When considering cosmeticenhancements, we generally think of common procedures such as Botox, facialfillers, chemical peels or liposuction. However, a less talked about procedure, anal bleaching, has gainedpopularity in recent years. Anal bleaching has garnered mainstream mediaattention with adult film stars and erotic entertainers visiting Dr. 90210 to lighten this particular area of the body whichmay be exposed during the course of their workday. Even gay icon Margaret Chounderwent side-by-side anal bleaching with one of her best gays last year onher reality television show, The Cho Show.
An L.A. area salon seems to have pioneeredthis phenomenon a few years ago. With the popularity of total waxing of the genital region, clients werediscovering areas of darker pigmentation, especially around the anus that wereotherwise camouflaged by hair. Apparently, hundreds of clients have used theirservices with about one third being men.
Although many people routinelybleach their teeth or hair, when it comes to bleaching the delicate skin of theanal area it is important to understand the causes of skin darkening and themedical and safety concerns associated with the procedure. So, let’s explorethe ins and outs of anal bleaching…
Causes of darkening:
Skin darkening around the outer anus can be due to at leasttwo main causes: increase in pigment or thickening of irritated skin. In orderto have effective treatment, i.e., lightening, the diagnosis must bedetermined. Increased pigment can be due to prior irritation or genetics.Thickening of skin, i.e., lichenification, may present as darkening, however itis truly increase in thickness of the top layer of the skin (epidermis). Thisirritation can be caused by many factors, including irritation from lack of hygiene,excessive rubbing of the area, chronic itch of the anus, pin worms, foodallergy, over-aggressive anal sex, skin allergy to items coming in contact withthe area.
There are a number of preparations for anal bleaching. Afteryour physician has ruled out irritation causing anal skin darkening, Irecommend the following treatments.
Here are the main treatments, from mild to deep:
Creams that lighten:
Hydroquinone (HQ)
2% HQ is readily available over the counter in variouscosmetic preparations. Evidence of improvement with HQ alone is usuallyobserved at 4-6 weeks, with improvement appearing to plateau at approximately 4months. For better efficacy, HQ is also compounded into various mixtures forthe treatment of hyperpigmentation. Tri-Luma is a popular, prescription skin-lighteningagent that combines 4% HQ, a mild topical steroid and retinoid in a creamformulation. Although it is notFDA approved for use in the anal skin area, under close physician supervision,it is safe and effective.
2. Azelaic acid
A naturally occurringacid, it has been formulated in topical preparations used to lighten skin. Itis safer than hydroquinones and hydrocortisones.
3. Kojic acid
Kojic acid lightens skinand is safe in the anal area. It is usually mixed with a combination of theabove two products. It can, however, cause irritation when used over a longperiod of time.
Procedures that causeanal bleaching:
Application of up to 20% hydroquinone and glycolic acid: I do not recommend this because there is a concern with hydroquinone cancer-causing potential at does this high.
Glycolic, salicylic or trichloroacetic acid (TCA) peel. These are very effective in lightening; however they are met with at least a week of irritation and redness, followed by a pink regrowth of skin. This should be only be performed by a licensed medical provider such as a physician or nurse practitioner.
Light based skin lightening:
Intense pulsed light (IPL) is an effective device to lighten skin. The procedure is widely-available and takes about 15 minutes and usually requires about 4 to 6 treatments. There is some discomfort involved as the procedure feels like getting snapped with a rubber band. The area may blister or scale for several days.
For deeper pigment around the anus, a Q-switched ND-YAG laser, which is used for tattoo removal can address the deeper pigment. This is may be painful and needs topical and/or injected local anesthetic.
Skin resurfacing lasers, like fractionated Er-YAG or CO2 lasers. These require local anesthesia and the recovery is up to 2 weeks.
My best advice in seeking anal bleaching is to find a medical provider with whom you are comfortable discussing this issue and approach it cautiously and safely with clinically-proven treatments and procedures.
