.

Due to the complex nature of these different coexisting factors, indicative symptoms of mercury poisoning may not manifest in the same way, raising another problem for proper diagnoses.

While exposure to mercury from skin-lightening products is mainly through skin absorption, inhalation of mercury vapors is not off-limit. In other words, users of mercury-containing products put not only themselves at risk of mercury poisoning, but also the whole household.

Skin lightening, or skin bleaching, refers to the practice of lightening skin tone by reducing skin’s natural pigments. Dermatologists may prescribe patients products containing these active ingredients at low concentration to treat certain pigmentary conditions and post-inflammatory hyperpigmentation. Due to potential adverse complications, many countries either banned or strictly regulate these ingredients.

Not surprisingly, most toxic skin-lightening products remain accessible and promoted on many social media platforms or in local markets. Some even go undercovered by purposely mislabelling the ingredient list by omitting toxic ingredients or using counterfeit labels.

So how should buyers go on from here?

“Consumers should always check the ingredients of their skin creams, be suspicious of very low prices which are likely to indicate the lotion is fake and potentially harmful, and never use a product containing hydroquinone”, said Simon Blackburn, chairman of Local Government Association’s Safer and Stronger Communities